Srs Male To Female
🔞 ALL INFORMATION CLICK HERE 👈🏻👈🏻👈🏻
Srs Male To Female
Sex reassignment surgery (SRS), also known as gender reassignment surgery or bottom surgery, is a set of plastic and reconstructive surgical procedures with the aim of making the genitalia of the patient congruent with their gender identity .
In the MtF case this means transforming the male genitalia with which the patient was born into an aesthetically accurate and functional vagina; under the care of an expert surgeon, normal urination, minimal scarring and the preservation of erogenous sensitivity can all be achieved.
Male to female sex reassignment surgery is a set of complex operations such as the orchiectomy, clitoris reconstruction, labia majora and minora reconstruction, mons pubis creation and vaginoplasty which are often bundled together in what is known as sex reassignment surgery or primary vaginoplasty ; in some cases, the labiaplasty and mons pubis creation might happen some months after the vaginoplasty procedure as well as the orchiectomy might be executed some months in advance.
As per other surgical procedures, the adjective primary means that it is the first reconstructive surgery of its kind on that patient, while secondary vaginoplasty would mean we are talking about a revision surgery to correct defects arisen after the first surgery, or to perform further procedures that weren’t possible during the primary surgery, or to improve functionality or the aesthetics after the first surgery.
Since ancient eras we have documentation about radical procedures on male genitals, obviously far from being modern surgeries, and about the role that these persons, known as eunuchs, had among the different societies throughout history.
The first modern surgery of this kind was performed in Germany in 1931, along with the transplant of the uterus and one ovary, but it ended with the death of the patient 3 months post-op.
In 1952, Danish surgeon Paul Fogh-Andersen became the pioneer of modern era sex reassignment surgery by performing gender reassignment surgery on a WWII veteran and US citizen: George Jorgensen (later Christine Jorgensen). The news was widely reported by the media and Christine Jorgensen became world famous and an activist and advocate for transgender rights; thanks to her, many transgender individuals became aware of the medical and surgical options available to them, giving hope to those suffering from gender dysphoria and propagating the knowledge in the field of transgender medicine and surgery.
As a result, the demand for this type of surgery increased steeply. A great number of people from all over the world started traveling to Denmark to undergo sex reassignment surgery until the Danish government, unable to cope with all the requests, had to limit access to this surgery to the Danish citizens only.
Meanwhile, the interest in the procedure grew also among US doctors and the John Hopkins University became the tertiary referral center for transgender surgeries in the United States in the 1960s. Patient selection criteria were very strict though and of the over 2000 requests received during the first 3 years of operation, only 24 were accepted. By the end of the 1970s this clinic closed its doors to the patients, but in the next 10 years over 1000 patients underwent sex reassignment surgery in the over 40 different university hospitals in the United States specialized in transgender medicine and surgery.
On the other side of the world, in Thailand, Dr. Preecha Tiewtranon and Dr. Prakob Thongpaew performed the first male to female sex reassignment surgery at Chulalongkorn University Hospital in 1975. In this country, transgender therapies became a subject of research and development, with the invention of novel surgical techniques and the improvement of aesthetic and functional results. The skills of Thai surgeons in this field is second to none and Thailand is considered to be the most advanced country for all what concerns transgender medicine and surgery; between 1985 and 1990 only 5% of transgender patients who underwent SRS in Thailand were medical tourists coming from abroad , but in 2010-2012 that percentage had already risen to 90% as proof of skills and knowledge of Thai surgeons.
Many authors believe the following to be the ideal goals of MtF gender reassignment surgery:
From a surgical point of view there are also the goals of using a technique which is effective, easily reproducible, and with consistent results among patients, having low risks and low complication rates.
This branch of medicine, relatively new and not much studied, has made huge progress over the last decades. As of today, it is possible to obtain a vagina and a perineum and genital area aesthetically impeccable, functional and permitting penetrative sex, which allows to reach orgasms and sexual satisfaction. It is not yet possible though to provide for reproductive function, there is no reconstruction or transplant of the reproductive organs, neither menstruation nor menstrual cycle can be obtained.
The following are the prerequisites to have access to the primary vaginoplasty and set in the Standards of Care 7 th edition by the World Professional Association for Transgender Care (WPATH):
The last criterion is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role, before undergoing irreversible surgery.
Before undergoing the vaginoplasty procedure for MtF sex reassignment surgery some exams and medical interventions might be needed, which can vary depending upon the surgeon, the surgical technique and the clinic or hospital at which the procedure will be performed.
Over the years, several surgical techniques have been developed to address sex reassignment surgery in transgender women. The most widely used technique and the “gold standard” for primary vaginoplasty is the penile skin inversion procedure ; for secondary vaginoplasty, the sigmoid colon vaginoplasty procedure is the technique usually employed. The latter is also chosen for patients with specific anatomical characteristics and is anyway the second most performed MtF SRS technique.
