MTF Sex Reassignment Surgery / Sex Change in Bangkok, Thailand
Penile Peritoneum Vaginoplasty / PPV
The Penile Peritoneum Vaginoplasty, commonly referred to as the PPV, is the newest and most advanced technique in vaginoplasty gender affirmation surgery. The peritoneum is a tissue that lines the abdomen and is the closest in function and texture to the actual lining of the vagina. The peritoneum tissue is elastic, self-lubricating, and has no associated smells or odors. The PPV technique uses a small amount of penile inversion for the entrance of the vaginal entrance, combined with the peritoneum to create the neo-vaginal canal. The procedure is performed laparoscopically (small incisions, practically no visible scarring).
Although relatively new as a gender-affirming surgery, the PPV technique has been successful for decades in the treatment of MRKH syndrome, a congenital condition where girls are born without a vaginal canal.
The surgical team, led by Dr. Kamol, is the world’s leading specialist in the PPV technique and has performed more than any other hospital. Kamol Cosmetic Hospital, making dreams a reality.
Advantages of Penile Peritoneal Vaginoplasty / PPV
- This technique can be used as a primary or secondary neovagina reconstruction. This technique is beneficial for patients who have previously undergone sex reassignment surgery, penile inversion whose vaginas have developed a loss of depth and are unable to perform sexual intercourse, or for those who want an “upgrade” to a more natal functional vagina with less maintenance.
- The vagina has a self-natural lubricant.
- The vagina is elastic.
- Hairless neo-vagina
- Fewer risks of intestinal dysfunction compared to the sigmoid colon vaginoplasty.
- Negligible scar due to the laparoscopic (keyhole) technique. There are only four tiny, virtually undetectable scars from the keyhole surgery. They look like tiny freckles and fade after 12 months to be more or less invisible.
- Peritoneal pulled-through has been performed on cis-gender girls for over 40 years and is well understood.
Disadvantages and limitations Penile Peritoneal Vaginoplasty / PPV
- The patient may experience dyspepsia/indigestion symptoms 1-2 weeks after the surgery.
- In a few weeks, the patient may experience a temporary bowel habit change, such as a change in the frequency of mucous defecation, constipation, or back pain (LAR-liked syndrome: low anterior resection-like syndrome).
- This technique is not suitable for those who are overweight or have fatty abdomen as Internal fat can cover the peritoneum, making surgery very difficult.
- In a circumcised or very short penile skin individual, the surgeon may use the hairless scrotal skin for the vaginal entrance reconstruction. Therefore, the patient may need scrotal laser hair removal for at least 6 months preoperatively or intraoperative electrolysis.
- Initial dilation can be painful for a few weeks due to over-sensitive of the peritoneum.
- If dilation isn’t maintained, the vagina can quickly lose depth.
- Postoperative intraabdominal adhesion can happen in approximately 1-2%.
- Due to the new technique for transgender women and no long-term study, a candidate for surgery needs to accept all possibilities of unlikely rare complications of this method.
- The patient needs hair removal around 5x6 cm at the base of the penis, as in picture 1.
- In a complicated case, the patient might be able to convert to a sigmoid colon.
Picture 1. Shows the area of the hair removal
Getting to know for Penile Peritoneal Vaginoplasty
Comparison between PPV and Colon Vaginoplasty
Penile-peritoneal vaginoplasty (PPV) and Sigmoid colon vaginoplasty are two surgical procedures used to construct...
Why upgrade to PPV?, penile peritoneum vaginoplasty
There are several reasons why a patient may choose to have a revision or "upgrade" surgery for their neovagina:
Limitations of Peritoneal vaginoplasty (PPV)
PPV is a surgical procedure used to create a functional and aesthetically pleasing vagina individuals born
Video : Our testimonials for Penile Peritoneal Vaginoplasty
Why is Kamol Cosmetic Hospital a world leader in Penile Peritoneum Vaginoplasty SRS-PPV?
