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Peritoneal Pull-Through Vaginoplasty (PPV) in Thailand

Peritoneal Pull-Through Vaginoplasty, or Peritoneal Vaginoplasty, is a new male to female surgery procedure that’s based on a gynecological procedure called the Davydov Procedure.

Peritoneal Pull-Through Vaginoplasty is the latest and most advanced technique for MTF Sex Reassignment Surgery/Gender Confirmation Surgery.

The procedure itself has been around for many years, with starting points in gynecology. Based on a gynecological methodology called the Davydov Procedure, PPV has been used for the creation of a neovagina in women born without a vaginal canal. More recently, the technique has been modified for use in gender-affirming surgery to create a neovagina in transgender women.

Just as in the Davydov Procedure, a vaginal canal is constructed from the patient’s peritoneal tissue – the tissue covering the abdominal wall. This has the advantage of creating a more lifelike neovagina with a more natural appearance and functionality compared to other techniques. The lining is elastic and self-lubricating, just like a natural vagina. Recovery is usually quicker than penile inversion and colon vaginoplasty, and less dilation.

Dr. Theerapong at Interplast Clinic is one of only a handful of surgeons offering this procedure for Sex Reassignment Surgery in Thailand.

MTF surgery Thailand interplast
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How is PPV Surgery Performed?

SSR PPV surgery is based on a method called the Davydov procedure where the patient’s own peritoneum is used to construct a neovagina. This has been used for years as a treatment for girls born without a vaginal canal – a syndrome which affects roughly 1 in every 4,500 girls.

The procedure is comparatively simple and offers excellent long-term results without many of the complications associated with other techniques.

During surgery, a laparoscope along with special instruments are inserted through small incisions on the abdomen. These instruments allow dissection of the potential space between the lower urinary tract (urethra, prostatic urethra, and bladder) and rectum. This space will become the neovagina.

The neovagina will be up to 6-7 inches deep with a pale pink colour. The vagina will have a self-lubricating lining that resembles a biological woman’s vagina in its looks as well as its function, including being able to shrink and expand naturally.

PPV can be used as the first MTF surgery or in corrective surgery. The procedure is safe, and most patients are very satisfied with the final result.

Recovery After Peritoneal Vaginoplasty Surgery

Surgery time:
6-10 hours

6-7 nights.

Pain management:
The genital area will be sore for several weeks after surgery. You will be given pain medication to deal with any post-operative pain – it is important to take your medication as directed and follow all instructions from your surgeon.

When can you fly home?
We recommend patients plan to stay in Thailand 3-4 weeks after surgery before flying home.

Peritoneal Vaginoplasty Advantages

  • The neovagina is self-lubricating without the odour associated with sigmoid colon vaginoplasty.
  • PPV vaginas are flexible and extend like an organic vagina.
  • Smaller risk of vaginal prolapse and shrinkage compared with other SRS techniques.
  • Faster post-operative recovery time than penile reversal and colon vaginoplasty.
  • Smaller risk of gastrointestinal issues compared to sigmoid colon vaginoplasty.
  • No visual scarring on the neovagina (it looks totally regular) and due to the laparoscopic method, there are just four little, essentially imperceptible scars from the surgery (these look like small spots and will fade out within a year).
  • A relatively simple surgical procedure compared to other SRS techniques.
  • The Davydov Procedure has been performed on cisgender women for over 60 years with excellent long-term outcomes.

Postoperative Recovery in Hospital

You’ll spend the first 5-6 days after your operation recovering at the hospital. At first you won’t be able to eat any solid food or drink anything. A urinary catheter will be in place the whole time to allow you to pass urine.

Sigmoid colon surgery patients will be encouraged to get up and start walking soon after surgery in order to stimulate the colon. Solid food can usually be introduced after 3-4 days. Patients recovering from PPV surgery will need to avoid walking and sitting up for the first 5-6 days. You’ll also be restricted from eating solid foods at this time.

Patients recovering from scrotal skin grafting can usually start walking and eating solid food after the first couple of days.

It’s important to note that many patients find the recovery period at the hospital the hardest part of the whole journey. You will be given medication for any post-operative pain, and nurses are there to help you with any physical discomfort, but it’s also quite important to have a family member, friend or partner with you to help you cope psychologically, if possible.