Male to female surgery, often called MtF transsexual surgery for M2F transformation or sometimes SRS surgery MtF, is done in one stage.
Male to female SRS surgery includes removal of male genitalia with simultaneous creation of female genitalia.
There are two basic techniques we use for creation of a new vagina.
Vaginoplasty using penile inversion technique is the procedure showcased in “The Skin I Live In” starring Antonio Banderas and Elena Anaya.
Elena is not a transsexual and the character she portrayed in the film was also not a Tgirl.
In the movie, the sexual reassignment surgery (SRS) was not done to solve gender identity disorder.
The doctor (Banderas) did it as a punishment to a natal male who had sex with his daughter, plus the surgeon was crazed over the suicide of his wife.
Male to female gender reassignment surgery (GRS) procedures are best done by a highly experienced and tremendously skilled urogenital reconstructive surgery at a highly specialized genitourinary center in order to get the best aesthetic and functional result.
Perovic vaginoplasty by means of penile inversion is male to female surgery that uses a superior, more advanced combination of penile skin and urethral flap.
Other surgeons do not use the urethral flap.
And plastic surgeons tend to emphasize appearance more than a lifetime of good sexual function for the patient.
If you have a normal penis size and you are UNcircumcised, then your penile skin is probably sufficient for creation of a neovagina using this technique.
The appropriate MtF transsexual surgery if you have LESS than average penis length is vaginoplasty using the rectosigmoid colon — a part of the bowel.
It is explained in our article specifically about that procedure.
That genital reassignment surgery is usually advisable if you are circumcised or your penile skin is insufficient for creation of a suitably deep MtF vagina.
However, vaginoplasty using the rectosigmoid colon is significantly more difficult and complex.
It takes more hours in surgery, requires the surgeon have greater skill and more advanced training, and costs more.
Many plastic surgeons, particularly in Asia, generally encourage patients to get penile inversion and let them discover later that it was not a very practical choice as so many people discover in “The Skin I Live In” .
Sava Perovic Foundation M2F patients can normally start having sexual intercourse 6-8 weeks after either type of male to female surgery.
Transgender sex change vaginoplasty using penile inversion to accomplish the male to female gender reassignment requires 5-6 hours of surgery.
The surgery is usually performed with epidural or spinal anesthesia but general anesthesia can be used depending on the patient’s preferences.
The male to female transition is done by careful disassembly of the penis to its basic components with complete preservation of vascularity (vessels that carry or circulate fluids, such as blood, lymph) as well as preservation of the sensitivity of all penile parts.
We consider erotic sensation and the the ability to have an orgasm as important as beautiful aesthetics and good quality of sexual life resulting from good function.
This male to female surgery also requires simultaneous creation of all parts of the female genitalia.
The clitoris is created by reducing the glans. The new labia minora is made from the inner preputial (foreskin) layer. The labia majora is created from a combination of penile and scrotal skin.
Deep and wide pelvic space for placement of the neovagina is created between the urethra, the prostate, the bladder in the front and the rectum in the back.
The new vagina is created by joining penile skin and the urethral flap.
It is very important to include urethral flap during this male to female surgery because it provides natural vaginal lubrication as well as excellent erogenous and orgasmic sensitivity.
Sava Perovic Foundation NEVER uses scrotal skin for creation of a vagina during any vaginoplasty.
Scrotal skin is hairy and prone to chronic dermatitis with an odorous discharge.
It’s an inferior choice for vaginal creation.
Dr Djinovic also simultaneously performs a bilateral orchiectomy, also known as transgender orchidectomy — the surgical removal of both testes.
If you want male to female surgery using penile inversion should stop taking hormones at least two weeks before surgery in order to decrease risk of deep veins thrombosis (blood clots).
You will have a face-to-face, pre-operative consultation and physical exam with Dr Djinovic in Belgrade the day before surgery. If:
- both you and the doctor and you find they have good mutual understanding;
- you have realistic expectations of what can be achieved by the surgery;
- both you and the surgeon agree to move forward with the surgery;
- you have your signed original letter on your psychiatrist's letterhead explicitly approving your surgery; you will then
- sign an informed consent form, and be
- admitted to the medical facility for preparation and dietary control.
The entire day before surgery only clear liquids are allowed to be eaten.
You will stay at the medical facility about five nights after surgery.
You will have a urethral catheter for 7-10 days until you start to urinate.
After checking out of the hospital, you will need to stay at a hotel or furnished apartment for another 3-4 more days while waiting for the final physical exam by Dr Djinovic.
Of course, if you can spare the time and stay longer you should.
Vaginal dilation is often necessary in order to avoid introital stenosis — constriction or narrowing of the vaginal opening and passageway.
About 7% of patients experience temporary stenosis of the vaginal introitus. In the majority of cases, this complication can be solved by dilations.
Occasionally, a small additional surgical procedure is required.