SRS (Penile Skin Inversion)

Male to Female Surgery

SRS (Penile Skin Inversion)

SRS by Penile Skin Inversion/Scrotal Skin Graft.

Sex change MtF

Result for Sex Reassignment Surgery by Preecha Aesthetic Institute.

Preecha Aesthetic Institute (PAI), the Pioneer for Sex Reassignment Surgery Thailand.

Transsexual person is someone who was born into the wrong body. They have the body of one gender and the mind of the other.  Transsexuals may be a female trapped in a male’s body or a male trapped in a female’s body.

Preecha Aesthetic Institute has been provide information, help and supportive for Transsexuals, and Cross-Dressers of all ages, we are especially Reconstructive Center located in Bangkok ,Thailand for those who are in the final stages of “Sex Reassignment Surgery”. We have been performed SRS by PSI, SSG  and SCG > 4,800 + cases.

Sex reassignment surgery (initialized as SRS; also known as genital reconstruction surgery, sex affirmation surgery, sex realignment surgery or sex-change operation) is a term for the surgical procedures by which a person’s physical appearance and function of their existing sexual characteristics are altered to resemble that of the other sex. It is part of a treatment for gender identity disorder/gender dysphoria in transsexual and transgender people.

Other terms for SRS include gender reassignment surgery, sex reconstruction surgery, genital reconstruction surgery, gender confirmation surgery, and more clinical terms, such as feminizing genitoplasty or penectomy, orchidectomy and Vaginoplasty are used medically for trans women.


Sex Reassignment Surgery  (Male to Female Surgery).

There are 2 main surgeries.

1. Penile Skin Inversion

2. Sigmoid Colon

- The SRS with Penile Skin Inversion (self- lubricate with organism).

- The SRS with Sigmoid Colon (lubricate with organism).

SRS with Penile Skin Inversion or Sigmoid Colon each provided the sensational glans clitoris, labiaplasty and vaginoplasty in one stage with 3 different techniques.


How do I select SRS best for my body ?

1. Long Penis (>6 inches (15 cm), when erect) = Penile Skin Inversion (PSI)

2. Medium Penis (2-6 inches (5-15 cm), when erect) = Penile Skin Inversion (PSI) with Scrotal Skin Graft (SSG)

3. Short Penis (<2 inches (5 cm), when erect) = Penile Skin Inversion (PSI, SSG) with Sigmoid Colon Graft (SCG)

Sex Reassignment Surgery (Sigmoid colon) transposition is used for patients who need more depth (exceeding 8 inches).


Best Candidate for SRS, MtF :

PAI (Preecha Aesthetic Institute), we are following WPATH/HBIGDA or SOCs.

The Standards of care for gender identity disorders – WPATH (World Professional Association for Transgender Health) the earliest sets of clinical guidelines for the express purpose of ensuring “lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment.” These standards are still the most well-known; however, other sets of SOCs, protocols and guidelines do exist, especially outside the USA.

- Specific minimum requirements as prerequisites to HRT

- Much of the criticism surrounding the WPATH/HBIGDA

- Psychological evaluation letter

- Highly controversial and often maligned document among patients seeking medical intervention (Hormones)

- Real-Life experience

- Physically healthy and emotionally stable with realistic expectations

- Must be over 18 year old with good health condition


Sex Reassignment Surgery (MtF) cost :

SRS package is inclusive :

- Accommodation for 5 days in hospital private room after surgery

- Operating Room Charges: OR Room Use, Recovery Room, Scrub & Circulate Nurse

- Regular menu food charges

- Laboratory Testing: necessary for the procedure as CBC, EKG, UA, Anti HIV, Chest X-Ray

(If age over 50 need to check Cardiology.  An extra charge 100 USD)

- Medical Equipments and Medical Supplies

- General Anesthesia – Pre Anesthetic Drugs, Anesthesia and Medical Gas (Oxygen, Nitrous Oxide)

- Medical Treatments

- Doctor fees

- Anesthesia fees

- Nursing services

-  A pack of sanitary napkin ring

- PAI’s GRS dilator (1 size)

- Take home medication and supplies

- Post op cares

- Transportation pick up


Service Accommodation

- Transportation pick up from airport –hotel-clinic-airport  as well as follow up period

- Mobile service during recovery with local number.  People can get in touch with you

- Hotel reservation at least 1 km from Preecha Aesthetic Institute

- Touring services

- Interpreter services  with any language


Type of Anesthesia: General Anesthesia


Preparation for Sex Reassignment Surgery (MtF) :

- Inform us about any allergies, any serious medical condition(s), and all medications you are

taking (both prescription and non-prescription).

