Male to female gender affirmation surgery

Male to female gender affirmation surgery, a.k.a. gender confirmation surgery, refers to the surgical process of creating female genitalia for individual assigned male at birth.

Common characteristics of patients undergoing gender affirmation surgery
Patients looking to undergo gender affirmation surgery must first have the following characteristics:
  1. Be aged 20 years old or above, or be at least 18 and have had permission granted by their legal guardians.
  2. Have received hormone therapy (estrogen) continuously for at least one year, whether in pill or injection forms.
  3. Have experience of living as a desired gender role continuously for at least one year.
  4. Have a diagnosis for either gender identity disorder or gender dysphoria from an expert physician and have an assessment as being in suitable mental health by at least two separate psychiatrists.
  1. Refrain from drinking and eating for at least 8 hours leading up to the surgery.
  2. Cease hormone medication for at least 2 weeks leading up to surgery in cases where that medication is in pill form, and for at least 4 weeks where injected form is taking place. However, the exact times for when these changes should take place are at the discretion of the doctor in charge of treatment.
  3. Doctors must be notified in advance if patients take any regular medication to treat underlying health conditions.
  4. Halt any drugs or herbal medicine that increase bleeding risk for 2 weeks leading up to surgery.
  5. Avoid smoking and drinking alcohol for 4–6 weeks leading up to surgery.
  6. Patients will need to request around 3-4 weeks off from work, which will be spent preparing for and then recovering from surgery.
  7. Those who have tested positive for HIV should ensure their CD4 levels are stable prior to surgery.
  1. Penectomy whereby the tip of the glans penis is kept for use as the patient’s new clitoris and labia minora to maintain sexual arousal.
  2. An orchiectomy to halt sperm and male sex hormone production.
  3. Vaginoplasty which commonly takes either of the following two forms:
    • Penile skin inversion and scrotal skin flap technique, which utilizes the existing nerve system to enable sensitivity in the neovagina.
    • Sigmoid colon technique.
  4. Feminizing genitoplasty; creating a labia majora from the patient’s existing genitalia and shortening their urinary tract.
The following advice should be adhered to following this procedure:
  1. Patients will have a catheter fitted to prevent closure of the newly created opening and enable them to urinate comfortably without disturbing the surgical wounds.
  2. A special device used to expand the vaginal cavity should be used regularly as directed by the doctor once the post-surgery protective gauze has been removed as this will prevent stenosis and ensure sufficient depth.
  3. A sanitary pad should be used as there may still be some bleeding for the week following surgery.
  4. Stitching will be removed 7–10 days following surgery.
  5. The start time and dosage for any hormone will be carefully managed by the medical team.
  6. Patients should rest for around 3–5 weeks. Healing process is likely to fully completed after approximately 6 months.
  7. Sexual intercourse is possible once the wound has healed, which usually takes approximately 6–8 weeks.
Similar to other forms of surgery, this procedure carries with it the risk of various complications and side effects, as follows:
  • Delayed or non-healing. Every genital procedure requires stitching of several tissue parts, each carrying its own risk of separation. However, such an occurrence can also be caused by improper post-surgery care or engaging in sexual intercourse before it is recommended to do so.
  • In adequate neovaginal size or depth, which can be caused by any of the following: inadequate sizing of the neovagina, pre-existing narrowing of the pelvic floor, or an insufficient amount of skin for use in creation of the neovagina. Such issues can be prevented with experienced surgical team and careful planning to ensure the procedure selected suited the individual. Vaginal stenosis is most likely caused by inadequate use of dilators as directed postoperatively.
  • Urethral stricture resulting from a membrane forming in the vaginal opening.
  • Vaginal perforation into the abdomen or colon, which can result from improper post-surgery care or improper use of the neovagina. However, this is a rare occurrence if the surgery is performed by experienced, well-trained professionals and where patients adhere strictly to post-surgical advices.
  1. Patients with underlying health conditions should consult their primary physician before traveling to hospital to ensure they are fully prepared and have sufficient medication with them.
  2. Patients under 20 must have documents providing permission from their legal guardian.
  3. Patients traveling from overseas should make plans to remain in Thailand for at least 4 weeks.
  4. Patients with plans to travel after the procedure should consult the doctor in charge of treatment before making any bookings.
  5. Patients will receive a medical examination on the day of their appointment and will then be provided with a ‘fit for travel’ medical certificate once they are discharged from hospital.

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