Male-to-female vaginoplasty: Preecha’s surgical technique

Abstract

The inverted peno-scrotal flap is considered the standard technique for vaginoplasty in male-to-female transsexuals. Nowadays, great importance is also given by patients to the reconstruction of the clitoro-labial complex; this is also reconstructed with tissue coming from glans penis, penile skin envelop and scrotal skin. Since the first sex reassignment surgery for biological males performed in Thailand in 1975, Dr Preecha and his team developed the surgical technique for vaginoplasty; many refinements have been introduced during the past 40 years, with nearly 3000 patients operated on. The scope of this paper is to present the surgical technique currently in use for vaginoplasty and clitoro-labioplasty and the refinements introduced at the Chulalongkorn University and at the Preecha Aesthetic Institute, Bangkok, Thailand. These refinements consist of cavity dissection with blunt technique, the use of skin graft in addition to the penile flap, shaping of the clitoris complex from penis glans and clitoral hood, and the use of the urethral mucosa to line the anterior fourchette of the neo-vagina. With the refinements introduced, it has been possible to achieve a result that is very close to the biological female genitalia.

Vaginoplasty in Male-to-Female Transsexual Surgery: A Training Concept Incorporating Dissection Room Experience to Optimize Functional and Cosmetic Results

“…In transsexual surgery especially, there is a lack of professional and public tolerance for suboptimal aesthetic and functional results [3–9,12–15]. As a result, the learning curve phases must be optimized.…”

“…In industry, measures of efficiency are easy to objectify and include criteria like production time, costs, quality control, etc. However, it is more difficult to assess a surgeon′ In transsexual surgery especially, there is a lack of professional and public tolerance for suboptimal aesthetic and functional results [3][4][5][6][7][8][9][12][13][14][15]. As a result, the learning curve phases must be opti-mized.…”

Vulvar condylomatosis after sex reassignment surgery in a male-to-female transsexual: Complete response to imiquimod cream

“…Some studies that evaluate HPV infection prevalence and its distribution in male anogenital sites, indicate that HPV detection among biological men is highest at the penile shaft, followed by the glans penis/coronal sulcus, and the scrotum, whereas HPV detection is lower in the perianal area, the anal canal and the urethra (Nielson et al, 2007). During male to female SRS using the inverted penile skin technique, the neovagina is covered with the skin of the inverted penis; the clitoris is constructed with a portion of the glans and its neurovascular bundle, labia minora with the prepuce, and the labia majora with the skin of the scrotum (Wangjiraniran et al, 2015). Considering that the tissue that is used during MTF-SRS are the most likely to be HPV positive, it could be possible to see an increase in vulvar condylomatosis and neovaginal dysplasia after SRS in the near future.…”

Description of the Baudet Surgical Technique and Introduction of a Systematic Method for Training Surgeons to Perform Male-to-Female Sex Reassignment Surgery

“…The first report of vaginoplasty was in 1930 by Dr. Kurt Warnekros, a gynaecologist from Dresden [1]. Subsequently many male-to-female sex reassignment surgical procedures have been performed using a penile-scrotal flap, a reversed penile flap or a pedicled intestinal segment, any of which could result in an adequately functional vagina [2][3][4][5][6][7][8].…”