Known as the standard procedure for male to female sex reassignment surgery, the penile skin inversion vaginoplasty is a surgical technique that includes an orchiectomy, a partial penectomy, penile dissection with creation of the vaginal canal, a labiaplasty and a clitoroplasty.
There are some slight modifications to this technique depending on the surgeon who performs the procedure, hence some of the passages described below might be executed differently.
Surgery begins with the insertion of a urinary catheter. An incision is made along the scrotal raphe, the midline of the scrotum, and the orchiectomy is performed. The penis is then dissected: the glans is separated from the shaft and the dorsal neurovascular bundle is dissected from the underlying corpora cavernosa. Corpus spongiosum is then excised performing an incision at the base of the penis; this is done to avoid possible swelling due to erogenous stimulation in a sexual intercourse, which would cause the neovagina to narrow too much. Corpora cavernosa are excised as well, but a small portion is left to constitute the base of the neoclitoris, which will be reconstructed using the dorsal part of the glans previously dissected. An internal pouch is then created in the region between the penis and the rectum, the penile skin is inverted and stitched at the end to create the vaginal lining and is then inserted in the space created. The urethra is then shortened, and a new urinary meatus is created. The neoclitoris is then positioned and the clitoral hood is reconstructed as well as the labia minora. Scrotal skin is then employed to reconstruct the labia majora and a stent is inserted in the neovagina to keep it dilated.
The urinary catheter and the vaginal stent are left in place for the first 4-7 days; when the stent is removed, the patient will begin the dilation of the neovagina following a schedule as advised by the surgeon, by daily inserting expanders for the first 6 months. During the first days, the patient will stay in bed and will receive heparin injections to prevent venous thromboembolism. Once the vaginal stent will be removed, the patient will be allowed to walk. The neovagina will be cleaned daily with antiseptic solutions such as betadine. 7 or 8 days after surgery the patient is usually discharged from the hospital. After 6 to 8 weeks from surgery and once surgeon’s approval is received, it will be possible to have penetrative sexual intercourse.
The prostate is usually not removed during surgery; this is because it constitutes an internal erogenous structure which is similar to the so-called female g-spot. For this reason, the patient will have to check its health status following the international guidelines or the GP’s advice.
Permanent laser hair removal is a fundamental step in this surgical technique to prevent hair growth within the neovagina or other reconstructed structures, with the risk of causing infections or constrictions. This is usually performed in the weeks and months prior to the surgery, but in some cases manual removal of the follicular units is performed by the surgeon during the primary vaginoplasty procedure.
Advantages of the penile skin inversion vaginoplasty
The advantage of using this technique is the avoidance of the risks involved with abdominal and intestinal surgery.
Disadvantages of the penile skin inversion vaginoplasty
The disadvantage of this technique is that to obtain an adequately sized neovagina, you need an adequately sized penis; hence, this type of technique might not be possible for patients with smaller penises, which is common especially among patients who started feminizing hormone replacement therapy before the full male sexual development, in adolescence. In the case of previous surgeries, such as circumcision, there might again be not enough tissue to reconstruct the neovagina; sometimes grafts of tissue from regions of the body other than the penile shaft can be used to avoid such issues.
Another disadvantage of this technique is the lack of natural secretions and lubrication, unless some modifications to this technique are performed, hence the use of a lubricant will be necessary to allow sexual intercourse.
Moreover, the neovagina will have the tendency to get narrower and its initial dimensions won’t allow for penetrative sexual intercourse, hence the patient will have to follow a dilating schedule as advised by the surgeon.
With this technique, the neovagina is reconstructed starting from a portion of the intestine, usually a section of the sigmoid colon when the large intestine is chosen, but sometimes the small intestine is chosen and in that case a portion of the ileum is resected. The benefit of using the sigmoid colon over the ileum is the larger diameter and the reduced secretions, far more abundant in other parts of the gastrointestinal tract.
A 12-15 cm section of sigmoid colon with its vascular pedicle still intact is removed; an internal pouch in the perineal regions is created by the surgeon and the intestinal section is transposed where the neovagina is intended to be. One of the ends is sutured to the opening of the neovagina, whilst the opposite end is sutured closed; the whole segment is anchored internally to the pelvis to avoid migration or torsion. The intestinal tract is anastomosed and checked for possible leaks.
Since part of the colon is used to create the neovagina, after surgery it is advised to follow international guidelines regarding screening, conduction of regular checks and prevention of colon tumors.
