Sex Change (SRS)
BCOSS doctors have developed a sex change technique called the Bangkok technique with the following details that make the outstanding result not just the cosmetic appearance, but also better functional result.
1. Dorsal Neurovascular Glans Penis Preputial Flap
2. Secondary Sexual Sensated Organ
3. Single stage with complex of scrotal-penile flap and scrotal skin graft that can make promisable depth of neovagina and full length of vagina can create by all scrotal skin graft.
4. Long posterior scrotal skin flap is designed to give thick sensated posterior wall of vagina. When compare between graft and flap on rectal wall, scrotal flap produce soft sensation and more elastic than skin graft during sexual arousal period. The scrotal flap can give more width and length of neovagina during sexual intercourse period while retract to be narrow and shallow during normal period (the same as female vagina) Moreover, the posterior sensated scrotal flap can facilitated orgasm though its own sensation that was preserved and by transmit the sensation to anterior rectum wall that is the organ that involve orgasm complex
5. Clitoris From glans penis with intact sensory nerves and vessels
6. Vestibule of Vagina between the Labia Minora and urethral flap to look similar to female vestibule from glans penis with intact sensory nerves and vessels.
7. Narrow neurovascular flap to create narrow hood of critoris and to look as close as genital female
8. Thin pedical flap sensate clitoris technique: The Doctor makes the neo-clitoris by keeping sensory nerves as close as possible. Doctor also keeps neurovascular pedicle as small as possible without having excess fascia, which produces a natural look.
9. Clistoroplasty, uses the top skin of the glans penis
10. Sensate inner labioplasty. The penile skin that surrounds glans penis looks similar to skin of inner labia, but thinner and more flaccid.
We use the skin of the glans and prepuce, with all nerves and blood vessels uncut. The penile skin that surrounds glans penis looks similar to skin of inner labia, but is thinner, and more flaccid. This cannot be used for the whole inner labia. The doctor uses two types of skin to create inner labia look more natural. The outer part is from scrotal skin, and inner part is from prepuces, which can sense just like neo-clitoris.
G spot of neovagina is combination of sensated labia minora, critoris, remnant of urethral flap between dissection. The cavity will be created just beneath the capsule of prostate gland that will lie over the penile skin. During dilation of neovagina you can feel sensated prostatic capsule. This complex of sensated 5 organ can create sensitive neovagina.
Long urethral flap technique: The doctor uses middle area of the outside, and above the urethral opening to create a urethral mucosa, which is smooth, lubricated, varnish, and in pinkish color close to natural appearance.
The labia minora which are anterior enough to cover the clitoris, uretha, and vaginal cavity (as in genetic women).
Labia minora which can be stretched manually (as in genetic women).
Pink or red colour of the inner surface of labia minora (as in genetic women).
Complete anatomic homology between the reconstructed neovagina and the natal female genitalia.
The fenulum which extends below the clitoris and which is continued to both sides of the labia minora (as in genetic women).
The advantage of Bangkok Technique
1. One stage procedure.
2. A more aesthetically pleasing and natural looking vagina.
3. Less skin hanging below the urethral opening from too large size inner labia.
4. Enhanced vaginal depth approximately 5-7 inches.
5. Less recovery time; 2-3 weeks after surgery.
6. More elastic vaginal wall with sensate G-spot at posterior and anterior vaginal wall.
Criteria of patients that suitable for Bangkok technique
2. penis is longer than 5 cm
3. has enough scrotal skin to raise scrotal flap
Nowadays the techniques of MTF surgery that has been done are
1. Penile skin inversion
2. Penile skin inversion with scrotal skin graft
3. Penile skin inversion with donor skin grafts from the abdomen, waist, thighs, buttocks
4. rectosigmoid colonvaginoplasty (primary)
5. rectosigmoid colonvaginoplasty (secondary)
6. delayed scrotal skin graft
Bangkok technique is the development of the second technique that add the width of vagina with scrotal flap and add the depth with all renant of scrotal skin graft