Wednesday, June 15, 2011

Scarless Male to Female Sexual Reassignment Surgery By Dr. Juta Jansi

Overview of the surgery:

Male to female Surgical Procedure:
Sex change surgery for male to female involves the removal of the penile muscle and testicles reshaping it to appear more female thereby constructing a vagina. An incision is made into the scrotum, the flap of skin is pulled back and the testis is removed. The skin is stripped from the penis but is left attached and the urethra is cut. The excess skin is used to create the labia and the vagina.

Duration of the operation:
The surgery usually takes 6-8 hours to complete according to the extent of the procedure.

Post operative care:
·        After surgery patient should remain on bed for the first 24 hours.
·        The surgeon will perform the necessary care and do the dilation at least 2 weeks.
·        Patient must dilate to achieve the desired depth and width of the newly made vagina. If patient will not dilate properly, the result would be narrowing of the width and depth of the newly made vagina due to scar contractures.
·        After each dilation session with the doctor, wound dressing should be performed to speed up healing process.
·        Patient should avoid strenuous activities which can interfere with the circulation.
  • The vaginal packing, all drains and urinary catheter are usually removed on the fourth or fifth day following surgery.
·        Increase fluid intake at least 8-10 glasses per day to promote urination.
·        Wound dressing is done daily to prevent infection.
·        The surgeon will remove the stitches after 5-10 days.

Recovery period:

  • The patient should stay in Thailand at least 2-3 weeks to complete the whole process and allow proper healing and at least 1 week hospital stay for observation and management.
  • Patients can resume taking hormonal medications in 10-14 days after the surgery. Consult the doctor for adjustment of the dosage.
  • Patient can start vaginal dilatation 2 times a day for the first few of months about 1 hour each time with an adequate amount of lubricant. Vaginal stents typically range in size from about 1-1/8 to 1-1/2 inches or more in diameter (28 to 38 mm), and must be inserted to full depth (4 to 6 inches or more). 
Possible risk and complications:
Patients must keep in mind surgeon’s instructions to prevent potential risk and complications following surgery. Possible complications include: Hematoma (bleeding), delayed wound healing, swelling, scarring and numbness or change in sensation, infection, hypertrophic scarring, partial or complete flap necrosis, intra-vaginal hair growth, recto-vaginal fistula.

Anesthesia use:
The procedure requires a general anesthesia.

Hospital admission:
You will be requested to sign in hospital consent form. Then you need five nights
admission to hospital for recuperation.

Requirements to have sex change surgery?
According to “The Harry Benjamin International Gender Dysphoria Association’s Standard of Care for Gender Identity Disorders “a patient must qualify on the following criteria prior to the surgery:
1.      Legal age of maturity in the patient’s nation. At least 18 years of age and will require permission from parents.
2.      At least 12 months of continuous hormonal therapy for those without medical contraindications. Patient should present a Hormonal therapy certificate.
3.      At least 12 months of continuous full time real life experience in a cross gender role.
4.      Patient should present a Certificate of recommendation from a qualified psychiatrist/psychologist dealing with transsexuals for the diagnosis of gender dysphoria.
5.      Physically fit for the surgery.

The goal of Sex reassignment surgery for Male to Female:
·        To create an erotic sensate area including clitoris, labia minora, labia majora and vaginal opening.
·        To achieve satisfactory vaginal depth.
·        To preserve orgasm during sexual intercourse.

Preparation before the surgery:

Criteria for approval are as follows:
  1. Letter of recommendation from a psychiatrist.
  2. Discontinued hormonal therapy at least 14 days prior to surgery. Hormones should be stopped before surgery to reduce the risk of thrombosis (blood clots).
  3. Physical check up prior to SRS. Laboratory test should be taken. It includes the following: CBC, HIV, FBS, Creatine, Urinalysis, Alkaline phosphatase, SGOT LDH EKG and chest x- ray. You can have your private doctor perform the physical examination and send the results via email.
4.      Patient must stop smoking 2-4 weeks prior to the surgery. Smoking interferes and delays wound healing process.
5.      Patients must stop taking medications such as anticoagulants (aspirin), anabolic steroids and supplements (Vit. E)  at least 4-6 weeks to prevent complicating medical factors prior to surgery.
6.      Assessment of the medical history and physical examination will be performed during the consultation with the surgeon as well as explanation of the course of surgery, recovery period, risk and complications.
7.      No intake of food or water 8 hours prior to surgery.
8.      The surgery usually takes 4-8 hours and is usually done through general anesthesia.
9.      Appointments should be one month prior to the date and time of the surgery.

