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Please note, we are a company based in Thailand and work with clients all over the world. Use this form, the chat widget or message us via social media and we will schedule a call or video chat with to discuss your customized surgical plan and journey.

Please note, we are a company based in Thailand and work with clients all over the world. Use this form, the chat widget or message us via social media and we will schedule a call or video chat with to discuss your customized surgical plan and journey.

Amani Thailand
Type of SRS Surgery

What type of SRS surgery is the right one for you?

This article outlines four techniques of Male to Female Sex Reassignment Surgeries (SRS), what each surgery entails (surgical plan), and the advantages and disadvantages of each procedure.

Penile Inversion Vaginoplasty

Utilizes skin from the outside of the penis to create the lining of the neovagina. The clitoris is built from the sensitive skin at the tip of the penis. Finally, scrotal skin is used to construct the labia majora.

Scrotal Skin Grafting Vaginoplasty

Utilizes a skin graft from the scrotum to construct the labia, urethra, vestibule, clitoris, and clitoral hood. Due to the fact that the vagina is created from existing genitalia, this technique allows for nerves to remain intact, allowing for the functionality and sensitivity of a natal vagina.

Sigmoid Colon Vaginoplasty

A graft of the patient’s colon is used to create the vaginal wall and the scrotal tissue is used to create labia majora, labia minora, and vaginal opening. Because the vagina is grafted from the colon, it is self lubricating. This technique is currently the most widely-chosen SRS surgery.

Peritoneal Pull-through Vaginoplasty

The peritoneum, the moist inner lining of the abdominal wall, is pulled down between the rectum and prostate, to create the vaginal lining and vaginal reconstruction. The remainder of the vaginoplasty procedures (labiaplasty, clitoroplasty, penectomy, orchiectomy, partial urethrectomy, and other associated procedures) are created from a scrotal skin graft, similar to that of the penile inversion technique. Type of SRS Surgery

Penile Inversion Vaginoplasty

Penile Inversion Vaginoplasty is a male-to-female gender reassignment technique, where the penile skin is inverted to create a vagina. Compared to the other methods, penile skin inversion is relatively simple and usually takes approximately 4 hours to complete.

In the penile inversion technique, skin from the outside of the penis is used for the lining of the neovagina. The clitoris is built from the sensitive skin at the tip of the penis. Finally, scrotal skin is used to construct the labia majora.

The penile inversion technique can provide patients with a sexually functional and aesthetically pleasing neovagina with excellent sensation but without the higher risk of complications of the more invasive procedures, such as sigmoid colon vaginoplasty. However, because of the shallow depth of the neovagina, the procedure is best suited for patients who do not wish to have vaginal intercourse after surgery.

The surgery begins with a small incision in the groin or scrotum to remove the testicles. Next, the penis is deconstructed. This involves a circumcising incision with dissection between Dartos and Buck’s fascia towards the base of the penis. Once this is complete, the remainder of the penile structures can be passed into the scrotal incision, leaving just a cylinder of penile shaft skin remaining.

With the penile skin separated, clitoroplasty is performed, followed by urethral dissection. A triangular-shaped flap is made below the perineal body, which will be used to create a posterior fourchette and connected to the penile skin tube. The neovaginal canal is then constructed from one of the perineal muscles

Most patients, especially those who have undergone previous circumcision, require some type of graft or flap to augment the neovagina in order to line the canal. The most common method is to utilize a skin graft from the remnants of scrotal skin

Two triangle-shaped scrotal skin wedges are removed once the neovaginal construct is positioned appropriately. Once the graft is thinned and defatted, the edges of the grafts are used to form a “cap” with the help of a dilator. The proximal edge of the graft is then stitched to the distal aspect of the penile shaft skin

The labia majora is created from the remaining scrotal tissue after its excess is removed through a lateral incision some distance away from the groin crease.

Advantages:

This method is relatively uncomplicated and requires shorter recovery time compared to other techniques. It is the best available method for patients who do not wish to have vaginal intercourse, due to the shallow depth of the vagina after surgery.

Disadvantages:

As the only source of the vagina comes from the patient’s penile skin, it would be required that the patient have a penis that is more than 4 inches in length. The depth of the vagina is short and therefore not ideal for individuals who wish to have vaginal intercourse. Also, in order to have an aesthetic and natural looking neovagina, patients may require a secondary labiaplasty.

Scrotal Skin Grafting Vaginoplasty

The scrotal skin graft and flap method is a common method and recommended for many SRS patients. Under this technique, skin graft and preputial flap are used to construct a neovagina and its main parts including clitoral hood, clitoris, vestibule, urethra, and labia. The surgery usually lasts 6-7 hours.

With this technique, the neovagina is constructed from different parts of the existing genitalia. With most of its nerves and vessels remaining intact, the newly constructed neovagina is functional and has erogenous sensitivity. Furthermore, due to the delicate selection of the material used, the neovagina will be very similar to that of a cisgender woman in terms of beauty, color, shape, arrangement, and size.

Clitoral hood: The clitoral hood is constructed from the penile skin and the dorsal prepuce flap that is connected to the clitoris.

Clitoris: The clitoris is formed from the top part of the glans penis, keeping nerves that supply it intact. Thereby creating a sensate clitoris and labia.

Vulvar vestibule: The vulvar vestibule (the part of the vulva between the labia minora) is formed from parts of the glans penis with intact sensory nerves and vessels and a narrow strip of urethral mucosa.

Labia minora: The prepuce flap with intact sensory nerves is used to construct the inner labia. The labia minora, which extends over the neoclitoris, upper vulva, urethral opening, and the upper part of the vaginal opening, is pink and can be stretched just like other labia.

Labia majora: The scrotal skin will be used to form the labia majora. The scrotal flap is set tightly to look like the labia majora of a young woman.

