Penile Peritoneum Vaginoplasty Surgery in Thailand

The penile peritoneum vaginoplasty (PPV) is an advanced technique used in gender affirmation surgery. This procedure utilizes the peritoneum, a tissue that lines the abdomen, to create a neo vaginal canal. The peritoneum is similar in function and texture to the actual lining of the vagina, being elastic and self-lubricating. Additionally, it does not produce any smells or odors. The PPV technique involves a small amount of penile inversion for the entrance of the vaginal canal and is performed laparoscopically, resulting in minimal scarring.

The advantages of PPV surgery include the following:
1. PPV surgery can be used for primary and secondary neovagina reconstruction. It is beneficial for patients who have previously undergone sex reassignment surgery and have experienced a loss of depth in their vaginas. It is also helpful for those seeking an upgrade to a more functional vagina with less maintenance.
2. The neo vagina created through PPV surgery is naturally lubricated, elastic, and hairless.
3. There are fewer risks of intestinal dysfunction in PPV surgery compared to sigmoid colon vaginoplasty.
4. The laparoscopic technique used in PPV surgery leaves only 4 tiny, virtually undetectable scars. These scars resemble small freckles and become less visible after 12 months.

Prior to the procedure, it is essential to carefully evaluate all potential drawbacks and associated risks.
1. After the surgery, patients may experience indigestion symptoms, such as dyspepsia, for 1-2 weeks.
2. Temporary changes in bowel habits, such as mucous defecation, constipation, or back pain, may occur in the weeks following surgery.
3. In individuals with circumcised or short penile skin, scrotal skin may be used for vaginal entrance reconstruction, necessitating preoperative or intraoperative hair removal.
4. Initial dilation may be painful for a few weeks due to peritoneal sensitivity. Failure to maintain dilation can result in rapid loss of vaginal depth.
5. Postoperative intraabdominal adhesions occur in approximately 1-2% of cases.
6. Hair removal of approximately 5×6 cm at the base of the penis is necessary.
7. In complex cases, conversion to sigmoid colon may be required.

This surgical procedure is a valuable option for patients with limited alternatives. This includes patients who require a revision surgery, nonbinary patients who do not desire a penectomy, patients who have experienced trauma in the area, patients with insufficient skin from the penile shaft and/or scrotal donor sites, and patients who have been on puberty blockers.
Additionally, it is important to note that this technique is not suitable for individuals who are overweight or have excess abdominal fat, as it can hinder the surgery’s effectiveness.
It is crucial to acknowledge that the new technique for transgender women has not yet undergone long-term studies, and therefore candidates for this surgery must be willing to accept the unlikely rare complications that may arise from this method.

Proper preparation is crucial for a successful outcome in surgery. To ensure this, patients should adhere to the following guidelines:
– Refrain from consuming water and food for at least 8 hours prior to the surgery.
– Abstain from taking any vitamin supplements for a period of 2 weeks before and after the surgery.
– Avoid using hormone supplements for 2 weeks prior to the surgery.
– Quit smoking for a minimum of 1 month before and after the surgery.
– Provide 2 certified documents from psychologists prior to the surgery.
– Prepare by cleaning and shaving the pubic area before the surgery.
– It is necessary to have an assistant on the day of surgery, and driving should be avoided.
– Inform the surgeon about any underlying diseases, medications being taken, or history of allergies.

After undergoing PPV surgery, the patient will remain in the hospital for a few days. On the fourth day, the doctor will remove all dressings, urinary catheter, and drainage, and will also provide instructions on vaginal dilation. If there are no complications, the patient will be discharged from the hospital.

For a successful recovery after sex reassignment surgery with the PPV technique, the patient should rest for one month for the first operation and two weeks for reconstructive surgery. During the healing process, it is important to abstain from smoking and alcoholic drinks for one month before and after the surgery. Additionally, avoid engaging in any strenuous exercise or activities, including sexual intercourse, for two months after the surgery. Hormone supplements should be avoided for two weeks following the procedure.