Jan 2020 lecture by Thai Surgeon showing internals of 4 types of SRS

48
u/HiddenStill
Thu Jan 30 12:53:16 2020 UTC
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(28 comments)

I expect this will interest a number of people. Among other things, at 6:23 there's a video comparison of inside of the vagina of a cis-women and skin graft, colonic flap, and peritoneal flap trans women.

Lectured by Worapon Ratanalert, MD, Department of Surgery, Faculty of Medicine, Chulalongkorn University and Thai Red Cross AIDS Research Centre Bangkok, Thailand in 22nd Bangkok International Symposium on HIV Medicine 2020 on January 15-17, 2020 at BITEC, Bangkok, Thailand

Youtube Post-operative care and neovagina care by HIV-NAT Thailand on 29 Jan 2020

I've not heard of this surgeon before, but he works at Chulalongkorn University which is where a number of top Thai surgeons trained in medicine.

At 4:17 there's a dilator with the words www.ladyboyshop.com on it, but the site doesn't seem to exist.

all 28 comments


17
u/darthemofan
Thu Jan 30 22:11:33 2020 UTC
(5 children)

Best part is at 13:26 about maintenance:

1) it suggest the use of acidyfying cream + introducing acidophilus

Any suggestion in the US?

2) it suggest HPV immunization: this is gardasil 9

I did it. plz do for your own safety.

9
Fri Jan 31 18:33:04 2020 UTC
(3 children)
  1. Given that BV is not uncommon among post-op trans women who had penile inversion, this makes a lot of sense, getting the pH balance and floral load right helps prevent BV. I don't know for the US, in Canada I'm going to use CanesBalance (lactic acid + glycogen) & I'm already taking an oral probiotic with 2 other strains L. rhamnosus (GR-1) and L. reuteri (RC-14). I'm looking at vaginal options too. There's a very promising probiotic suppository called Lactin-V that's in clinical trials, but that's a few years out still.
  2. Reminds me, I need to discuss this with my family doctor. I'm out of standard age range, but I really don't want throat, oral, anal, or vaginal cancer.
Fri Jan 31 22:08:37 2020 UTC
(1 child)

[deleted]

3
Fri Jan 31 22:24:45 2020 UTC
(0 children)

I should probably bounce the pH balance idea off of my care team before putting it into practice. Otherwise though, they're very much in favour of probiotics be it from yoghurt or supplements with data backing up their effectiveness.

1
Fri Jan 31 23:08:51 2020 UTC
(0 children)

Age is for refunding. If you pay you can get it

For the probiotic oral wont do much good

I'd try to stick it there lol

8
u/Kim_333
Sat Feb 1 12:42:27 2020 UTC
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(10 children)

Thank you for this.

Their results look really natural but there is a difference in looks between their PI technique and the newer technique.

With the new technique, the inner labia are formed by penile skin and are extended down around the entrance. The result can be a more natural look. So if there is enough material for the inner lining ( I have seen this also with scrotal skin ) they are able to form labia that go down all the way right from the start. US surgeons seem to be reluctant to use this kind of technique, possibly because it takes more time. People obviously were told that it is not possible because of the pressure of dilation afterwards but the pictures show that it is very well possible, and asking for this kind of technique if there is enough available material might be an idea. It may be necessary to talk through with surgeons if they can produce a result that withstands dilation but the surgeons in the vid have it solved. Hopefully more surgeons also offer this kind of look because imo it is an improvement.

the site doesn't seem to exist.

They seem to be hosted on a virtual system and there seem to be issues with binding it to their hostname / IP . Maybe they moved their server, and it will be resolved later.

Here is a picture of one of their dilators.

Here are the dilators from PAI,

and here are those from Kamol as example.

5
OP
Sat Feb 1 14:44:34 2020 UTC
(6 children)

Where is the first dilator example from?

The main thing about the website was the name. It seems wildly inappropriate from a western point of view, which no doubt goes to shop I don't understand Thailand very well.

3
Sat Feb 1 15:37:54 2020 UTC
(4 children)

Where is the first dilator example from?

Its from google cache :) The website seems to have been running a while ago.

In Thailand it can be a mix ... I have talked to a variety of people on a ladyboy forum that would range from what would be called crossdressers to transgender people who had SRS. People cannot change their gender marker there, so their social status is different than in the west. They may be seen as some kind of big group, and people seem to not be as aware as in the west concerning expressions. And people there imo are less restrained concerning sexual implications.

Do you have more info concerning the surgeons in the vid ? It would be nice if they would spread this technique, like Preecha did, who taught a lot of other surgeons.

2
OP
Sat Feb 1 16:03:33 2020 UTC
(3 children)

I added him to the wiki, but couldn’t find much

https://www.reddit.com/r/TransSurgeriesWiki/wiki/srs/thailand#wiki_worapon_ratanalert

It was a presentation by what looks like a reputable group, so I expect all the surgeons in Thailand who care about these things either know already or will in time. I might be able to find out more, but it would take a long time.

I added this too

https://www.reddit.com/r/TransSurgeriesWiki/wiki/srs/thailand#wiki_thai-path

3
Sat Feb 1 19:23:45 2020 UTC
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(2 children)

I might be able to find out more, but it would take a long time.

I don´t think its necessary.

The most important part is that there seems to be an affordable alternative in the making with reputable surgeons to the prices of US surgeons for this method. The prices otherwise are out of reach for most people who pay out of pocket.

This is what the Facebook of the Tangerine Clinic says .

"Consultation about sex reassignment surgery | Consultation to resolve cases of gender change, all types of problems | Consultation on general plastic surgery | Reserve a fast track surgery at Chula Hospital with us."