Sigmoid colon vaginoplasty is often the first choice as operative technique in secondary vaginoplasty, when the primary vaginoplasty failed or did not yield the expected results.
Advantages of sigmoid colon vaginoplasty
The advantage of this technique is that the neovagina will surely have sufficient dimensions to be functional, it will have a mucosa as internal lining which is physiologically lubricated and there will be reduced need of following a dilating regimen post-op. The appearance and the consistency of the tissues is also much more like the ones from a cisgender vagina.
Disadvantages of a sigmoid colon vaginoplasty
The main disadvantage of this technique is the fact that it involves abdominal and intestinal surgery, with an intestinal anastomosis, which carries all risks related to this type of surgery. Another disadvantage of this technique is the fact that the secretions produced by the neovagina might be too abundant or with an unpleasant odor; this is more likely when the ileum is used instead of the sigmoid colon. Moreover, this surgery will leave some visible abdominal scars due to the need of performing abdominal incisions.
Dr. Suporn Watanyusakul has developed his own proprietary technique for the vaginoplasty procedure, performed for the first time on a patient in the year 2000.
This technique uses scrotal skin for the reconstruction of the vaginal canal, using groin skin flaps if scrotal skin is not sufficient. Penile skin is used instead to reconstruct the labia minora, the clitoral hood and other aesthetical details of the external genitalia. This technique is generally capable of obtaining a neovagina of greater dimensions when compared to the penile skin inversion technique; it is considered superior from the aesthetics’ and erogenous sensation’s side due to the usage and preservation of tissues that are each other’s embryologic analogues in male and female development. Moreover, while dissecting, Dr. Suporn always retains the Cowper’s glands (aka bulbourethral glands), positioning them within the neovagina, hence guaranteeing natural lubrication when sexual arousal occurs.
Dr. Chettawut Tulayaphanich developed his own proprietary technique for the vaginoplasty procedure, using a scrotal skin graft similarly to Dr. Suporn.
Dr. Chettawut utilizes penile skin to create the labia majora and minora and to reconstruct the clitoral hood; scrotal skin will constitute the vaginal lining, sometimes by adding groin graft if the skin available is not sufficient, and with this surgical approach the depth obtained is generally greater than with that of the penile skin inversion technique. In his technique, Dr Chettawut retains bulbourethral glands too, to allow for a natural lubrication of the neovagina.
This technique, like Dr. Suporn’s, is regarded as superior to the others both in terms of aesthetics and in terms of functionality. The sensitivity is defined as excellent and it is possible to reach an orgasm. Two are the areas that retain erogenous sensitivity: the clitoris, which is reconstructed from the dorsal part of the glans and which is innervated by the pudendal nerve, and the vulvar vestibule which is reconstructed from the ventral part of the glans and is connected to the pudendal nerve branches as well. Moreover, Dr Chettawut preserves the sensory innervation of three more nervous branches: at the level of the clitoral hood, of the inner labia and in the vaginal canal adjacent to the prostate. This is a guarantee of further and greater sensitivity of the reconstructed structures.
This technique was used in the past to perform secondary vaginoplasties when the primary vaginoplasty with penile skin inversion did not provide satisfactory results. It utilizes flaps harvested from the medial region of the thigh or from the inguinal region to create the neovagina, sometimes combined with penile flaps by using sutures for the creation of a single flap of greater dimensions.
The advantage of this technique is that non-genital flaps contract less after surgery, so they require less post-op dilatation. The main disadvantage is the possible complication to the flap donor site, scarring where di flap is harvested, unnatural consistency of the reconstructed tissues. Moreover, there are no structures which allow for natural lubrication of the neovagina.
This technique was used in the past utilizing skin grafts harvested from the penis or from the scrotum to reconstruct the neovagina. The advantage of the penile graft over the scrotum one is that it has fewer hair follicles, nevertheless it is a rarely used technique since it is possible to achieve better results by using penile skin as a pedunculated flap. Scrotal grafts instead are used currently when the penile skin obtained from penis dissection is not sufficient to create a neovagina of functional and acceptable dimensions.
This is one of the first techniques ever used to perform the vaginoplasty in transgender patients. It utilizes non-genital skin grafts to create the neovagina; the grafts usually come from abdomen skin. The advantage is that there is no risk of having insufficient tissue for the reconstruction of a functional neovagina, the limited presence or absence of hair follicles and the low risk of post-op complications. The disadvantage is the tendency of the skin grafts to shrink, the suboptimal sensitivity, the absence of natural secretions and the scarring of the donor area.
Recently, the use of grafts harvested from the buccal mucosa is being investigated. In some cases, grafts or micro-grafts have been harvested and then stitched together to obtain a graft of the desired dimensions. In other cases, a small portion of tissue has been harvested and then cultured in the lab to increase the number of cells and the size of the graft. This technique is not yet widely used but has the advantage of having a high survival rate and the presence of natural secretions, reason for which it might be utilized in the future.
