Surgical Name : Gender Re-assignment Surgery, Sex Re-assignment Surgery
Hospital Admission: 5 nights
Duration of Operation: 5 - 8 hours
Anesthetic: General Anesthesia
Recommended stay in Bangkok: 14 - 21 days

Who benefits from gender change?

• Clients with a strong desire to be treated as the other gender.
• Clients with a strong conviction that one has the typical feelings and reactions of the other gender.
• Clients with a strong desire for the primary and /or secondary sex characteristics of the other gender.
• Clients with a strong desire to be of the other gender.
• Clients with a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics.
• Clients with a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender.

How is gender change surgery performed?
General anesthesia is applied to the patient by an anesthesiologist. A new vagina is formed between the anus and the urinary tract, approximately 5-7 inches deep. The skin covering the penis is used to construct the inner labia, and a vaginal wall is consequently covered with skin graft from scrotum. The core of the penis is removed, and the sexual sensory nerves are kept for use in creating the clitoris. The testicles are removed to decrease of male hormones. The male urinary tract is shortened and shaped so that urine can flow out in the same manner as other women. If the surgery has not been properly undertaken, urine may shoot up when urinating in sitting position.

The exterior parts such as the Major Labia, Minora Labia, urinary tract, and clitoris are reconstructed to look beautiful and perfect as a female sexual organ which can still experience sexual sensations as before.

Human body treats the new vagina as a wound, your doctor may require long-term maintenance of volume (vaginal dilation), by using medical graduated dilators, dildos, or suitable substitutes, to keep the vagina open.

Sexual intercourse is not an adequate method of performing dilation.
With current procedures, trans women do not have ovaries or uteri. This means that they are unable to bear children or menstruate until a uterus transplant is performed, and that they will need to remain on hormone therapy after their surgery to maintain female hormonal status.

Pre-Operative Care
Our team will evaluate your medical history to check for conditions that may delay the surgery or the healing process. Some of the common conditions are:

• Bleeding tendencies – problems with blood clotting, or lack of clotting.
• Scarring problems you have had in the past – like keloid scars and hypertrophic scars.
• Hypertension (High blood pressure) – particularly if it is not under control.
• Smoking – this may affect your reaction to the anaesthetic and prolong the healing process. Please stop smoking 4 weeks prior to surgery.

Please avoid aspirin and brufen-containing medication for two weeks prior to surgery to eliminate the chance of post op bleeding. Generally it is best to continue any blood pressure or blood sugar medications. These may safely be taken with a sip of water on the morning of surgery. Women should ensure negative pregnancy test before surgery.

Foreign patient is required to secure psychiatric letter or a certificate from your therapist to support your request for sex reassignment surgery. Normally we use Harry Benjamin criteria for selecting the appropriate candidate.

She must undergo at least 6 months hormonal therapy prior to surgery.

Post-Operative Care

• 1-2 days after the surgery, the patient should lie on his back, with hips raised and legs slightly apart as this will help reduce swelling.
• On the third day after the surgery, the patient may lie on her side.
• On the 4th day after the surgery, Dr. Boonchai will remove the draining tube, open and clean the wound. The urine drainage/edema tube will also be removed.
• On the 5 th day, the wound will then be cleaned, and the patient may return home.
• Patients of Sex Reassignment Surgery must come back for removal of stitches, and dilation of the vagina using the Dilator which is available at the hospital. In order for the patient to maintain the width and depth of the vagina, the patient should dilate the vagina at least twice a day, for about half an hour each time.
• The patient must clean the wound, as well as dilate the vagina at least twice a day until the external wound and that in the vagina are fully healed.
• The patient must refrain from sexual intercourse for at least 2 months.
• The patient must ensure that she keeps her appointment with the doctor.