They also have a vid with a discussion about the peritoneal method there (in Thai ):

"Discussions about sex change using peritonitis with Apophun Pisamasuwajo"

So people who are interested might inquire with the clinic. It may also be an idea to talk about possible downsides, like a possible permanent lubrication, and therefore only using peritoneal tissue for a part of the inner lining.

And very important imo is also that it is possible to extend the labia down around the entrance. Hopefully many surgeons start to offer it as alternative. Until then it may be necessary to ask.

1
OP
Sat Feb 1 19:45:39 2020 UTC
(1 child)

I'd thought Tangerine Clinic was for local trans people in Bangkok. I'd previously only heard of them doing HRT, and had thought they were closed.

https://www.reddit.com/r/TransDIY/comments/dtdc3c/has_anyone_tried_tangerine_community_health/

2
Sat Feb 1 20:06:22 2020 UTC
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(0 children)

Well it doesn´t look like that. Their FB is up, the last vid was uploaded on Jan. 14th, and the photos were updated 12 hrs ago.

And in the video at 13:39 they state that they have launched a campaign at the Tangerine Clinic to help trans women with issues.

I don´t know though if they offer their services only to local people or if they would help people from abroad who are willing to pay out of pocket. But at least asking may be an idea.

2
Tue Feb 18 05:45:40 2020 UTC
(0 children)

When I was there, of your identification hadn't been changed regardmess of how female you present, they unabashedly refer to you as Sir without offense or any sense of intending you being chagrined. A girl I met there had a male name and she looked more female than Beyonce. She was continuously "sirred" or "Mistered". It was annoying if for no other reason than my social and cultural sensibility.

2
Tue Feb 18 05:32:49 2020 UTC
(2 children)

The last white dlators you show as Kamol's are what I received from PAI, the curved tip soul source like dilators were not given to me in 2017

3
Tue Feb 18 17:51:36 2020 UTC
(1 child)

Maybe they changed suppliers in the meantime. If you click on the PAI images you can see them in the original size. They now have a label saying its from them.

And some people like the straight ones more for dilation. The curved ones are easier to insert.

If you are interested in curved ones you could contact PAI, maybe they give you a rebate for their set as a customer of them. And there are also sets available from soulsource, here for example.

2
Tue Feb 18 18:44:27 2020 UTC
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(0 children)

Those that you show are the same dilators they showed at the time I received my surgery. They were actually what I expected. What I actually received were the white ones. A total of two. A smaller one and larger one. Just a heads up for girls going. They may have switched over by this time since that was a bit of time ago. Anyways, they sufficed till I got some soul sources. Plastic sticks are....well...plastic sticks.😊

6
u/atlshuizhang
Fri Jan 31 01:55:40 2020 UTC
(0 children)

I think it's also useful to compare the walls. A cis-vagina has mucous layers and muscular layers. In this respect, only the sigmoid colon neovagina could match the cis-vagina. Penile inversion neovagina and peritoneal neovagina don't have the muscular layers. Probably someone could search Google and post a few pictures.

13
u/hrt_breaker
Thu Jan 30 13:21:08 2020 UTC
(5 children)

Lol, normal vagina 🤨

10
OP
Thu Jan 30 13:32:45 2020 UTC
(3 children)

I think that kind of thing is typical in Thailand.

10
Tue Feb 18 05:27:19 2020 UTC
(0 children)

Thailand is a strange mix of acceptance and denial of our validity. They're very nice and sociable but have strict rules about our place in their society. It's oxymoronic. My sense there was that I was accepted but I also sensed I was set apart from "normal" society. Almost as if I was being patronized? It's super hard to explain it. You have to experience it for yourself.

8
Thu Jan 30 13:44:16 2020 UTC
(1 child)

I know. It's typical everywhere trans people haven't gotten through.

I'm not super bothered by it but can't help to notice.

12
OP
Thu Jan 30 13:48:30 2020 UTC
(0 children)

Its an odd country with respect to trans people by our standards. A strange mix of really good and bad.

3
Thu Jan 30 23:46:36 2020 UTC
(0 children)

Nice link.. Haha on Thai surgeons websites it still says Men with penises this long should get this type of srs etc.. and pictures show man with penile inversion procedure..

4
u/[deleted]
Thu Jan 30 18:20:59 2020 UTC
(5 children)

I had no idea peritoneal even existed, let alone that it was the best option!

12
OP
Thu Jan 30 18:27:51 2020 UTC
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(4 children)

The lecture is very interesting, but I think it’s arguable whether it’s the best option. There more on these surgeries in the wiki here.

Edit: typos

9
Thu Jan 30 19:17:07 2020 UTC
(3 children)

It's really difficult... it looks really promising but so few are doing it and everyone seems very cautious about long-term prospects

4
Thu Jan 30 22:12:12 2020 UTC
(0 children)

Yeah from what I have seen and was told the long term prospects are the issue. And your surgeon is approaching from the health of the patient perspective.

​

Granted the people I have seen that do the Peritoneal do it as a revision, so you should be able to get a revision down the road. While second surgery isn't exciting I think for the overly cautious you can do both after more data is around.

2
Tue Feb 18 05:35:09 2020 UTC
(1 child)

I think that presently, Colo is still the best and safest long term option.

2
Mon Dec 5 06:20:59 2022 UTC
(0 children)

PI is the gold standard, and non penile inversion techniques like suporn, as for what bowers and others use its a little unclear but regardless sigmoid colon vaginoplasty seems solidly the least reliable technique