This technique has not yet been used for surgery on transgender women, but it has been performed on cisgender patients suffering from cervical cancer or from vaginal agenesis. For this surgery, an acellular dermal matrix is used; ADM is one of the most used biomaterials in reconstructive surgery in recent years, consisting of the dermal matrix harvested from tissues in humans or animals, without the cellular components. In the future this technique might be employed also for the transgender women, but the main disadvantage is the high costs.
This technique utilizes the tissues harvested from the male sexual organs to create an aesthetically pleasing and accurate vulva (the external female genitalia) like the above surgical procedures, retaining erogenous and tactile sensitivity. However, the vaginal canal is not reconstructed hence penetrative sexual intercourse is not possible.
This is the ideal surgery for all those patients not interested in having vaginal sexual intercourse. The advantages are shorter surgery time, less expensive surgery, lower risks and no need for continuous dilatation of the neovagina or daily cleaning of the reconstructed vaginal canal.
Dilatation is usually recommended for the first 6 months post-op. After 6 months, if the patient has regular sexual intercourse the use of dilators will not be needed. The dilation regimen requires the use of tutors increasing in diameter from 20mm to 32mm with a length of about 13cm; initially they are used three times a day for about 50 minutes each time. Once the desired dimensions are reached, it will be sufficient to use them 2-3 times a week, or less if the patient has regular sexual intercourse. It is required to apply a generous amount of water-based lubricant before using the dilators, to avoid tissue damage and pain.
Surgical wounds are cleaned daily and have to be kept dry and clean until complete healing. The vaginal canal will require daily hygiene to avoid complications and infections.
Until the transplant of the female reproductive organs will be made possible by medical advances, pregnancy is not possible for transgender women.
When evision surgeries are requested it is usually to improve the aesthetics of the results, but sometime a secondary vaginoplasty is indicated to improve the functionality of the neovagina.
4-6 weeks after surgery it is generally possible to go back to work.
Risks and complications of male to female sex reassignment surgery include general risks which are not specific to this surgery but shared with any surgery such as risks related to general anesthesia, intra-operative and post-operative bleeding, infections, scarring, delayed healing, accidental damage to surrounding tissues.
Among the specific risks related to SRS there are urethral strictures, narrowing of the neovagina, meatal stenosis of the new urethra, rectovaginal fistulae, graft necrosis, loss of sensitivity, unsatisfactory dimensions of the neovagina.
Sigmoid colon vaginoplasty also carries the risk of abdominal adhesions and anastomotic leaks.
As of today, about 20 surgeons perform gender reassignment surgery in Thailand, most of them working in the following clinics:
At present, about 2-3 sex reassignment surgery are performed in Thailand every day on foreigner transgender women (MtF medical tourists ).
Thailand is considered the best country in the world to undergo SRS as well as other surgical procedure for the transgender patient; this is because of the great skills and expertise of local surgeons, the innovative techniques and great number of surgeries performed, the excellent quality of the hospitals and clinics, the unique hospitality and the lower costs.
Costs vary depending on the clinic, the surgeon and the operative technique, ranging between US$ 10,000 and US$ 20,000. Length of stay is about one month, 1-week pre-op and 3 weeks post-op.
Medical Blogger committed to accuracy, I am passionate about delivering my readers critical insights into the medical field.
Former paramedic, instructor and medical school student.
You can read more about me in the dedicated section of the website.
You must be logged in to post a comment.
Sex reassignment surgery - Wikipedia
Male to female sex reassignment surgery – Guide to MtF SRS Vaginoplasty
srs /introduction - TransSurgeriesWiki
Male - to - Female SRS in Thailand - Dr. Pichet - Bangkok Plastic Surgery
Sex Reassignment Surgery ( SRS ) | 1 Year Post-op Male to Female
Wiki for /r/Transgender_Surgeries r/ TransSurgeriesWiki
Reddit Inc © 2021. All rights reserved
Surgeons by country, including photos.
The main techniques, in approximate order of popularity
There's lot of different names/acronyms for this, and I'm just using SRS out of long term habit. Also GRS, GCS, GAS.
A post on Susans says that keeping testicles after SRS (by moving to the abdomen) has been done in the past, that it was common in the 1950's, started by Elmer Belt , and that a Tess Cowen had done it.
Undescended testicles have a higher risk of cancer than normal, and are often removed. This suggests that not removing testcles during SRS would increase the risk of cancer, but I'm not aware of any studies (and there probably aren't any due to the small numbers doing this)
Suporn, Chettawut, probably others in Thailand.
