Sex Reassignment Surgery (Vaginoplasty)

Gender dysphoria or gender identity disorder refer to individuals who experiences psychological abnormalities that cause conflicting feelings regarding their perceived gender and their biological sex. These conditions are relatively common in today's society as the society becomes more openminded and accepting, allowing these individuals to seek treatment with more confidence and success. As a result, they are able to live happy lives within the society as who they really are.

Pre-surgery

Before undergoing gender reassignment surgery, the patient must be diagnosed with gender dysphoria or gender identity disorder. The doctors will also determine whether the surgery can be performed, with the following steps:

1. The patient must live in society as the gender different from their biological sex consistently for at least 12 months and have successfully adapted to living in this gender role.
2. The patient must receive behavioral and psychological evaluation by at least two psychiatrists, with one of them being a specialist in this field.
3. Hormone therapy must be administered to prepare the body for the transition to the opposite gender prior to the surgery.
4. Any surgery not related to the construction of the sexual organ must be done before the gender reassignment surgery can take place.

Goals of Vaginoplasty

1. Constructing a new vagina that is of appropriate size and depth for sexual intercourse if so desired by the patient. The depth may not be necessarily exceptionally deep, depending on the patient.
2. Constructing a new genital structure that closely resembles female genitalia, including the labia majora and minora.
3. Realigning the urethra so that it points downwards.
4. Constructing sensory receptive or the sensitive clitoral area.

Complications

1. Incisions from the surgery split open or not healing properly. Detachment of the newly constructed vagina occurs quite often as the incisions comprise of multiple stitches from different parts of the skin. It can also be resulting from an inadequate postoperative care or premature use of the new sexual organs. Regular wound treatment can be administered in some cases. Corrective surgery may be necessary in severe cases.
2. Blood congestion
3. Vaginal stenosis – after surgery, the patient should regularly expand the vaginal canal for at least 6-12 months to prevent vaginal stenosis, in which the vaginal canal becomes narrower and shorter. If this complication happens freshly after the surgery, it may be expanded through dilatation. However, if it is left untreated until it becomes rigid and hard with fibrous tissues, corrective surgery may be necessary.
4. Shallow vaginal canal – as with vaginal stenosis, corrective surgery may be needed to reinforce the depth using other tissues such as colonic tissues.
5. Neovaginal perforation into the colon – surgical intervention is needed. In less severe cases, the perforation can be stitched closed. However, in cases with severe infection, temporary colostomy may be necessary to drain feces through the abdominal wall until the perforated wound is healed and the intestines is returned to its location.

Physician

Dr. Naratip Songthong

Department of Surgery (Plastic Surgery)