- Qualify letter from Psychiatrist doctor or Hormone Therapist

- No Aspirin at least 2 weeks before surgery.

- Stop vitamin E Oil 1 day before surgery.

- Stop smoking 2 days and a month after surgery.

- Stop Hormone, if taken 2 weeks before surgery date

- Tell doctor if you have any serious medical condition(s).

- Stop meal and water starting from midnight before surgery.

- Plan to be in Thailand at least 14 days after or at least 15 days (Before and after) surgery.


The Sex Reassignment surgical Procedure


1. Creation of vaginal space between urethra, prostate gland, bladder and rectum
2. Bilateral orchietomy
3. Degloved penis shaft
4. Separation of urethra from penis
5. Isolation glans penis with 2 dorsal nerves and vessels
6. Penile skin inversion to line vaginal cavity with or without scrotal skin graft orsigmoid colon graft
7. Clitoroplasty (Sensate)
8. Urethropalsty
9. Labiaplasty, major and minor

A portion of the glans (head of the penis), with its nerves and vessels, is converted into a clitoris. In so do, the clitoris will be functional in sensation as well as in appearance.

The excess erectile tissue around the urethra should be removed in order to avoid symptoms that stem from engorged erectile tissue during sexual arousal, that may result in the narrowing of the vaginal opening.


 Sex Reassignment Surgery recovery

After sex reassignment surgery, pain that is easily controlled by medication usually will subside in a few days.  Dressings have been applied; we will be replaced a few days.  Sutures will be removed within a week of surgery.  Although the surgeon has made every effort to keep scars as inconspicuous as possible, they are the inevitable result of surgery.  Minimal swelling and discoloration of the breasts will disappear rapidly.

Healing process may occur for weeks or even months following surgery.

Dilation will be given an instruction during follow up visits.

The decision on when to return to work and normal activities depends on how fast you heal and how you fee.  To permit proper healing, you should avoid over activity and refrain from overhead lifting.

For SRS patients – a full post-operative care kit necessary for dilation, including a -piece dilator set specially manufactured for GRS as design by Preecha Aesthetic Institute.


Treatment after surgery for SRS, More instruction will be given after surgery:

After release from hospital you will recover with the aid of liaison at the hotel.

During recovery in the hotel, you must follow instructions including:

1. Dilating is the most important thing you can do to ensure the success of your surgery. If you do not dilate responsibly, this can result in the shortening of depth and width of the newly made vagina because of the scar contracture.

2. Failure to dilate properly can result in serious injury. You will be instructed to gently dilate into the right direction after the vaginal packing is removed.

3. Dilation can be painful for the first weeks, but is essential for developing maximum depth and ensuring post operative functioning of the neovagina.


During the recovery period, after each dilation session SRS :

- The wound should be washed gently with Hibiscrub (pink color) in the shower followed by douching while seated in the toilet:

- Douche solution (proportion) = 5-10 ml (cc) of Beta dine solution mixed with 1L of water or until the container is full.

- Insert the douche to full depth, squeeze, and hold tightly the container.

- While holding tightly the container, extract the douche;

- Keep the wound dry and apply Beta dine solution with cotton balls; and apply Kemicitine ointment with a cotton applicator. If there is some bleeding, press or apply pressure with a dry cotton ball to the site for 15 minutes. During the first weeks after surgery, feminine knapkins (tampons) should be changed several times per day due to normal vaginal bleeding during recovery.

- After one month of SRS operation you will be required to start applying Premarin cream to your neo-vagina. Apply two times a day to soften your neo-vagina. This would generally take around six months.

- You can return to female hormones as before surgery or after two weeks. You should consult your endocrinologist to re-adjust the dosage. A sudden change in hormone levels, for some individuals, may result in the fluctuation of emotion.


Sex Reassignment Surgery: Time required: 2 hours

Anesthesia: General Anesthesia

Recovery Sex Reassignment Surgery: Required to be in Thailand 15 days (Totals)

Back to work: after 20 days more

Strenuous activity: 4-8 weeks

Fading of scars: several months to a year


Sex Reassignment Surgery Male to Female Thailand

Schedule (require 14 days after surgery in Thailand)

Post-operative check-ups by PAI’s surgeon at least twice weekly and more frequently if necessary – while you are here.

Day 1 – Consultation and Prepare for Laboratory Testing

Day 2-6 – Surgery and 5 days in hospital private room after surgery

Day 6 – Discharge from Hospital
Day 6 to 13 – Stay in hotel for recovery period and follow up on doctor appointment

Day 7-10 – Stitches removal

Day 13 – Final check up and prepare for letter fit to fly and  issue for a new letter with gender name change
Day  14 – Safe to fly

All transportation during recovery period in Bangkok will be sponsor by PAI.