Sometimes used after an initial SRS has failed or depth is not sufficient. Has more restricted BMI requirements than other SRS techniques (eg Chettawut less than BMI 28 vs 35, age less than 45, weight less 80kg).
Olmec in India have a variation on this technique.
Chapter 18, "Surgery in Complications: Colon Vaginoplasty" by Paolo Verze, Davide Arcaniolo, Marco Franco, Roberto La Rocca, and Vincenzo Mirone
Surgeons who (probably) do this procedure or a variation include
This started getting a lot of attention after Jess Ting did an article in Wired Magazine in 2017
This paper has a brief critique of the peritoneal technique
See the SRS wiki pages for surgeons.
Removal of the entire scrotum, including testicles. Best not do this if you plan on having SRS in the future as the tissue it useful.
This referes to the surgery itself, rather than a person who's non-binary having a traditional surgery. For that, look under Real Life Experience.
Doctors who offer penile preserving SRS include
https://twitter.com/410goneallopen and https://twitter.com/410goneallin with Dr Satterwhite, quoting a bit "So taking tally of everything, I have a penis, a vagina, and 'inner' labia."
There's one non-binary surgery by James Bellringer (UK) - see the post on transbucket
Heidi Wittenberg in the USA offers non-binary surgery - We understand that some patients will not be looking specifically for transfeminine or transmasculine surgeries. For these patients, we offer individualized surgical options. Examples include penile preservation vaginoplasty and vaginal preservation phalloplasty .
Pornhub. There's a lot of fairly standard trans porn on Pornhub, however I'm not sure these two links can be classified as transgender related. Some of the others I saw are even further afield and I've not included them here.
I've not seen what's in here, but judging by the rest of the site I expect its extremly graphic.
Surgeons who (probably) do this procedure include
A cis-male had penectoctomy due to cancer
This involves injection of local anesthetic into the nerves of the penis to remove sensation. It's supposed to be temporary, but can apparently result in a permanent loss of sensation. If you were to have SRS later on I'd assume you would continue to have no sensation. It seems like a really bad idea.
Transplanting genitals from a person of one gender to another has not yet been done. Womb transplants have.
Papers in the Journal of Minimally Invasive Gynecology
Revisions to fix problems with the original surgery.
Hanna Simpson - Surgery by Kathy Rumer, Revision by Marci Bowers
TV show Botched Season 1 Episode 3 with Kimber James
Emily Tressa had SRS with Jess Ting in USA at 17
It should go without saying, but this is exceptionally dangerous.
Some cis-women have labiaplasty to alter their labia minora.
Porn is obvioulsy not representative of the average vagina/vulva.
I'll collect a few results here to illustrate various points of post-op results. I find it helpful to look wth legs closed, open, and internally/labia apart as different things can be seen in each. Sometimes what looks very good with legs closed is not so good with legs apart or labia spread. In particular look closely at the labia majora, labia minora, anterior commissure, posteriour commissure, inside vulva. Some problems of SRS, eg assymetry of labia, can be fixed or improved by revision, but I don't know how that varies among surgeons.
In porn its quite common to obscure the view with hands or toys, and presumably its intentionally as sometimes you'll never find a photo without that.
Mia Fever (see Brassard) at first glance appears to have an excellent result, except that its misleading as you can actually see very little.
Overviews of the entire surgery process.
Women have many varied reasons for choosing their surgeon andprioritise different things. These include
If you have freedom to choose a surgeon it can be difficult to get started evaluatining them due to the amount of choice. Personally I'd start by looking at the most popular surgeons as judged by the number of reviews in the wiki - they are presumaby popular for a reason and the number of reviews make it easier to judge the risk of having problems. ie no botched surgeries for a surgeon with no reviews doesn't mean anything, except that a surgeon with no reviews probably doesn't have much practice/skill either. Look at photos of results very carefully and educate yourself on what you are looking at - you may find you have different opinions on what is good/bad to others.
Some are looking for the best surgeon in the world, money no object. Its not an easy question to answer - I've noticed a number of exceptionally wealthy trans women all choosing different surgeons. I'd start looking at surgeon in the USA and Thailand, starting with the most popular.
Some prefer surgeons in their own country so that its easier to get problems taken care of. This post mentions local surgery in both Sweden and Germany and still having problems getting doctors to help.
I'm not aware of anyone who's sucessfully sued a surgeon for botched surgery anywhere in the world.
Surgeons have different eligibility requirements for surgery. Some (many) will not perform surgery under 18. In Thailand it is not legal to perform surgery under 18, and parental permission is required under 20. There's a wide variation in health/weight (BMI).
And by new I mean inexperienced at this particular surgery.