Vaginal wall: The remaining scrotal skin (after constructing the labia majora), perianal skin flap, and (occasionally) inverted penile skin flap will be used to construct the vaginal wall which will have fully functional depth, elasticity, and natural color.

Vaginal wall: The remaining scrotal skin (after constructing the labia majora), perianal skin flap, and (occasionally) inverted penile skin flap will be used to construct the vaginal wall which will create fully functional depth, elasticity, and natural color.

G-Spot of neovagina:  The g-spot area is composed of the labia minora, clitoris, part of the urethral flap, and prostatic capsule. This complex of sensate organs creates an erogenous g-spot for the neovagina.

Advantages

Patients with a penis length shorter than 4 inches can undergo surgery, as well as those with a longer penis.
The skin grafting technique produces an aesthetically pleasing and natural-looking neovagina.

The depth of the neovagina is sufficient for vaginal intercourse with a typical depth between 5-6 inches.
It is a one-step procedure, meaning patients will not need a secondary labiaplasty in most cases.
The length of the surgery is shorter than that of a colon vaginoplasty.
Shorter recovery period compared to a colon vaginoplasty.

Disadvantages

This technique is highly sophisticated

Surgical Candidates:

In order for patients to undergo vaginoplasty using the skin grafting technique, patients must fit the following criteria:

  • Be under 60 years of age
  • Have sufficient scrotal skin to form a scrotal flap

Type of SRS Surgery

Sigmoid Graft Vaginoplasty

Sigmoid colon vaginoplasty is a specialized SRS technique that transforms a penis and scrotum into a functional and aesthetically pleasing neovagina. By adding the patient’s colon graft inside the vaginal wall, the preputial flap and scrotal skin can be effectively utilized to form an aesthetically pleasing and functional labia minora, labia majora and vaginal opening while the sufficient depth is still achieved by a colon graft. A section of colon is grafted, resulting vagina with normal discharge.

Advantages:

  • Prevents unnatural appearance of red colon mucosa that arises in other colon vaginoplasty SRS
  • Many results of other surgeons’ sigmoid vaginoplasty show a visibly red color of the colon mucosa at the lower part of the vaginal opening. However, this is not found in the vagina of a natal female. Dr. Theerapong’s technique corrects this outcome by utilizing the posterior flap on the sides of the vaginal opening. This conceals the junction between colon and skin flap, and makes the red color not visible at the lower part of the vaginal opening.
  • Widening neovaginal opening to accommodate smoother intercourse and dilation
  • One of the striking advantages of the sigmoid colon vaginoplasty procedure is that this design can create extended labia minora and wider opening of neovagina, which results in more comfortable sexual intercourse and dilation. Therefore, patients undergoing this technique can have pleasurable intercourse and fewer difficulties with dilation. The average depth of a vagina constructed by colon vaginoplasty is 7 inches.

 

Disadvantages:

  • Visible incisional scar on the bikini line.
  • Patients will need to have bowel preparation and can have only liquid food before and after the operation.
  • Longer recovery period compared to other SRS methods.

Type of SRS Surgery

Peritoneal Pull-through Vaginoplasty

Peritoneal Pull-Through Vaginoplasty, or Peritoneal Vaginoplasty, is a newer male to female surgery procedure that’s based on a gynecological procedure called the Davydov Procedure.

Peritoneal Pull Through Procedure is an abdominal approach to obtain peritoneum and develop Denonvilliers fascia between the rectum and prostate to create a space for the neo-vagina or vaginal reconstruction.

Risks include all the risks involved in a penile inversion technique if being done concurrently, as well as: stricture, stenosis, graft failure, lack of lubrication, and risks of abdominal procedure of damage to bowel, bladder, prostate, muscles, nerves, and vessels. Another risk is the lack of literature and long-term data on this procedure.

During surgery, a laparoscope and several instruments are inserted through small 5-8 mm incisions on the abdomen. These instruments allow dissection of the potential space between the lower urinary tract (urethra, prostatic urethra, and bladder) and rectum. This space will become the future vagina.

Peritoneum flaps are pulled through to the area between the urethra and the rectum to line a portion of the vaginal canal. The top of the vagina is separated from the abdominal contents by closing the peritoneal lining approximately 15 cm from the vaginal opening. The remainder of the vaginoplasty procedures (labiaplasty, clitoroplasty, penectomy, orchiectomy, partial urethrectomy, and other associated procedures) are similar to that of the penile inversion technique.

Advantages:

• Self-lubricating lining with some elasticity
• More vaginal depth
• Requires less dilation, less douching
• Requires less pre-op hair removal
• Less risk of prolapse
• May be less risky than Sigmoid Colon Vaginoplasty, plus no odorous mucus discharge and no need to monitor colon pathology

Disadvantages, Risks, and Complications

• All the risks of the penile inversion vaginoplasty
• Additional risks of an abdominal laparoscopic procedure, including intra-abdominal organ injury, ileus, herniation, and others
• Flap failure and stenosis
• Unknown long-term outcomes

Which SRS Surgery/Technique is right for YOU?

The suitable surgical method varies from person to person depending on their specific needs and preferences. To determine which surgical method is the most suitable for their sex reassignment surgery, patients should consider the following factors:

  • Depth of the vagina they wish to have and its functionality implications.
  • Desired characteristics of their labia majora, how large and how firm labia majora would they prefer to have?
  • Incisional scar on labia majora and preferences as to whether the scar is on the inner or the outer side of labia majora.
  • Desired characteristics of their labia minora (size and appearance)
  • Size of clitorisPatients should think carefully about these factors before consulting with doctors. Preference of these factors can be communicated to the doctor during consultation so that the doctors can provide recommendations and design the best surgical plan for patients.

Type of SRS Surgery