Common questions regarding Sex reassignment surgery (SRS)
The dilation will be for life but the frequency of dilation time can be adjusted for 2-3 times per week after 2 years.
Dr.Chettawut recommends patients to keep the dilation routine schedule every day for 2 years in order to maintain original depth.
Each surgeon has developed their own technique and we do not know the details of each surgeon’s technique.
All Standard SRS (Sex reassignment surgery) will be performed by penile NON inversion technique which means Dr.Chettawut do not intend to use the valued penile and prepuce skin to be inverted inside the vagina in order to be the skin lining of the vaginal wall. In contrary, the penile and prepuce skin will be utilized mainly for the aesthetically sensate inner labia (like a lip in a biological female) as well as a good formed vaginal opening.
Dr.Chettawut explains that with his SRS technique, all of his SRS patients will always be able to achieve special female erotic sensations as well as being able to naturally experience orgasm (climax). Dr.Chettawut’s technique maintain these sensations by meticulous preservation of almost every sensate tissue from the glans penis and its prepuce skin (the foreskin which cover the glans penis) as well as all specific sensory nerves (branches of pudendal nerve) supplied to the following structures. 1. Clitororal hood 2. Clitoris (normal size as in biological female, not oversized) 3. Clitoral frenulum 4. Vulva vestibule 5. Inner part of inner labia (labia minora) 6. Outer part of inner labia (labia minora) 7. Side wall of vaginal opening
The scrotal skin will be used for both outer labia construction and also skin graft material.
The naturally beautiful appearance of outer labia (labia majora) can be always expected from Dr.Chettawut’s work.His skin graft technique by using scrotal skin and sometimes with additional groin skin always provide adequate skin lining inside vaginal canal which will be created as deep as possible to individual pelvic anatomy. The achievement of depth of vagina between 6-7 inches is normal and Dr.Chettawut can guarantee that there will be no hair inside your vagina.
The average time for SRS operation is 6.5 hours. Dr.Chettawut is always the only surgeon who performs your surgery from the start to the end and he strives to obtain full satisfaction in the reconstruction of all new genital structures as well as the best possible scarring.
It is your responsibility to find out whether your sex reassignment surgery (SRS) certification needs notarization by your country’s Embassy in Bangkok.
From our experience, some states in US such as Florida, Illinois require the SRS certification to be notarized by the US Embassy in Bangkok.
Because the embassy does not keep record of licensed Thai surgeons, they will ask you to first visit and to certify your SRS certificate at Ministry of Foreign Affairs in Bangkok, Thailand located at Chaengwattana Road.
Once the certificate is notarized by Ministry of Foreign Affairs then the embassy will notarize your SRS certificate without any question.
The trip to visit Ministry of Foreign Affairs and US embassy should be planned in separate days since the location of each place is very far from each other and usually the process at Ministry of Foreign Affairs will take 1 full day.
Please be advised that the US Embassy will not accept walk-ins therefore you should make an appointment in advance at least 1 week prior your departure date so that the notarization process will be completed on time.
This process depends on the requirement of your city/state/country system.
The Ministry of Foreign Affair is located at Consular Service at Chaengwattana Building – 123 Changwattana Rd., Laksi District Bangkok 10210 Tel (662) 981-7171 Operation hours: Monday – Friday from 8.00 am – 16:00 pm (No need to make appointment)
To visit the Ministry of Foreign Affairs website, Click Here
The process of visiting Ministry of Foreign Affairs Thailand (written by one of our former patient based on her personal experience) can be requested upon e-mail and we will send the attachment file to you.
Concern of short genital skin (prepuce-penile-scrotal skin)
According to Dr.Chettawut’s non penile inversion technique, the lack of prepuce skin from previous circumcision will not affect the creation of inner labia (laibia minora) and vaginal opening because he can use the remnant of foreskin (distal part of penile skin near the circumcised scar) for the inner labia construction and the remaining penile skin to be a part of vaginal opening.All SRS patients with circumcised penis can achieve both aesthetic outcome of external genitalia and excellent vaginal depth from Dr.Chettawut’s SRS work.