This is my opinion for what it's worth.
There's many new trans surgeons appearing in recent years. You might reasonably think that all surgeons are highly qualified professionals who are all much the same, and none of them could possibly be incompetant. After all, even the best surgeons in the world were once inexperienced and unknown. And even the best still have reports of botched surgeries So what if you choose one of these?
You may have little choice due to insurance, or perhaps they are close to your home and you value that. Still, I think its worth understanding the risks.
Some complications are minor and easily rectified. Others will will be a traumatic journey over many years and multiple surgeons, and some appear to be hopeless. I would suggest you want to reduce the chance of this ever happening. You may not get it to zero as even the most well regarded surgons have cases, but you can reduce it.
If you want to go off HRT to get a last sperm sample, search for Clomid in Dr Will Powers sub .
Most surgeons require HRT to be stopped before surgery. The main exception appears to be implants/pellets for which you would time the surgery for when estrogen levels are low.
http://marcibowers.com/transfem/resources/faq/#discontinue-my-hormones - "The time-honored dogma for patients undergoing vaginoplasty is that estrogens increase the risk for blood clots and that all hormones must be discontinued. This suspension of hormones leaves patients moody, depressed, achy and overall not feeling well around the time of surgery. On the other hand, we do not stop hormones or birth control pills in natal women undergoing gynecologic surgery. My feeling is that those same rules can apply for our patient population so long as we drop doses as low as possible. Such has been our philosophy since 2003 without incident. We do not interfere with those who have already discontinued their HRT on the advice of their home physicians or specialists. Dropping the dose as low as possible 4 weeks prior to surgery is our current advice except in patients with higher risk."
https://transcare.ucsf.edu/guidelines/feminizing-hormone-therapy - "There is no evidence to suggest that transgender women who lack specific risk factors (smoking, personal or family history, excessive doses or use of synthetic estrogens) must cease estrogen therapy before and after surgical procedures, in particular with appropriate use of prophylaxis and an informed consent discussion of the pros and cons of discontinuing hormone therapy during this time. Possible alternatives include using a lower dose of estrogen, and/or changing to a transdermal route if not already in use."
Suporn is said to get good results for this condition.
The WPATH Standards of Care require (page 106) one year of living in your preferred gender (and HRT) before genital surgery. The one year is known as RLE , or sometimes RLT (Real Life Test) as in you don't get your SRS without passing it. Note that the WPATH SOC is not a legal requirement, surgeons are not required to follow it, and it is open to some interpretation.
Its possible, though rare, to get SRS without even presenting/identifying female or having any intention of socially transitioning. Lots of trans people don't believe this is possible (and some believe it shouldn't be allowed). You must take estrogen or testosterone afer removing the testicles otherwise you'll be at risk of osteoporosis (this is very bad) and other problems. As evidence its possible, and with reputable surgeons:
SRS letters are usually written in accordance with the requirmenents the WPATH Standards Of Care and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) .
The WPATH SOC is a set of best practices for treating transgender people, while the DSM-5 contains the standard diagnostic criteria for being transgender.
Neither are laws nor are they absolutly required to get genital surgery, but its very difficult to find a surgeon/psych who doesn't follow them, or at least go through the motions. Insurance companies may make things even more difficult. Thailand does have laws on genital surgery that are not exactly the same as WPATH and requirements does vary somewhat between surgeons.
https://thegalap.org/ - "The GALAP Movement. We are a group of transgender, nonbinary, and allied mental health clinicians in the U.S. who believe in improving access to letters for clients who are seeking gender-affirming medical care. We resist the harmful practices of gatekeeping and believe in an informed consent model where clients can affirm their gender identity without the steep cost of sessions with mental health professionals and reductionist clinical practices. As such, we want to create a movement towards to providing free and low-cost letters for gender affirming access to medical care."
I had to put this somewhere - this is a post by cis-women with MKRH talking about her experiemce, and its something many of us can relate to.
Personally, I'd check these psychs are accepted by your surgeon before using them.
I've heard of Graham L Peveller being accepted in Thailand.
Surgeons have weight/BMI limits, often around 15 to 30 for SRS. The range for colon-vaginoplasty is smaller.
For very large amount of weight loss excess skin may need surgical removal. The reddit fasting sub says that fasting can eliminate this skin through a process called autophagy.
https://en.wikipedia.org/wiki/Crohn%27s_disease - "Crohn's disease is a type of inflammatory bowel disease (IBD) that may affect any segment of the gastrointestinal tract from the mouth to the anus."
https://en.wikipedia.org/wiki/Phimosis - "Phimosis is a condition in which the foreskin of the penis cannot be pulled back past the glans."
https://en.wikipedia.org/wiki/Psoriasis - "Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin."
https://en.wikipedia.org/wiki/Transurethral_resection_of_the_prostate - "Transurethral resection of the prostate (commonly known as a TURP, plural TURPs, and rarely as a transurethral prostatic resection, TUPR) is a urological operation. It is used to treat benign prostatic hyperplasia (BPH)."
