“It must be very clear that the outcome of any SRS reconstructive surgery is completely irreversible, can never be as realistic as natural ones, and after SRS, one can never become a genetic father or mother for whole life.”

Requirements for Sex Reassignment Procedures

The minimum requirement to start Hormonal therapy or Breast Surgery is:

• Patient must be a major (or Parental release form).
• Must be in stable frame of mind, and are living in society as the new desired external appearance (Real Life Experience) for at least 3-months.
• Consultation & counselling with psychiatrist (mental health physician) for at least 3-months, to rule out any abnormal mental status or infatuation or temporary attraction/any secondary gain; and approval of psychiatrist to undergo hormonal therapy and/or breast surgery.
• Affidavit (notarized) from patient that he/she is major and can fully understand pros/cons & take the decision regarding the therapy/surgery.

The minimum requirement for Genital Surgery is:

• Patient must be a major (or Parental Release Form)
• If married, the spouse must sign Spousal Release Form
• Must be in stable frame of mind, and are living in society as the new desired external appearance (Real Life Experience) for at least 1-year.
• Continuous consultation & counselling with psychiatrist (mental health physician) for at least 1-year; and approval with two independent Psychiatrists for surgery at two different intervals (a gap of at least 6-months) to rule out any abnormal mental status or infatuation or temporary attraction and IQ of patient.
• Affidavit (notarized) from patient that he/she is a major and can take decisions regarding the surgery after fully understanding the pros & cons and understanding of irreversibility of the procedures.

Male to Female or M to F (Trans Female)

The procedures involved systematic excision of penis & testicles, Creation of neo-vagina using penis skin, creation of labia majora & labia minora by scrotal skin and creation of clitoris by de-bulked sensate flap of glans penis. Breast implant (Silicone cohesive gel or expander implant) completes the procedure. Though the surgery can be performed in single or two stages, but few further stages may be required to fine-tune the result or to perform ancillary procedures like laser hair removal, vocal cord surgery to change the voice etc.

The postoperative outcome of vaginoplasty is variable. It usually allows coitus (sexual intercourse), although sensation might not always be present. The physical factors, the narrowness of the male pelvis can reduce the available area to use for vaginoplasty and limit vaginal dimensions.

Female to Male or F to M (Trans Male)

F to M is more complex and complicated procedure than M to F. The surgery is always staged and are :

• Excision of breast, salpingo-oophorectomy, hysterectomy & excision of vagina (in Single or two stage, depending on completion of formalities)
• Reconstruction of neo penis using microsurgical technique.
• Placement of penile implants for penile erection.

A gap of 4-6 month is required in between each stage for proper healing of the areas. few further stages may be required to fine tune the results or to perform ancillary procedures like vocal cord surgery to change the voice etc.

Patient Testimonials

Hi All! My name is Angela, and I would love to share my experience while I was at Lucknow! I had come down to India from Bangkok sometime in April 2014, for getting my Sex Reassignment Surgery (Male to Female). I had decided to get my surgery done in India and I came across SIPS online, and immediately felt an unexplained connection. I was so excited and had been communicating to DR. R.K. Mishra through EMails and I felt so very comfortable already! However, once I reached, I was a bit scared about how it will all go, but, after an appointment with him, I was convinced that it will be a smooth process, and that I was lucky to have such an understanding and patient doctor! I felt very relaxed on the day of my surgery, and I woke up in the recovery room, post surgery.The care and hospitality I’d be given, while at the hospital was absolutely wonderful, and I would recommend SIPS to anybody who seeks any kind of cosmetic surgery/treatment. Although it is now almost 2 Months Post Op, I still consult Dr. Mishra and he is as helpful as always! I’d like to thank Dr. R.K. Mishra and his team for the services provided. I recommend SIPS and especially Dr. R.K. Mishra to everybody, and I’m sure the world will be a healthier, better place to live in. **** Good Wishes to Dr. R.K. Mishra and his Team at SIPS.

A. Penile Girth Enhancement Surgery

Method involves injection of purified own fat cells beneath the skin of penis, to achieve penis girth enhancement. Sometimes, the derma-fat graft is applied just beneath the skin of penis to provide better and more predictable enhancement in girth of penis. On an average, after the surgery, penile girth is increased by 2-3 centimeters. The procedure has very rare but some side effects including decrease of sensation, scarring, and deformation.

