Penile Peritoneal Vaginoplasty (PPV SRS)
Penile Peritoneal Vaginoplasty is a cutting-edge male-to-female procedure for Sex Reassignment Surgery. This gender-affirming surgery is only performed by a handful of hospitals around the world, including Transgender Thailand's partner hospitals.
For these types of vaginoplasty procedures, peritoneal tissue from the abdomen is used to create the vagina as it is most similar to vaginal tissue in the human body. It is elastic and self-lubricates like a cisgender vagina and it doesn’t require regular dilation.
PPV surgery or sexual reassignment surgery also has the least amount of pain among various gender transition procedures. Flap vaginoplasty also has the least risks and the fastest overall recovery time. This male-to-female sex transition surgery is widely recognised as the procedure with the most advantages and better outcomes and is often recommended for people who want to live by their self-identified gender identity. In some cases, it can also be performed as reconstructive surgery for patients with vaginal agenesis.
Vaginal Agenesis is a rare disorder that occurs when the vagina and the uterus don't fully develop.
How does gender reassignment surgery help in alleviating gender dysphoria?
Gender dysphoria or gender identity disorder occurs when a transgender patient is distressed because their body is the opposite gender of their self-identified gender expression.
Gender reassignment surgery is a medical and surgical treatment that could help transgender men and transgender women live confidently in a body aligned to their gender identity.
Surgical Treatment Procedure
For Penile Peritoneal Vaginoplasty procedures, penile inversion is done alongside a peritoneum pull-through procedure that creates a vaginal canal. This technique for creating a vaginal canal isn't new. It has been utilised by cisgender women for over 60 years.
Penile inversion vaginoplasty is also called the Davydov procedure, which was used as a treatment for girls born with the congenital defect called “MRKH Syndrome” or being born without a vaginal canal. This syndrome affects roughly 1 in every 4,500 girls.
For MRKH syndrome patients, peritoneal tissue is used to make a vaginal canal connect the vulva to the womb. Several months following the Davydov procedure, this peritoneal tissue is almost identical to vaginal tissue. For male-to-female surgery for trans women, the outer vagina (including labia and vaginal opening) is made with penile and scrotal skin, while the inside of the trans vagina and vaginal canal are made with peritoneal tissue. The outcome is closer to a cisgender vagina. Not only the Penile-Peritoneal vaginoplasty procedure is highly advanced with good outcomes, but it's also a good option for patients who need revision surgery if they previously underwent sex reassignment surgery and were not satisfied with the results. Penile Peritoneal Vaginoplasty techniques also work as an added surgery for trans female patients who seek a more functional vagina.
Advantages of SRS-PPV
- The penile inversion technique provides vaginal elasticity comparable to a cisgender vagina.
- Vagina has self-lubrication capabilities without any unpleasant smells.
- The penile inversion technique has minimal chances of vaginal prolapse and shrinking.
- Peritoneal Pull-Through Procedure (Davydov technique) has a faster recovery time.
- These types of surgical techniques have significantly fewer risks in comparison with other MTF transition procedures.
- Peritoneal Pull-Through procedure leaves no visible scarring from surgery.
- MTF vaginoplasty gives patients less pain than other surgeries.
- This type of penile surgery is able to mimic vaginal functionality better than other male-to-female bottom surgery techniques.
- The penile inversion technique is a tried and tested method that has been utilised for over 60 years.
- Penile Inversion Vaginoplasty has a reduced risk of intestinal issues and intra-abdominal organ injury than sigmoid colon vaginoplasty / sigmoid vaginoplasty.
Disadvantages of SRS-PPV
- Some patients may suffer from indigestion/dyspepsia for up to 3 days post-procedure.
- Penile inversion surgery is unfortunately not available for patients who have a fatty abdomen or are overweight as these patients are not ideal for laparoscopic procedures (keyhole surgery).
- A gender confirmation surgery patient must undergo hair removal covering around 5x6cm at the base of the penis.
- In rare complicated cases, a surgeon may have to convert to open procedures or sigmoid colon neovagina surgery to complete a vaginoplasty procedure.
Requirements of SRS-PPV
- This sex reassignment surgery requires a minimum hospitalisation of 7 days.
- Approximately 6 hours for this gender affirmation surgery.
- Preferably vaginoplasty patients will be asked to stay in Thailand for up to 3 to 4 weeks to ensure a full recovery. Most facilities have accredited hotels located near the hospitals for the patient's convenience.
Sexual Sensation and Function Post Procedure:
An important consideration and discussion about this gender confirmation surgery is the sexual functionality of the surgically created vagina. A large part of this is dependent on sensation, which is determined by the number of nerve endings in the sexual organs. In male and female sexual organs, there are around 8,000 different nerve endings.
With the PPV procedure, the surgeon's goal is to carefully find and preserve as many nerves as possible and to create sexual arousal points in the neo-vagina. These arousal points include the neo-clitoris, the inner sides of the labia minora, the bilateral ridge of the neo urethral plate that is created from the skirt of the glans penis, and the bulbourethral glands in front of the prostate.
The final sexual arousal spot is the G-spot low on the prostate glands which also have sensory nerve endings. The surgeon places the created vagina very near the prostate gland surface.
If the surgeon is successful, the newly created vagina should have significant nerve endings and preserve the sensations of the organ needed for sexual function.
Questions To Ask Plastic Surgeons Before Gender Affirmation Surgery in Bangkok, Thailand
Dedicated plastic surgeons will take care to answer every question that a patient may pose before and after performing any procedures. It is often advised for a patient to list the questions on a paper in advance of the consultation.
Some key questions to ask surgeons before sex reassignment surgery include:
- Are you a board-certified plastic surgeon?
- How many years of experience do you have in cosmetic surgery?
- Do you have specific experiences with gender reassignment plastic surgery, such as performing facial feminization surgery, gender-confirming surgery, breast augmentation surgery, vaginal reconstruction, penile preservation vaginoplasty, or recommending hormone therapy for transgender patients?
- Are the results I am seeking realistic?
- What are the methodological limitations of gender reassignment surgery?
- Will there be visible scarring?
- If so, until when would I need to take pain medication?
- What type of chin implants would be most appropriate to achieve my desired breast size?
- What is the treatment plan?Would I need to see a mental health professional after undergoing sex reassignment surgical procedures?
- Would this surgery help me live by my desired gender?