Kamol Cosmetic Hospital is a leading provider of gender confirmation surgery, known for achieving consistently excellent results. Our modern hospital is equipped with state-of-the-art technology and techniques, including the advanced SRS-PPV method performed by a specialist abdominal surgeon in collaboration with a plastic surgeon. This technique is not widely available as it requires a specialized skill set and may not be as profitable for other surgeons who prefer to use older, less effective methods.
Our surgeons are highly skilled and experienced. In particular, Dr. Kamol's technique for SRS involves hiding scars in the labia, resulting in a natural, cisgender appearance. With Dr. Kamol, you can choose the desired appearance of your vulva/vagina within reason. Kamol Cosmetic Hospital is committed to providing our patients the best care and results.
Penile inversion vaginoplasty is a technique that can be used to reconstruct a neovagina as a primary or secondary method. It is particularly beneficial for patients who have undergone sex reassignment surgery and have experienced a loss of depth in their vagina or for those who want a more functional and low-maintenance vagina. This technique has several advantages, including a natural self-lubricating mechanism, fewer risks of intestinal dysfunction compared to the sigmoid colon, and minimal scarring. We use a laparoscopic or keyhole surgery approach, which leaves only four small spots on the abdomen that are barely visible.
Accredited by the Joint Commission International (JCI), the gold standard in global healthcare, Kamol Cosmetic Hospital is a trusted destination for gender confirmation surgery.
Frequently Asked Questions (FAQs)
A: Penile Peritoneal Vaginoplasty (PPV) is a type of vaginoplasty that combines penile inversion with peritoneal lining grafts to create a vaginal canal. The peritoneum, a thin, self-lubricating tissue from the abdominal cavity, is used to help form a deeper, functional vagina with potentially better long-term moisture and elasticity.
PPV is often chosen by patients who have limited donor tissue or who want an alternative to full-depth penile inversion or colon vaginoplasty.
A: Peritoneum Vaginoplasty (PPV) is a surgical technique used to create a neovagina (a new vagina) using the peritoneum, which is the membrane lining the abdominal cavity.
It's a method commonly chosen by individuals undergoing gender affirmation surgery, providing both depth and self-lubrication.
A: PPV has several advantages that make it a preferred choice for many:
- Self-Lubrication: The peritoneal tissue naturally produces lubrication, reducing or eliminating the need for artificial lubricants.
- Good Depth: PPV often allows for the creation of a neovagina with sufficient depth for comfortable sexual intercourse.
- Aesthetically Pleasing Results: The resulting neovagina often has a natural appearance.
- Reduced Need for Skin Grafting: In many cases, PPV can avoid the need for skin grafts from other parts of the body, reducing scarring elsewhere.
A: The best way to determine candidacy is through a consultation, but here's a general overview. Ideal candidates typically:
- Desire Vaginoplasty: You should be sure that you want to undergo the procedure.
- Are in good health: General fitness for surgery is crucial. Existing medical conditions need to be well-managed.
- Have realistic expectations: Understanding the procedure’s capabilities and limitations is vital.
- Are psychologically prepared: A sound mental state and understanding of the long-term commitment to aftercare.
- Undergo hormone therapy: Often, some period of hormone therapy will be beneficial prior to the surgery.
A: The initial consultation is an important step. During your consultation, we'll:
- Review your medical history: This helps us understand any potential risks or complications.
- Discuss your goals and expectations: We want to know exactly what you hope to achieve with the surgery.
- Perform a physical examination: This helps us assess your anatomy and determine the best surgical approach.
- Explain the procedure in detail: We'll walk you through every step of the process, from pre-op preparation to post-op recovery.
- Answer all of your questions: We want you to feel fully informed and comfortable with your decision.
- Address risks and benefits: We will openly discuss both the positive aspects of PPV and its possible risks.
A: Preparation is key to a successful outcome. Before surgery, you'll need to:
- Undergo medical evaluations: Including blood tests, EKG, and chest X-ray, as needed.
- Stop smoking: Smoking impairs healing and increases the risk of complications. Ideally, you should quit several weeks before surgery.
- Avoid alcohol and certain medications: These can interfere with anesthesia and increase the risk of bleeding.