If you have a short penis, it will not affect the depth of your vagina because the skin graft lined inside vagina come from the scrotal skin and in some case combined with extra groin skin.
With non-penile inversion technique, the penile skin is used for only external genital structure, mainly for natural look (lip-like) labia minora and part of vaginal opening.
The short penis condition can affect the size of labia minora (to be small), however Dr.Chettawut can maintain a good definition of labia minora as in normal variation of biological woman.
Dr.Chettawut’s non inversion technique is suitable for all variation of penis sizes.
In case your scrotal skin (the skin that covers testes) is insufficient (too short), it is necessary to add “Extra groin skin graft procedure” to get a more skin graft so that the total amount of skin graft will be enough for creating a neo-vagina as deep as possible.
Note: The groin skin graft is an additional work during SRS by taking the nearby groin skin without creating another incision or scar.
There will be an extra charge of 32,000 THB of this additional groin skin graft procedure of which Dr.Chettawut will confirm if you need it or not after physical examination on consultation day.
In summary, good depth of vagina between 6-7 inches can be achieved by the combination of scrotal and groin skin graft for those who have small scrotal skin.
Before SRS operation, the sufficient skin graft must be well planned and prepared for your neo-vagina.
Concern of choosing between standard sex reassignment surgery and primary colon vaginoplasty
It is true that the colon vaginoplasty can provide a vagina depth of 7-8 inchesIt is true that the colon vaginoplasty can provide a vagina depth of 7-8 inches, but the deep part which is beyond 6 inches depth will be difficult to reach by normal dilation or penile penetration due to its upward direction along the curve of sacrum (bone at the upper, back part of the pelvic cavity).
In summary, Dr.Chettawut always recommends the standard SRS with skin graft for primary sex change surgery which is safer and cheaper surgical procedure than the primary colon vaginoplasty.
No, it is not necessary to choose primary colon vaginoplasty because the standard sex reassignment surgery with skin graft can provide a good vaginal depth of 6-7 inches even in case of very short penis.
However, Dr.Chettawut’s non penile inversion technique preserves the cowper’s gland, the prostate gland and small glands around the urethral opening which can secrete some lubrication during sexual arousal.
These self-lubrications are useful as they come from the patient’s physiological response during sexual arousal; however they are considered not enough for adequate lubrication during routine dilation or sexual intercourse.
Compared to self-lubrication from SRS with colon graft (sigmoid colon vaginoplasty), the discharged lubrication come from nature secretion of colon mucosa which is not directly related to sexual arousal.
The amount of self-lubrication from colon graft varies individually and is difficult to predict before surgery.
One drawback of colon vaginoplasty is the colon may secrete too much discharge (lubrication) which leads to dampness and unpleasant smell.
In Dr.Chettawut’s opinion, the vagina which made from either skin graft technique or colon graft technique always need the application of water soluble lubrication (for example KY jelly or QC jelly) in order to avoid a risk of irritation or tearing during vaginal dilation or sexual intercourse.
With the standard SRS with skin graft, the skin lining inside neo-vagina will not create self-lubrication.
Since the penile skin is not used for lining inside vagina, Dr.Chettawut’s patients who are choosing between standard SRS with skin graft and SRS with colon graft shall obtain the same look of their genitalia.
Regarding to the location of colon graft, it is normally set inside vagina and hardly seen from outside.
However there will be a possibility that the red color of colon mucosa can be seen from outside if the patient has a very short penis which cannot provide adequate skin to cover the whole part of vaginal opening.
Doctor Chettawut can perform non penile inversion technique on his SRS patients who choose either standard SRS with skin graft technique or SRS with colon graft technique and the appearance of external genitalia from those two techniques will be the same.