One month before the surgery:
Prepare and Plan: Put your schedule together for the day before, day of, and first few days.
Appointment: should be one month prior to the date and time of surgery.
Preoperative tests: Make certain all test ordered (CBC, EKG, X-ray) by your surgeon MUST be completed at least 5 days before surgery and no more than 30 days before surgery.  Test results should be received by surgeon for clearance. If medical clearance is not yet received at the expected date of completion, surgery maybe delayed or cancelled.
Stop smoking: Smoking must be avoided for about 3-4 weeks prior to surgery, as nicotine interferes with circulation and will greatly affect healing process.
Stop taking medications: Avoid taking any medications such as hormones, anticoagulants, anabolic steroids and supplements at least 4-6 weeks to prevent complicating medical factors prior to surgery. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding.
Stop drinking alcohol: You will likely to be asked to stop drinking alcohol, a week before the surgery and throughout your recovery period.
Vital information: A preoperative visit or call is essential to review your health, your goals and any vital information including allergies and health considerations.

One week before the surgery:

Confirm your day of surgery: Review all orders and instructions and put your schedule together a few days before the surgery.
Continue to practice healthy habits: No smoking, no drinking alcohol and stop taking medications to ensure safety.
Relax: Get plenty of rest.  Anxiety is common over the thought of surgery, so don’t hesitate to contact our office.  We are here to support you and answer all of your concerns regarding surgery.

One day before surgery:

Pack your personal belongings for the day of surgery.
Nothing by mouth. No candy, gum or mints. Anything more than a small amount of water as needed for brushing teeth or swallowing medication may result in the need to cancel surgery.
Dress appropriately:  do not wear jewelry, hair clips, body piercing, cosmetics.  (If there is something you cannot remove, let the admitting nurse know right away)
Wear comfortable, clean, loose- fitting clothing: Do not wear jeans or any tight fitting bottom; rather have a pair of loose, drawstring sweatpants to wear home. You may wear a robe. Wear slip on, flat shoes with a slip proof sole; no heels. Wear clean cotton socks as the operating room can feel cool.

During the surgery:
·        Appointment for consultation with the surgeon. The discussion will be regarding medical health history as well as the explanation of the course of surgery, recovery period, risk and complications. Don’t hesitate to ask questions for clarification and the technique to be used for SRS.
·        Routine Physical examination
·         Admission to hospital
·         Singing of informed Consent for legal purposes.
·         The operation date and time will be arranged within twenty-four hours after Preoperative consultation.
·        During surgery, your vital signs will be watched closely.
·        Patches containing leads for monitoring your heart will be placed on your chest. .
·        After your surgery, you will be taken to a recovery area where you will stay for about an hour.
·        A nurse will closely monitor you as you wake up from the anesthesia, checking your vital signs frequently.
·        If you feel pain, ask your nurse to give you pain medication.
·        Once you are awake and your vital signs are normal, you will be taken to your own hospital room and your family will be able to visit you there.
·        You will be discharged from the hospital as soon as your surgeon believes that you are ready and are not experiencing any complications from the surgery or anesthesia.
·        Genital electrolysis must be done prior to SRS to prevent hair in and around their new vagina.
·        Please remember that the effects of the anesthesia medications go away very slowly. Do not plan on doing anything important the day of or day after your surgery. You will feel drowsy for hours after your surgery. For these reasons, you MUST NOT drive a car, work with machinery, or sign any important papers for at least 24 hours.

It is important that you follow the written instructions given to you when you are discharged.

For more information about the procedures you may contact International Marketing Coordinator: osias05@hotmail.com or call   mobile phone: +66816572522, Tel: (662) 753-9206

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