Set up appointment or having questions for Preecha Aesthetic Institute :

1. Write your question, interest at consult us in program form

2. Via email

2.1   list your expectations or procedure that you are interest and give us your detail as possible

2.2   email to us

2.3   We will get back to you shortly after receive your question with recommendation from specialize surgeon

Once you know your planning date for surgery.

Here is the next step.

3.1   Consultation with us via email for details and procedure

3.2   Plan your available date to be surgery and departure from Bangkok

3.3    We will confirm you for surgery date

3.4    You may start to book your airline ticket

3.5    We will confirm you all detail and hotel booking, if require

3.6    For transportation to be pick up from the airport, we can do for you as optional


PAI (Preecha Aesthetic Institute)

898/1 Sukumvit 55

Wattana, Bangkok 10110 Thailand

Tel: (662) 715-0111


Meeting Point (Airport)

We collect you and any accompanying travellers from Bangkok Suvarnabhumi International airport – irrespective of day or time of arrival of your flight. We return you to the airport at the end of your stay.

The driver will stand by for you at the door number 4 (Meeting point) after exit from customs.  The driver will stand by with your name and PAI’s logo.

Hospital within a package - Your cost of meals and accommodation in the hospital during post-operative recovery in a private single-bed room with television and full air conditioning. You may also have guests stay in your private room at sofa bed (no charge).


Hotel - Hotel partners offer special rate for PAI.

Prior to admission to , and discharge from hospital, patients stay in local hotel accommodation. We can arrange Hotel accommodation as co-operate rate and low rate (located from 20-100 meters  from Preecha Aesthetic Institute).


All hotels approval by Preecha Aesthetic Institute (PAI)

  • Free internet via broadband with a wireless network and wired network.
  •  Lounge facility
  • Full air condition
  • House keeper
  •  TV with DVD movies
  •  Laundry services / Self Services
  •  Restaurant / Cooking facilities
  •  Recreational trips to areas of local interest
  • Room, bed, floor clean and hygiene



- Thai, Spanish, Italian, Japanese and English

- Other Language upon request


The payment can be prepared in Cash by US dollars, Euro Dollar, Japanese Yen, HKD, SGD, AUD or pay by Traveler‘s Cheques.

If using credit cards, the hospital will charged 3% for international transaction fee.  This is only for surgery fees.  Hotels are not charged for international transaction fee.

An extra charged for HIV is 30% from total cost.


Cost of meal

Cost of living meal per day is 15-20 USD.


Passport and VISA

Preecha Aesthetic Institute can issue the letter to clarify with your local Embassy or Passport.

All travellers to Thailand must have a valid passport, which would remain valid for 6 months after the date of entry into Thailand.


Tourist Visa Exemption (30 days without VISA)

Australia, Austria, Belgium ,Brazil ,Bahrain , Brunei Darussalam   ,Canada, Denmark ,Finland ,France, Germany  ,Greece ,Hong Kong ,Iceland  ,Indonesia  ,Ireland  ,Israel  ,Italy  ,Japan  ,South Korea ,Kuwait ,Luxembourg , Malaysia  ,Monaco  ,Netherlands  ,New Zealand  ,Norway  ,Oman ,Peru  ,Philippines  ,Portugal , Qatar , Singapore  ,Spain  ,South Africa  ,Sweden  ,Switzerland  ,Turkey  ,United Arab Emirates, United Kingdom  ,United States of America ,Vietnam.

Airport Immigration and Customs

Please present the supporting documents confirming the scheduled operation upon request. Please do not carry any unnecessary drugs or dangerous objects in your luggage.


Air Travel Tips for Transgender People

Nothing on this webpage is meant, or should be interpreted to mean, that transgender people or anyone else should attempt to circumvent security or deceive security personnel in any way. It is meant only to provide tips to transgender people who may otherwise be subjected to unfair or embarrassing selective scrutiny or treatment.


Who You Are: Identification Issues

All passengers 18 years of age or older are required to provide proof of identity at check-in and at the security checkpoint.

- The name you use for your airline reservation must match the name on your identification.

- If your current name does not match your passport, we recommend that you consider getting an updated ID if possible.

- For an international flight, you will need to present a valid passport, visa, or any other required documentation. Passengers without proper ID may be denied boarding.

- “For e-tickets, you will need to show your photo identification and e-ticket receipt to receive your boarding pass.”

- If you do not currently look like the picture on your picture ID, we recommend that you consider getting an updated ID with a new picture if possible. If you cannot or if you are still concerned about ID issues, consider carrying an explanatory note from a physician or therapist explaining why you may not look like the picture on your ID.