You need to take adaquate estrogen (or testesterone) after surgery to avoid medical problems. The worst seems to be osteoporosis.
Some women need to take testosterone after SRS (or orchiectomy) as a result of too low testosterone.
This is also a problem for some cis-women.
Its not common, but the the adrenal glands produce testosterone and after SRS or orchiectomy they can in some cases increase production to compensate for sudden loss.
The clinic’s ‘Post-Op Care’ book says that in about 10-15% of cases “unwanted male characteristics can return immediately post-operative” as the body attempts to make up for
the loss of testosterone and that the treatment is anti-androgens “for at least 3 months”. My doctor said much the same and prescribed low dose spironolactone (25mg) to allow my body to adjust. I took it for a few months, and as usual it fixed that problem.
General anesthesia can cause post-op depression.
According to wikipedia a vagina ranges from 4.3" to 4.7" during sexual arousal, and the avergage errect penis length is 5.17" . However the post-operative trans women's vagina does not stretch.
Sweden (Karolinska University Hospital), 10.4cm (sample 80)
Suporn average 7.0 inches/17.8 cm, min/max is 6.0"/8.5", from 2010-2017
Chettawut, SRS with skin graft = 6.5-7 inches, SRS with colon graft = 8-9+++ inches
Cis-women's depth in a post on susans Re: Chettawut girls, are your vaginas working well? by Susan in 2015
I need to review these, I'm not sure which ones are related to depth.
Susans wiki article on Vaginal dilation .
Cis-women may dilate for various reasons - Vaginal dilation: When it’s indicated and tips on teaching it in OBG Manag. 2012 December;24(12):12-18, by Kristene E. Whitmore, and Susan Kellogg Spadt.
Sleepless Rants, Episode NaN in 2018, "Since I’m bed-ridden for a few months, I needed a decent desk in bed that would allow me to still be productive whilst mostly laying down."
Note that the Soul Source dilators are pretty much the standard dilators after SRS and are supplied by many SRS surgeons. The others are more likley intended for cis-women, and some may not be of sufficient lenght.
Be careful with lube in the first few months after surgery, use water based lubes as other chemicals can interfere with healing.
Cleaning the vagina with water, etc. It seems to be required early post-op, but somewhat unlcear how often you need to douche in the long term. For cis-women its not reccomended
Marci Bowers (SRS surgeon) - http://marcibowers.com/mtf/wp-content/uploads/sites/3/2014/05/Discharge-instructions-for-GRS-edited-revisions-no-phone-number.pdf - "There will be some blood-tinged discharge on your pads for at least a few weeks This diminishes as healing advances. Odor will change from a somewhat foul‘healing odor’ to a more natural ‘feminine odor’ over 6-12 weeks. Douching during this period with warm water and capful of vinegar is acceptable. Beyond 12 weeks, douching is discouraged as it depletes the vagina of bacteria that maintain the normal vaginal health and well-being."
UCSF Center of Excellence for Transgender Health Vaginoplasty procedures, complications and aftercare by Toby Meltzer (SRS Surgeon) - "Initially the patient should douche daily during frequent dilation. Douching can be reduced to 2-3 times a week when dilation is less frequent."
reddit Post-vaginoplasty: do you douche? by stellaproiectura in 2018 - "I’m recovering from GRS with Dr. Brassard and their recovery booklet specifies to douche every single day for the rest of your life. This seems abnormal; for cis women, douching is generally ill advised ever, let alone once per day. I’ve spoken to former Brassard patients who were not informed to douche daily, and who haven’t douched at all in years. Others douche once a week. "
reddit For those post-op, how's sex? by transthrowaway45345 around 2016
susans Do you girls douche? by kimbee777 in 2016
susans To douche or not to Douche? by Gail20 in 2018
Vaginoplasty: Male to Female Sex Reassignment Surgery, Historical notes, descriptions, photos, references and links. by Lynn Conway 2000-2006 - "The postop woman may need to douche occasionally, especially after intercourse, in order to keep her neovagina clean and odor-free."
Pain is common in the weeks/months after surgery. A small percentage of women have severe pain for longer.
