Vaginoplasty Sex Reassignment Surgery | Ocean Clinic
Vaginoplasty

Vaginoplasty Sex Reassignment Surgery

Sex Reassignment Surgery (SRS) represents an essential and crucial step in the treatment process for many trans women who suffer from gender dysphoria. During recent years, there has been an increase in the number of SRS performed, as more and more trans women opt for surgical intervention in order to obtain the physical apprearance of their gender identity and therefore an increased quality of life. With modern surgical techniques, we are able to achieve excellent functional and aesthetic results, i.e. an authentic neo-vagina. However, in our opinion a modern SRS is far beyond genital and breast surgery. It is about offering a care and service, based upon trust, respect and understanding. Therefore,of equal importance is offering a wholistic individual treatment concept, with a full range of surgical and non-surgical treatments, support and continuous aftercare, carefully addressing patients needs. While some patients achieve their goals with genital and breast surgery, others may require facial feminization (FFS), body feminization, voice adjustment etc. We are proud to have been actively participating in this exciting evolution and modification of contemporary surgical techniques over the past several years. Based upon our extensive experience, we are dedicated to offering expertise and excellence in this field, where reconstructive and aesthetic surgeries are inseparable.

  • Technical term
    vaginoplasty, gender reassignment surgery
  • Duration of surgery
    2.5 to 4.5 hours (including breast augmentation)
  • Anaesthesia
    General
  • Discharge from clinic
    1 week
  • Fit for society
    10 days
  • Back to work
    About 4-6 weeks
  • Aftercare and recovery
    no intercourse for 3 months, lifelong dilation

What to know before Vaginoplasty

What to Know Before Vaginoplasty Sex Reassignment Surgery. Ocean Clinic

One surgery only, during which a genital reassignment and, if requested, a breast augmentation, is performed. (average duration: 4.5 hours)
A second surgery months later, which is still often the case with older techniques, is not necessary.

The primary goal is to reconstruct an authentic aesthetic and functional vagina. There are two well hidden lateral scars alongside the major labia. The vagina will provide a penetration depth of minimum 10-12 cm, possessing excellent sensitivity and normal urination function. The vulva will be covered by minor and major labia.

The outcome should give increased self-confidence,diminished gender dysphoria and allow you to live a normal life. This includes swimming, wearing a bikini, having a satisfying sex life regardless of sexual orientation, wearing the clothes you prefer etc, and countless other things, which every woman deserves.

We operate according to the Thai technique, as described by Dr. Preecha. Dr. Preecha is one of the pioneers of SRS, who started to develop his own approach over 30 years ago. We adopted some minor modifications to his technique, which we believe improve the healing process, however the core procedure is attributed to him.

The operation includes the removal of penis and testicles and reconstruction of inner/outer labia, clitoris, opening (meatus) of the urethra and the neo-vagina.
There are two methods for reconstruction of the vaginal cavity:

Penile Skin Inversion (PSI)
The skin of the penile shaft is inverted to make the neo-vagina. Additionally, a skin graft can be used, which is obtained from the resected scrotal skin. With skin grafting, the penetration vaginal depth is prolonged and hence independent of original penile length. The goal is a penetration depth between 10 and 14 cm (4 - 5.5 inch)
(N.B. in biological women depth is 8 to 11 cm; 3 – 4.5 inch).

Sigma-colon interponate
The vaginal cavity is constructed with a section of large bowel. This means that a piece of about 14 cm long will be resected from your colon, one end will be closed and once the segment is placed into the dissected vaginal cavity, the other end will be reattached to the skin (introitus). Your colon will be re-attached again, allowing the normal passage. This is a two-team approach, jointly carried out with a general surgeon, specializing in colorectal surgery, who simultaneously uses a laparoscopic (camera) technique (i.e. access through little scars only and hence avoiding the large belly scar).

From outside, the vagina (vulva) looks the same, independently of the chosen technique. The only difference lies in the tissues used for the construction of the vaginal cavity.

From outside, both techniques, as described previously, look the same.
The construction of the vaginal cavity depends upon your preferences and your anatomy, in particular your penile length.

We recommend that for patients with a shorter penis length the neo-vaginal construction with a bowel segment (sigma colon interponate) is preferable. For patients with average penile length, the skin method (PSI) is sufficient. The colon method has an added benefit, giving some degree of natural secretion, as the bowel mucous is relatively similar to vaginal discharge. However, the amount of secretion decreases over months after surgery and the remaining amount is highly individual. This may vary between barely any to perfectly satisfied or even excessive. Some patients report unpleasant smell, whereas other do not notice any.

The choice of the right technique requires a thorough examination and frank and transparent discussion with your surgeon.

