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Male to Female Sex reassignment surgery is a complex and irreversible procedure.

Patients need to be evaluated and approved by a psychiatrist (M.D) or clinical psychologist (PhD). Patients who plan to undergo SRS or any sex change procedures should meet the following criteria:

• The patients must legally reach maturity age in the patient's nation.

• The patients must be strongly persistent in their desire for sexual reassignment surgery for at least 2 years.

• The diagnosis of gender dysphobia must be made by a clinical psychologist dealing with transsexuals.

• The patients must have lived and worked exclusively in the cross-gender role for not less than 6 months.

• The patients must take female hormonal treatment for not less than 6 months before the surgery, except those who have lived in the cross-gender role for a long time and have been assessed psychologically healthy.

Technique of sex reassignment surgery:

• All cases are done under general anesthesia.

• The perineal skin flap is designed in proper shape and size and will finally be joined with the inverted penile flap for vaginal opening reconstruction.

• The vaginal opening and space are created below the urethra (urinary tube) and the prostate gland. After passing the prostate capsule at 4 inches depth, the plane become loose and the direction will be a downward slant to the recto-vesicle pouch. The depth of this newly created space normally 6-7 inches, or even more in some cases depending on the anatomy of individuals.

• Bilateral orchidectomy (removal of testes and spermatic cord) is performed.

• The inverted skin flap from the penis is used for the skin lining of neovagina. If the penile skin is not adequate for the total lining, the scrotal skin graft will be routinely added for additional depth.

• The penis shaft is removed except some small parts of the gland penis and its sensory nerves and vessels for constructing the sensate clitoris.

• During clitoroplasty, all sensory nerve branches will be well identified and meticulously preserved for good sensation. The clitoris is set in its normal position and the clitoral column and hooding are also fashioned in one stage to make it look more natural.

• The urethral opening is centrally located above introitus (vaginal opening) and the urethral mucosal set between the clitoris and urethral opening in order simulate the pink wet vulva mucosa.

• The excess erectile tissue around the urethra is removed. This is to avoid any symptoms of engorged erectile tissue during sexual arousal that may result in narrowing of the vaginal canal.

• The scrotal skin flaps are converted into the outer labias. The scrotal fat contents are well preserved to augment the labias.

• The inner labias are simultaneously made from the prepuce flaps (pink-colour skin attached to the gland penis), which are long enough to cover the neoclitoris, urethral and upper part of vaginal opening. However, thinner lip appearance of the inner labia can be done later at the labiaplasty stage.

• A vaginal packing is placed inside the neovagina for 4 days and the patient is normally discharged after a week.

• Occasionally some patients will be prescribed hormonal therapy following the reassignment surgery.