Non-penile Inversion Sex Reassignment Surgery with Skin Graft Technique


Dr. Chettawut’s non penile inversion with skin graft is reliable male to female sex reassignment surgery (SRS) technique renowned world-wide to achieve satisfactory outcomes for a natural look of female genitalia, excellent sensation and vaginal depth. According to Dr. Chettawut’s SRS technique, the 6 – 7 inch vaginal depth can be expected regardless of the penile size.


Unlike the traditional penile inversion technique, this technique allows WIH SRS surgeons to manage the valued penile skin for an anatomically precise and natural look of the inner labia and vaginal opening by using non-penile inversion technique which offers a more refined and defined aesthetic results of external genital appearance that is comparable to a cis female.


Dr. Chettawut’s non penile inversion technique is one step male to female sex reassignment surgery which provides the best possible vulva appearance, sexual pleasure and physiological function of the vagina. Throughout the delicate process, each part of the female genital organ is newly constructed as same as biological female genitalia, comprising:

1.   Mon veneris (Mon pubis)
2.   Clitoral hood
3.   Clitoris
4.   Clitoral frenulum
5.   Vestibule of the vulva
6.   Labia minora (inner labia)
7.   Labia majora (Outer labia)
8.   Urethral Opening
9.   Vaginal opening and posterior fourchette
10. Vagina

Since the penile skin is no longer inverted into the vaginal cavity, the skin graft harvested from scrotal skin is used as the main source of skin graft for the lining inside a vagina.

For patients who do not have enough scrotal skin as a result of previous orchiectomy, hormone replacement therapy and many other factors which shrinks the skin, WIH SRS surgeons can obtain additional skin graft from the groin to join the scrotal skin in order to complete the needed skin graft. So, an excellent 6.5 – 7 inch depth of the vagina can be expected even in SRS patients whose penis size is small and short. 

The urethral orifice is set above the vaginal opening at the correct anatomical position to allow female pattern of urine flow. All spongiosum (spongy) muscles around urethra are completely removed to prevent tissue engorgement during sexual arousal, which can narrow the vaginal opening or cause difficulty during sexual intercourse. Individualized self-lubrication can be also expected by preservation of specific secretory glands around the urethral & vaginal opening

The benefit of the non-penile inversion approach combined with possible scrotal and groin skin graft provides hope for those who have short penile length and those who have scarce scrotal skin, thus yielding outstanding results for both aesthetic external appearance and excellent vaginal depth.


Type of Anesthesia:    General anesthesia with local sedation administered by certified anesthesiologist for patient’s safety

Operation Hour:          6 hours

Length of Stay:           5 days 4 night


  1. All stitches are made meticulously to attain the best possible new genital structure with minimal scarring.
  2. Start dilating your vaginal cavity to maintain vaginal depth with the provided dilators following the dilation schedule or advised by your surgeon.
  3. Get plenty of rest during the first 2 months after surgery and also stay away from stress as much as possible.
  4. You may do light activities but do not lift heavy objects for 2 months.
  5. Do short regular walks for the first 2 months after surgery to help with the healing process.
  6. A gradual return to work is recommended, such as starting off with light duties or reduced hours.
  7. To ensure your complete healing, it is necessary to avoid any activities which may cause wound tear or wound complication.
  8. Do not stretch or spread the labia in order to see or take a photo for at least 3 months.
  9. Avoid sexual intercourse for at least 3 months
  10. Avoid exercises which are susceptible to acute overstretching of the genital area, including yoga, aerobic dancing, pilates, swimming, etc. for at least 3 months
  11. Strenuous activity (any activities which may put pressure against the genital area, like, hiking uphill, horseback riding, bicycling or motorcycle riding) for at least 3 months.


     1.   How is the skin graft prepared?

To ensure that the skin graft will be 100% hairless, the prepared sheet of skin will be double checked through light illumination and the possible remaining hair follicles are meticulously extracted before the graft is tubed and inserted inside a newly constructed vagina.

The length of tubed graft will be calculated carefully to match with the depth of the vagina which is normally 6.5-7 inches according to the average depth of vagina resulting from Dr. Chettawut’s non penile inversion technique.

2.    What is the result of female genitalia from Dr. Chettawut’s non penile inversion with skin graft?

WIH SRS surgeons will create a natural shape of vaginal opening in vertical orientation for the best realistic anatomical appearance and physiological function.

For labiaplasty, WIH surgeons utilize both penile and prepuce skin to form the well-defined inner lip (inner labia or labia minora).

The constructed inner labia are normally pink in color and extend to the bottom of the vulva vestibule to become the posterior fourchette which is similar to the appearance of inner labia in biological women. 

The vaginal opening can also expand appropriately to accommodate pleasurable sexual intercourse and vaginal dilators in varied sizes.