- Follow pre-operative instructions carefully: This includes dietary restrictions and hygiene protocols.
- Aftercare plan: Arrange for someone to help you during the initial recovery period.
A: While specific details can vary, here’s a general outline of the procedure at Kamol Hospital:
- Anesthesia: You'll be placed under general anesthesia.
- Incision: An incision is made, typically in the lower abdomen or perineum.
- Creation of space: A space for the neovagina is created between the bladder and rectum.
- Peritoneal flap: A flap of the peritoneum is carefully dissected and used to line the neovaginal space.
- Clitoris and Labia Formation: The clitoris and labia are created using existing tissue to create a natural appearance.
- Closure: The incisions are closed with sutures.
- Dressing and Packing: A dressing and packing are applied to support the neovagina during initial healing.
A: Recovery takes time and patience. Here's a general timeline:
- Hospital Stay: You'll typically stay in the hospital for several days after surgery for monitoring and pain management.
- Pain Management: Pain medication will be prescribed to manage discomfort.
- Swelling and Bruising: Expect swelling and bruising in the surgical area, which will gradually subside.
- Wound Care: You'll receive detailed instructions on how to care for your incisions to prevent infection.
- Dilation: Regular dilation is crucial to maintain the depth and width of the neovagina.
- Activity Restrictions: You'll need to avoid strenuous activities and heavy lifting for several weeks.
- Follow-up Appointments: You'll have regular follow-up appointments with the surgeon to monitor your progress.
A: Dilation is a key part of the post-operative care. It involves using dilators of increasing sizes to keep the neovagina open and prevent it from closing. It's essential for maintaining depth and width.
Neglecting dilation can lead to narrowing or closure of the neovagina, which would require further surgery to correct.
A: Dilation is a long-term commitment. In the initial months after surgery, you’ll need to dilate several times a day. Over time, the frequency can be reduced, but you will likely need to continue dilating indefinitely to maintain the vaginal opening. The exact schedule will be determined by your surgeon based on your individual healing process.
A: As with any surgery, PPV carries potential risks, including:
- Infection: Infection is a risk with any surgical procedure. We take precautions to minimize this risk.
- Bleeding: Excessive bleeding can occur during or after surgery.
- Hematoma: A collection of blood under the skin.
- Wound Healing Problems: The incision may not heal properly.
- Fistula: An abnormal connection between the neovagina and rectum or bladder.
- Vaginal Stenosis: Narrowing of the vaginal opening. This is why dilation is so important!
- Loss of Sensation: There may be changes or loss of sensation in the neovagina.
- Bowel Injury There is a risk of damaging surrounding structures such as the bowels during the operation.
- Anesthetic Risks: Complications related to the general anesthetic.
- Need for Revision Surgery: Additional surgery may be needed to correct complications or achieve the desired result.
A: This depends on individual needs and the complexity of the procedure. We recommend scheduling a consultation to receive a personalized cost estimate. We're committed to providing transparent pricing and will discuss all costs upfront.
A: We’re committed to providing comprehensive aftercare support, including:
- Detailed post-operative instructions: Covering wound care, dilation, and activity restrictions.
- Regular follow-up appointments: To monitor your healing progress.
- 24/7 access to our medical team: In case of any concerns or emergencies.
- Nutritional Support: Recommending dietary advice to best improve recovery outcomes.
A: Kamol Hospital is a world-renowned center for gender affirmation surgery, offering:
- Experienced Surgeons: Our surgeons are highly skilled and experienced in performing PPV, with a proven track record of success.
- State-of-the-Art Facilities: We use the latest technology and techniques to ensure the best possible outcomes.
- Compassionate Care: We provide compassionate and individualized care in a supportive and respectful environment.
- Comprehensive Support: We offer comprehensive support throughout your entire journey.
- Commitment to Excellence: We are committed to providing the highest standards of care and achieving outstanding results.
A: To schedule a consultation, please contact us through our website, by phone, or via email. Our patient coordinators will be happy to assist you in scheduling a convenient appointment.
