Sex Reassignment Surgery with Colon Flap Technique


Also called colon vaginoplasty, SRS colon flap or genital reconstruction surgery, sex reassignment surgery with colon flap technique is life-changing surgery for all transgender women or trans women across the world in which a part of the colon is sectioned to create the vaginal lining for a self-lubricating vagina with greater depth than can be achieved with the standard SRS skin graft technique.


   1.   Trans women with a vaginal issue after primary sex change surgery

It is perceived as a major issue for trans women who have already transitioned, but encounter or suffer from the issue of vaginal depth or width, like vaginal shortening or vaginal narrowing (vaginal collapse).

Short vagina (Vaginal shortening, or vaginal depth is less than 4 inches) is considered a non-functional vagina as it cannot provide satisfactory sexual intercourse with an average-sized penis. Vaginal narrowing or collapse is a condition of total vaginal canal shrink as vaginal opening is still normal, which can also contribute to suffering during sexual activity.

As these issues become severe, surgery to correct them is of essence. The colon flap technique SRS (secondary colon vaginoplasty) can be an option that helps break through these physical barriers, enhancing quality of life to the fullest.

   2.   Trans women who undergo SRS for the first time

Whilst many trans women worldwide select Dr. Chettawut’s SRS non penile inversion with skin graft technique as their primary sex change surgery (which can offer the excellent functionality and depth of 6.5 - 7 inches, aesthetic results of external genital appearance comparable to a biological female, and the best possible sensation and ability still preserved to achieve orgasm), some may decide on the SRS colon flap technique alternatively due to the following reasons:

Greater Depth

The SRS colon flap technique offers the advantage of creating a more excellent depth (averagely 8 - 9+++ inches) of the vaginal canal, which can be considered a significant aspect for some individuals due to different lifestyles and personal preference.


This technique can offer the advantage of producing natural self-lubricant, enabling more effective functionality during sexual activity, while the traditional SRS skin graft might produce less.


At WIH International Hospital, our highly-experienced and skilled team of SRS surgeons is ready to provide comprehensive care services all throughout your life-changing journey, ultimately delivering perfect transformations that unlock your life to the fullest, physically and mentally.

During your SRS with colon flap technique, part of the colon is sectioned via an incision placed on the lower abdomen (like Caesarean section incision in biological females). A 20 cm colon segment is selected from a part of the sigmoid colon for being used as the colon flap. One end of colon flap is closed while the other end is open and slides down through the vaginal tunnel for suturing to vaginal opening.

For trans women with a vaginal issue after primary sex change surgery

WIH SRS surgeons will rectify the short or collapsed vagina, starting from removing post-scarring tissue inside vagina, re-creating the vaginal tunnel with proper dimension (vaginal width) to finally using the colon flap for a new and healthy lining inside vagina.

For trans women who undergo SRS for the first time

The colon flap technique successfully offers 8 - 9+++ inches according to the average depth of vagina resulting from Dr. Chettawut’s non penile inversion technique with colon flap technique. This lives up to each individual’s desires in which a greater depth than Dr. Chettawut’s skin graft technique offering 6.5 - 7 inches is expected.

Normally, WIH SRS surgeons will reconstruct the colon flap as meticulously and strategically as possible by lining it inside the vaginal canal with 1.5 - 2 inches in length. This advanced inner lining technique aims especially to conceal the colon mucosa (which is red) from sight, thus offering the best natural-looking vagina possible.

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


Anesthesia:         General anesthesia by certified anesthesiologist for patient’s safety

Operation Time:  6 – 7 hours

Length of Stay:    6 days 5 nights


  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.   What is the result of female genitalia from Dr. Chettawut’s non penile inversion SRS?

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.

   2.   Why non-penile inversion sex reassignment surgery? 

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 which is comparable to a cis female, while still preserving the best possible sensation and ability to achieve orgasm.

   3.   What are the causes of short or collapsed vagina from primary SRS?

The causes of short or collapse vagina from primary SRS can be:

           1. Insufficient creation of vaginal tunnel or inadequate skin graft during SRS operation
           2. Poor healing inside neo-vagina due to skin graft failure or post-inflammatory scar
           3. Patients’ failure to maintain their original vaginal depth by stopping or ignoring regular and proper vaginal dilation.

   4.   Why is the colon flap technique the best solution to treat short or collapsed vagina?

The skin graft technique cannot be effectively applied inside a recreated vagina because the skin graft cannot heal and survive in post-scarring tissue. Unlike skin graft, the colon flap brings its own blood supply to the post-scarring area and can heal properly.

This is why the colon flap technique is the best solution to treat short or collapsed vagina as it can provide healthy tissue for a new lining inside vagina with excellent depth and self-lubrication.

   5.   Does the colon flap technique provide self-lubrication?

The colon flap technique provides self-lubrication since the colon flap itself can naturally produce or secrete mucus (which is a lubricant). How much lubrication to be produced varies for each individual.

   6.   Why do dilation after SRS with colon flap technique?

Patients are required to do regular and proper vaginal dilation as advised by WIH SRS surgeon to maintain vaginal depth and elasticity and especially to maintain the connection of the inner lining between the skin and colon mucosa. If stopping or ignoring regular and proper vaginal dilation, patients may encounter or suffer from the scar narrowing which contributes to difficulties during dilations or sexual activity.