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Sex reassignment surgery SRS , also known as gender reassignment surgery or bottom surgery, is a set of plastic and reconstructive surgical procedures with the aim of making the genitalia of the patient congruent with their gender identity. In the MtF case this means transforming the male genitalia with which the patient was born into an aesthetically accurate and functional vagina; under the care of an expert surgeon, normal urination, minimal scarring and the preservation of erogenous sensitivity can all be achieved. Male to female sex reassignment surgery is a set of complex operations such as the orchiectomy, clitoris reconstruction, labia majora and minora reconstruction, mons pubis creation and vaginoplasty which are often bundled together in what is known as sex reassignment surgery or primary vaginoplasty ; in some cases, the labiaplasty and mons pubis creation might happen some months after the vaginoplasty procedure as well as the orchiectomy might be executed some months in advance. Since ancient eras we have documentation about radical procedures on male genitals, obviously far from being modern surgeries, and about the role that these persons, known as eunuchs, had among the different societies throughout history. The first modern surgery of this kind was performed in Germany in , along with the transplant of the uterus and one ovary, but it ended with the death of the patient 3 months post-op. The news was widely reported by the media and Christine Jorgensen became world famous and an activist and advocate for transgender rights; thanks to her, many transgender individuals became aware of the medical and surgical options available to them, giving hope to those suffering from gender dysphoria and propagating the knowledge in the field of transgender medicine and surgery.
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Dr. Suporn Watanyusakul MD – Chonburi

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Vaginoplasty Modifications to Improve Vulvar Aesthetics

There are a number of techniques available, however most surgeons perform a highly-modified variant of the original penile skin inversion technique, which can be done in a single stage with hours spent under the knife. If you started to transition early during male puberty, or your junk is very small even when erect, the sigmoid-colon technique may be a better option, and can also be done a single stage. See vaginoplasty for a deep discussion of techniques. Techniques outside of these two are either very old e. Different doctors have their own recommendations and methods to prevent hair growth inside the vagina post-op. The graft Dr. Chettawut uses for the inside of the vagina does not contain any hair, and although the grafts that become the vulva often do contain hair, chettawut recommends that most hair removal is left until after surgery so that any damage to the skin it might cause wont affect healing.
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Vaginoplasty Modifications to Improve Vulvar Aesthetics

Improvements to vulvar aesthetics, particularly the clitoral complex and labia minora reconstruction, are difficult and remain the challenge of genital reconstructive surgeons. Various modifications of penile inversion technique have been introduced to improve vulvar aesthetics in recent years. Generally penile inversion vaginoplasty leaves limited penile tissue to reconstruct the natural labia minora. This article describes improvements made to overcome substantial limitations of the widely used traditional penile inversion vaginoplasty technique, with emphasis on creating a realistic vulvar aesthetic appearance in all respects, without compromising sexual sensation or vaginal depth.
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Suporn Watanyusakul is a Thai plastic and reconstructive surgeon. He is considered by some to be a world leader in surgical procedures for transgender individuals. He instead constructs the vaginal canal with scrotal skin and uses the penile tissues for the labia, clitoral hood, and other external features. A full thickness inguinal groin crease skin graft is used for the vaginal lining in cases where inadequate scrotal skin is available.
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