SRS Explained
My last post seemed to produce many more questions than I expected. Or different questions than I expected, at any rate. So I thought it might be a good idea to explain how my chosen form of surgery works when compared to others. Plus, it should have the added effect of calming me down.
To simplify things, there are three basic forms of vaginoplasty (the technical term for SRS) for trans women. I'll call them "Western Surgery", "Eastern Surgery" and "Colon Surgery", but to be fair, all forms can be found in any region of the world. They vary not only in cost and methods but also aesthetics and sensation results (those are fancy words for a realistic, orgasmic vagina). So I'll show you what's different about them and explain why I'm flying all the way to Thailand to get what's rightfully mine.
First things first, before you can even get the surgery there are several hoops you have to jump through first. You have to be of a consenting age in your country (18 in the States), one year of hormone therapy, one year of "real-life experience" and two letters from therapists (one of which must be have a PhD). Generally, to get those letters you need two years history with one of the therapists. You must also have a "demonstrable knowledge" of the ins and outs of surgery. Most interpret that to mean you must watch a video of the surgery take place and know about multiple surgeons. All of these are just the legal requirements. There's also physical requirements. Generally speaking, most surgeons won't work with HIV/AIDS infected patients and if they do they charge a lot more. You also need a full physical with blood work to demonstrate you're healthy enough to undergo anesthesia and most surgeons have a weight limit in the mid-200s mark. There's also the matter of hair removal in the "unmentionable" region so you don't have hair in your...well, moving on. Oh, and you need money. There's no payment program for this surgery. It's cash up front only.
I'll use Marci Bowers as an example of Western Surgery. When I first began to seriously research surgeons she was my first choice. Primarily because she's a fellow trans woman and a gynecologist. So I figured she would know better than most about what makes a good vagina. She practices what is commonly called "two-stage" surgery. The costs are astronomical, around 20K, which only rises when you consider travel, hotel, etc. Marci is famous, and her fee reflects that. As for the method, she has a variation on the original form of surgery. This is the inversion technique or the "turning the outie into an innie" procedure. To simplify, they take the birth defect, turn it inside out and place it into the pelvic region to create the vaginal canal. The clitoris is created by moving the most sensitive nerves and the outer vulva is created from scrotal tissue. It's been around for a long time and it works. The only problem is that's just the first step. In order to have labia and a clitoral hood you need to undergo "Labiaplasty". This bumps the cost up even more in order to have a realistic looking vagina. Here's an example of the results before labiaplasty. Her patients report positive sensation, which is really the most important aspect of the surgery in my opinion. After all, no vagina is perfect. But this traditional method places less sensation on the clitoris and labia and more in the vaginal canal. Which is a little less than accurate representation of a cissexual vagina.
Pros:
In the United States, less travel
Sympathetic surgeon
Good Sensation
Cons:
High cost
Two surgeries
Vaginal stimulation over clitoral
The least common and, quite frankly, least popular type of surgery is Colon Surgery, actually called Primary Colon Segment Vaginoplasty. The procedure is more or less the same as Western Surgery, however a segment of the Colon is used in order to achieve better depth rather than use skin grafts. This results in a self-lubricating vagina, which sounds like a great sales point until you learn self-lubricating means always lubricating. Sorry if that's TMI for you, it certainly wasn't a pleasant visual for me. The most prominent doctor who performs this type of surgery is Dr. Pichet Rodchareon of Thailand, though there are plenty of American and European surgeons who perform this same surgery. The cost with Pichet is around 10K, which is much cheaper than Bowers but can still require a second surgery for some patients. He's a hit-and-miss surgeon. A lot of girls love him and a lot of girls hate him. Personally, I don't like those odds. The fact that Pichet no longer allows pictures of his results is a pretty bad sign in my book.
Pros:
Lower cost
Self-lubricating
One-step (usually)
Cons:
More travel
Always lubricating
Mixed Results
My surgeon of choice is Dr. Chettawut Tulayaphanich (try saying that three times fast!) who's a great example of Eastern Surgery. I call this technique thus because it's much more common in Thailand and other Eastern countries. Dr. Chettawut's price is reasonable, around 10K not including travel and hotel expenses. And his method is much more accurate in terms of matching a cissexual vagina. Instead of using the birth defect to create the vaginal canal, the skin is used to create the clitoris and outer vulva areas, making these areas more sensitive. The vaginal canal is created by using scrotal tissue and, if needed, skin grafts. He also places the canal close to the pelvic bone and urethra, resulting in a g-spot (yes!) which most other surgeons cannot. Very rarely does he require a second surgery to fix the labia and he consistently has good results. I've yet to find a girl who was unsatisfied with her outcome. The results are some of the best I've seen. To top it all off, his staff cares for you at your hotel through the entire healing process and Thailand is a very accepting country when it comes to trans folk.
Pros:
Lower cost
Best sensation
Sympathetic staff
Consistent results
Cons:
More travel
The final step in all surgery is recovery. This involves "dilation", which is stretching the new vaginal canal out several times a day with a stent (a nice, medical word for dildo) for the first few weeks, slowly increasing the size of the stent and decreasing the frequency of dilation. Ultimately, the only dilation required after a year or so can be in the form of sex or masturbation once a week. This is one of my boyfriend's favorite "perks" of dating a trans girl. He'll get to use the line, "But honey, we have to have sex. It's prescribed by your doctor." Is he a lucky guy or what? There's also a need of douching once in a while. Like dilation this decreases in frequency over time. To add irony into the whole thing, I'll need maxi pads for the first few weeks until the bleeding and swelling go down. To quote Hedwig and the Angry Inch, "It's my first day as a woman, already it's that time of the month." And that plane ride back home will be enjoyed in a wheelchair and later on a donut pillow. Sounds like fun, right? But it's worth it.
Really, once I found Chettawut it was a no-brainer. My boyfriend and I are very excited about our upcoming trip, not to mention the fun we'll have after the fact. Hopefully that answered a lot of your questions but feel free to ask any more, I know I gave the super simplified version. Stay tuned for information about what my trip to Thailand and surgery might be like.