Flight Bookings

We do not provide a flight booking service for journeys to Thailand. There are many local agency base in your country, which lower cost or you may search a booking flight via website.


Preecha Aesthetic Institute surgeon’s team

At PAI, we are only one center and biggest group of qualify plastic surgeon in Thailand for multidisciplinary in aesthetic and reconstructive surgery.  Because we believe no one can work best in all kinds.

Therefore, at PAI, Dr.Preecha Tiewtranon, MD has had  highly selective qualify doctors who match for each type of procedure, FFS, SRS, body contouring as well as anaesthesiologist and team of operating theatre nurses.



FAQs (Sex Reassignment Surgery)

Q: How did you pick the PAI?

A: I was lucky that my mother has a doctor friend, who happens to be a great surgeon.  She recommended me to a doctor at PAI.  The best thing was their greatest cares.

Q: What came before the operation?

A: You must consult with psychologist and see if you was truly ready to get it done.

Q: How did you feel after SRS surgery?

A: I woke up feeling vey blurry.  There were tubes everywhere.  The saline drip was inserted into my left hand and the pulse rate meter on the right.  There was also a tube attached into the bulging part of my new female sex organ to take the blood out of my body.  I was also new to the whole female peeing thing so, they had another tube inserted into my urethra to ease me into the process.  On the third day after surgery, my body got used to the new organ and I was ready to pee on my own.

Q: How do you feel now?

A: I have more confidence, and feel more like myself.  People keep telling me that my body shape really changed and looks more feminine in every way.  In terms of sex, I have the same feeling as any women.

Q: I was wondering if you have any combination packages that would involve SRS surgery and a facial feminization surgery?

A: Yes.  We can set up combination packages for SRS, Facial Feminization Surgery and/or Breast Augmentation at the same time.

Q: Do you make labia major and minor ?

A: The labia majors and minors are created.

Q:  Do we have orgasm in this surgery technique?

A:   We cannot guarantee,because even natural female do not all have orgasm. But70-80% of our patients reported orgasm.

Q:  What does vagina looks like after surgery? Will it be natural as women’s vagina? Do any one can recognize with this vagina that we were a boy before?(I have seen the pictures of your surgery in the web site but I would like to ask about it again)

A:  Many partners and gynecologists cannot tell.

Q: What is depth of vagina?

A:  The depth is made deep to peritoneum , which is 6 inches, but the result is depended on the length of penis ,if it is short we add the scrotal skin graft to line the cavity.  To maintain the depth is your job, by daily dilatation.

Q: Can I put down the deposit ?  If yes, How much..

A:  We require a payment of 10% of the total price of the operation.   You can pay more than the deposit if you wish, and may choose to pay in full. This will obviously be of some benefit to some patients in that only one set of bank charges will therefore be payable.

 Q: Am I able to combine surgery ?

A: Yes, you can.  SRS can be combine with Facial Feminization and Breast Augmentation at the same time to avoid too many anesthesia.

 Q: How can I take picture for you to review before coming ?

A: Please make sure the camera is positioned  ensure the image is not distorted. Send the images as email attachments.  Please don’t send larger image because it’s take so long to open.

 Q: Is a letter provided by the Doctor after sex reassignment surgery thailand is completed that can be used to legally change my gender tag on important documents like Birth certificate, social security?

A: Yes, it is .  We will issue the SRS letter for you after surgery.  You can use the letter for gender change in your country.

Q: Is it recommended that more time is needed to visit and have procedure performed (One Month 30 days) verses 14 days?

A: No, it is not.  The most or minimum stay for GRS (MtF) recovery period in Thailand is 14 days after surgery.  But if you want to make sure that you are well recovery.  You may stay in Thailand up to 20 days.

Q:  Will final outcome of SRS (penile skin inversion) to be achieve sensitive, feeling and orgasms ?. 

Yes.  Goals of SRS here are patient must receive sensation, G spot, aesthetically acceptable vulva include clitoris, labia minora, majora and vaginal introitus.  Shortening of the urethra, with creation of a urethral opening that allows a downward urinary stream.  Eliminate of erectile tissue completely (to avoid narrowing of introitus and protrusion of the urethral during sexual arousal.  To achieve adequate vaginal depth. To preserve orgasmic capabilities.  Minimize and hide scarring. To make neo vagina, appearance and overall realistic.

Q:  I had my my srs surgery done here back on July, 2011 it was a complete success and I’m happy with my results, my primary doctor told me to ask when my surgery was done was my prostate removed during surgery. 

For Sex Reassignment Surgery (MtF), we don’t removed prostate.




All surgery carries risks – But can minimize by closely following your surgeon’s advice on follow up care during the healing process.


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