Dr. Chettawut’s non-penile inversion technique is one stage male to female sex reassignment surgery which provides the best possible vulva appearance, sexual pleasure and physiological function of the vagina. The delicate process of creating each part of the female genital organ is described below:
1. Mon Veneris
The mons pubis known specifically in females as the mons veneris is a round mound over the pubic bone. The size of the mons veneris varies with the amount of fat tissue of the mon pubis which is sensitive to estrogen.
This mons veneris after SRS contains the neurovascular pedicle which carries the blood supply and nerve endings responsible in making the clitoris as well as some particular structure of the vulva vestibule unquestionably sensitive.
2. Clitoral Hood
The clitoral hood is a fold of skin that surrounds and protects the clitoris. It is vital not only in protecting the clitoris, but also in achieving pleasure during sexual arousal as Dr. Chettawut’s non penile inversion technique preserves the special sensory nerve that directly innervates this structure.
Dr. Chettawut uses the foreskin of penis (called prepuce) which is normally a pink colored muco-cutaneous tissue in order to provide a natural appearance as in a biological woman.
The clitoris is made from the most sensitive part of the glans penis that transmits erotic sensation from the innervation of dorsal nerve of clitoris.
The clitoris is set in the anatomical position which is not too high or too low, and designed to bend anteriorly away from the pubis as same as the natural alignment in a biological woman.
The size of clitoris is designed resembling a female clitoris unless the patient requests for the size to be a bit bigger than normal.
Regardless of the size, Dr. Chettawut can guarantee the ability to achieve orgasm since the clitoris is made from the most sensitive part of the glans penis that transmits erotic sensation from the innervation of dorsal nerve of clitoris.
4. Clitoral Frenulum
This tiny fold of tissue is made from the prepuce skin which unites the labia minora and the bottom part of the clitoris. The clitoral frenulum is also sensitive due to the dorsal nerve endings coming from the clitoris.
5. Vestibule of the Vulva
The vulvar vestibule is a part of the vulva between the labia minora. Dr. Chettawut constructs the upper part of vestibule by using the sensate skin innervated by branches of pudendal nerve and the lower part of vestibule by using the pink urethral tissue to make it look more appealing.
6. Labia Minora (Inner Labia)
The labia minora are two flaps of skin on both sides of the vaginal opening, situated between the labia majora (outer labia). The coloration of labia minora can be light pink for those who have originally pink penile foreskin (prepuce).
The length and size of labia minora can vary depending on the condition of the foreskin which is different between circumcised and uncircumcised patients.
According to Dr. Chettawut’s non penile inversion technique, the penile skin and the foreskin (prepuce) are intentionally used to form a flap like structure for the best possible form of female labia minora. The constructed labia minora has a lot of sensory nerve endings which contributes to sexual pleasure.
7. Labia Majora (Outer Labia)
The labia majora in female is homologous to the male scrotum. During sex reassignment surgery, Dr. Chettawut uses the scrotal skin as well as its fatty tissues for labia majora construction.
The natural look of the labia majora can be expected in both lying and standing positions. After labia majora creation, the left over scrotal skin can be used as the skin graft for the vaginal canal lining (see detail on the Dr. Chettawut’s skin graft technique).
8. Urethral Opening
The urethral reconstruction in conjunction with the total removal of surrounding spongy tissue called corpus spongiosum is an essential step during sex reassignment surgery.
During sex reassignment surgery, the urethral opening will be set in the correct anatomical position to allow a normal pattern of female urination while the total corpus spongiosum is eradicated in order to prevent the engorgement of the tissue under urethra (during sexual arousal) which may compromise the aesthetic look of vulva and may cause narrowing of vaginal opening.
9. Vaginal Opening and Posterior Fourchette
The vaginal opening is located in between the labia minora and comprised of penile skin and perineal skin. The best possible shape of vaginal opening can be expected which is normally vertically oriented (not like a big hole).
It is also possible to achieve a half-moon-shaped area behind the opening which is called the posterior fourchette.
The vagina is a tubular part starting from the vaginal opening to the blind pouch at the bottom of vagina. The lining of vagina is normally made from skin graft which can be taken from the scrotal skin and/or groin skin.
The vagina from SRS with skin graft can be potentially self-lubricated by the remnant para-urethral glands and intact Cowper’s gland. Stimulation of the G-spot (around the intact prostate gland) can possibly transmit the erotic sensation inside the vagina and achieve vaginal orgasm.
According to Dr. Chettawut’s SRS technique, the 6-7 inches depth vaginal depth can be expected regardless of the size penile size.