Death or Brain Damage from Anaesthesia by Dr Jennifer Hares, in 2017 - "The risk of dying in the operating theatre under anaesthetic is extremely small. For a healthy person having planned surgery, around 1 person may die for every 100,000 general anaesthetics given. Brain damage as a result of having an anaesthetic is so rare that the risk has not been put into numbers."
https://www.transvisie.nl/transitie/volwassenen/intimiteit/ - shows an very high rate of loss of sensation, google translated - "In the sex confirmation operations, the surgeon will do his/her utmost to make the sensitivity of the new genitals possible. However, not everyone will actually succeed. In transgender women, the Amsterdam UMC (VUmc) indicates that this works in 80% of all operations."
Onderzoek Transgenderzorg, Nederland, https://www.transvisie.nl/wp-content/uploads/2016/12/onderzoektransgenderzorgnederland.pdf , google translated - "Conclusion: 81% of the vaginoplastics in the VUmc lead to one or more recovery operations. On the basis of the prudent figures that are there, the data from Thailand / Germany / Ghent (B), the percentage of recovery operations in these countries seems significantly lower."
Many papers don't mention who the surgeon was. Got to wonder why.
I'm not not sure what else to call these. They can be quite disturbing to view.
I've only put a few here, but there are more listed on the sureons pages.
Not necessarily a complication of surgery.
See Death on the main surgery wiki page.
Usually its a small matter to have it fixed, but occasionally its more of a problem.
Some women have a long and difficult recovery
See [Hair Loss]( r/TransSurgeriesWiki/wiki/index #wiki_hair_loss) on main surgery wiki page.
https://www.hotoctopuss.com/guest-post-leandra-vane-on-orgasm-hunting-with-nerve-damage/ - "I was born with nerve damage. I grew up in a body that was mostly numb, and when I was 24 years old, I had a spine surgery after which I lost even more sensation. Today, I don’t have feeling in over half of my body. But I still love having orgasms." by Leandra Vane in 2018
https://en.wikipedia.org/wiki/Necrosis - "Necrosis (from Ancient Greek νέκρωσις, nékrōsis, "death") is a form of cell injury which results in the premature death of cells in living tissue by autolysis."
Need to review these to find out where the data came from, some may be not relevant
Be aware that there are some hate subs targeting transgender people on reddit by misrepresenting surgery, regret, and detransition. I've not linked to them as the discussion there is very misleading and quite disturbing. If you're not sure if you're looking at a hate sub go to subredditstats.com and look at how the users of the sub overlap with known hate subs like gendercritical, itsafetish, lgbdropthet, etc (don't go looking at those subs, you'll only get upset).
Regret is rare, but there are a few cases.
PDF 3rd biennal EPATH Conference Inside Matters. On Law, Ethics and Religion , see page 118, "Detransition rates in a national UK Gender Identity Clinic"
Of the 3398 patients who had appointments during this period, 16 (0.47%) expressed transition-related regret or detransitioned. Of these 16, one patient expressed regret but was not considering detransitioning, two had expressed regret and were considering detransitioning, three had detransitioned, and ten had detransitioned temporarily. The reasons stated by patients for their regret or detransition included: social factors, reporting physical complications, and changing their mind about their gender identity and identifying as their gender assigned at birth. The 16 patients consisted of 11 trans women, two trans men, two cis men, and one person assigned male at birth who said their gender identity was “trans”.
Ignore the YouTube video on regret by the Russian propaganda channel "RT Documentary", for obvious reasons.
Outcome of Vaginoplasty in Male‐to‐Female Transgenders: A Systematic Review of Surgical Techniques, https://onlinelibrary.wiley.com/doi/full/10.1111/jsm.12868 in 2015
The Journal of Clinical Endocrinology & Metabolism
Transformation génitale homme–femme (aïdoïopoïèse) by Marc Revol in 2014
Vaginoplasty with a Pudendal-Thigh Flap in Intersexuals by Yuzaburo Nambaa, Narushi Sugiyamaa, Shuji Yamashitaa, Kenjiro Hasegawaa,
Yoshihiro Kimataa, and Mikiya Nakatsukab in 2008
There's a lot of academic papers listed in a spreadsheet here .
Management of gender dysphoria : a multidisciplinary approach by Carlo Trombetta, Giovanni Liguori, Michele Bertolotto (note that this book contains a chapter by the discredited psychologist Kenneth Zucker )
A collection of photos (these are possibly quite old)
A collection on a French site including Suporn, Marc Revol, Stan Monstrey, Michael Sohn, Yvon Menard, Brassard
A collection including Brassard, Chettawut, Bowers, McGinn, and Suporn.
Post-op porn, generally its difficult or impossible to find out who the surgeons were
Collections of links to transgender medical topics, including to surgery, post-operative results, and HRT.
r/estrogel - compounding topical HRT
r/transvancouver - Vancouver, Canada
r/transnord - Nordic & Baltic countries
.jpg){kind=spacer}