We follow the Standards of Care (SOC) issued by WPATH (World Profession Association for Transgender Health). Some of the key points are:
  • Persistent, well documented gender dysphoria (certified by your psychiatrist or psychologist)
  • Approx. 1 year of hormone therapy (certified by your endocrinologist)
  • Age of majority and fully informed patient with a signed consent
  • In the case of uneventful healing process, you will stay in the hospital for about a week. Afterwards you will be discharged home or to your hotel and we will see you initially on a daily basis to assist you with dilatation and wound care. We will provide you with all the necessary materials, including the dilators, sitting rings, materials and products necessary for wound care.

    Evaluating our results of the last 3 years, our complication rate lies below 3%. However, it is imperative that patients are clearly and transparently informed of any potential complications that can occur during this complex procedure.

    Firstly, standard complications which are the norm for any surgical procedure, such as hemorrhage, infections etc. As we experience very little instance of bleeding , we avoid placing drains.

    Specifically, very rarely, fistulas can present, which are connections between neo-vagina and the rectum and / or the urethra, resulting in leaks and considerably prolonged healing process. Reports in literature suggest stenosis of urethral opening and therefore difficulty of urination is one of the most common complications. (with our surgical technique, we have not experienced any so far). Theoretically, by damaging the clitoral pedicle, clitoral necrosis results in orgasm inability. The vagina can shrink and eventually become too shallow and / or too narrow, particularly if you do not follow the regular dilation program.

    Most likely (about 3%), you will experience some superficial wound healing and minor loss of skin transplant, all of which is usually treated conservatively (without any additional surgery) by washing out the wound and special wound care.

    During the initial days and weeks after the surgery, you should witness a gradual improvement, prompt wound healing and reduction in swelling. With this technique, it takes up to 3 - 6 months in order to achieve the full closure of small and large labia and hence a final aesthetic outcome.

    Patient testimony

    My transition has given me self-confidence, not only because my body is finally aligned with my intimate feelings, but also because I feel myself credible in my gender expression.

    We recommend regular daily dilation, particularly during the first year. Our specialized nurse will provide you with instructions and information, which are clearly summarized in our brochure given to you prior to the surgery.

    In the long-term, you should have regular check-ups with your gynecologist. We can assist you by providing you our recommendations and guidelines for clinical examination, blood checks and imaging.

    The pre-operative epilation for a hair-free area is advisable for trans women who prefer a smooth appearance or who have a dense hair growth on the penile shaft, hence avoiding partial hair growth inside the neo-vagina. Note, however, that the laser treatments take up to a year.

    All of our patients so far have an excellent sensitivity. Most of them report having orgasms.

    We advise 3 months after the procedure at the earliest. In case you need additional support and advice, we can provide you with further recommendations, based upon the experience of our patients, sexologists and psychologists.

    You can stop testosterone suppressor (Androcur, Cyproterone acetate) as your testicles will be removed. You should continue with estradiol substitution (estrogen), following the advice of your endocrinologist.

    The most effective method is augmentation with silicone implants, which can be performed in the same surgical session as SRS. The choice of implants is highly individual, based upon your anatomy, amount of subcutaneous fat and obviously your preference. In most cases, the result can be optimized by additional simultaneous fat grafting to superior and medial breast pole, resulting in a natural appearance and often-desired décolleté. In our opinion, the paramount care should be dedicated to creating the smallest possible gap between the breasts (1-2cm only), a so-called intermammary distance. The larger gaps (exceeding 3-4 cm) are often stigmatizing and unfortunately still often well observed in trans women and should be avoided. The type of prosthesis, position of the pocket and surgical technique must be personalized in order to achieve the most natural, yet still attractive and feminine outcome.

    Not every patient suffering from gender dysphoria requests a surgical treatment. The degree of dysphoria and the necessary therapy are highly individual and need to be carefully assessed.
    However, should the patient require the change of primary and / or secondary sexual characteristics, there is no alternative to surgery.

    Clinical fellowship over many months at Preecha Aestehtic Institute (PAI) and King Chulalungkorn University Hospital in Bangkok, Thailand. Organizers and hosts of international symposiums about modern surgical techniques in SRS and transgender. Dr. Fakin was the head of SRS program at The University Hospital Zurich until 2018 and performed over 100 SRS in the course of past 3 years with a complication rate below 3%. Invited speaker to numerous international congresses and symposiums. Very high patient satisfaction rate and resulting presence in the media. Authors of land mark study about breast augmentation in trans women. About to publish surgical results and comparing the SRS techniques. Dedicated to quality, excellence, respect and service. Well versed in the long and often difficult path of gender dysphoria process, with accompanying concerns, hopes and expected outcomes.

    The next step

    Vaginoplasty Sex Reassignment Surgery after surgery and beyond. Ocean Clinic