B. Penile Length Enhancement or Elongation / Enlargement Surgery

Approximately one-third to one-half of the penis is inside the body, and is integrally attached to the undersurface of the pubic bone. Penis lengthening involves the release of the fundiform ligament and the suspensory ligament that attaches the two erectile bodies to the pubic bone (ligamentolysis). The suspensory ligament makes the penis arch under the pubic bone. Release of this ligament allows the penis to protrude on a straighter path, further outward to give a longer physical appearance. With the penis on stretch, the ligament is divided close to the pubic bone until all midline attachments have been freed. Once these ligaments have been cut, part of the penile shaft (usually held within the body) drops forward and extends out, enlarging the penis by 2–3 cm (0.78–1.18 in.). After surgery, part of the postoperative treatment includes stretching of the penis to prevent the released suspensory ligament from re-shorten as it was previously. The procedure has rare but some side effects including loss or decrease of sensation.

C. Penile Lengthening by External Stretching Device

“Jelqing (milking), Clamping (constricting ring or device at the base of penis) or Hanging weights
on the penis are risky and dangerous techniques, and should never be used.
These may lead to amputation of penis.”

Inflatable implants

A further method is to replace the two corpora cavernosa with inflatable penile implants. This is performed primarily as a therapeutic surgery for men suffering from complete impotence; or in those patients with a new reconstructed penis, who has lost their penis due to trauma or cancer surgery. An implanted pump in the groin or scrotum can be manipulated by hand to fill these cylinders from an implanted reservoir in order to achieve an erection. The replacement cylinders are normally sized to be direct replacements for the corpus cavernosa, but larger ones can be implanted.

One advantage to this surgery is that an erection can be created whenever desired, for as long as is desired and as firm as desired. However, this surgical procedure can never be reversed.

Penoscrotal Webbing

Penoscrotal webbing can occur as a result of bad circumcision by quacks, whereby the underside of the penis is adhered to the scrotum. As a result a web forms, and the scrotal tissue becomes attached to the underside of the penis like a turkey neck.

Correction of penoscrotal webbing (by a double Z-plasty) is a procedure performed as an outpatient under local anesthesia or IV sedation.

Testicular Implants

There are a number of reasons why a testicular implant is considered, these include: Adults and children with undescended testicles, children and adult males with loss of one or both testes due to trauma, torsion or cancer. Men that have very small and/or deformed non-functional testes may also choose to have a testicular implant. But always remember, these implants are artificial testes made up of silicone, and can never produce sperm or hormones & are non-functional. They are used for aesthetic reason.

Testicular implants can create a normal cosmetic appearance of scrotum and give a man or a child confidence.

In recent years, the most commonly performed female genital procedure is Hymen Repair or Hymenoplasty or revirgination; in which the thin membrane that covers vaginal opening is restored to its original shape to give you a virgin appearance.

Available Female Surgeries

A. Hymenoplasty or Revirgination

Suturing of a tear in the hymen such as might be caused by sexual assault, soon after the assault, to facilitate healing. Sometimes hymenoplasty surgery is performed as a purely cosmetic procedure as repair of torn tags of remnant of hymen or recreates a totally new hymen using flaps from the vaginal lining with its blood supply. This surgery is performed preferably 8-12 weeks before the intended marriage. Patients are advised to refrain from penetrative sex for up to three months following this procedure.

The Procedure

Typically, the procedure takes 1 to 2 hours and is performed under local anesthesia as a day care procedure. Some patients prefer the addition of IV sedation or even general anesthesia. Very fine invisible sutures are applied from the inside to repair torn hymen. These sutures automatically absorbs itself within 2-3 weeks time. You will go home after surgery; there is no need for an overnight stay in the hospital.

B. Vaginoplasty or Vaginorrhaphy

Vaginoplasty, sometimes referred to as rejuvenation of the vagina, is a procedure that can usually correct the problem of stretched vaginal muscles for women who’ve experienced multiple childbirths, as vaginal muscles tend to experience enlargement due to stressful expansion during the delivery. The result can often be loose, weak vaginal muscles. Vaginoplasty can enhance sexual gratification for women who for whatever reason lack an overall optimum architectural integrity of the vagina. Vaginoplasty or Vaginorrhaphy tightens and restores the diameter of vagina and supporting structures to a “pre-pregnancy” state, thereby re-establishing friction that increases sexual gratification for both women and men.

Vaginoplasty can also be performed as reconstructive procedure for correcting the defects and deformities of the vaginal canal and its mucous membrane, and of vulvo-vaginal structures that might be absent or damaged because of congenital disease (e.g. vaginal atresia) or because of an acquired cause (e.g. physical trauma, cancer). As such, the term vaginoplasty generally describes any such vaginal surgery, and the term neovaginoplasty specifically describes the procedures of either partial or total construction or reconstruction of the vulvo-vaginal complex.

The Procedure

The procedure usually performed under general anaesthesia, may be as simple as placing sutures at the introitus (vaginal opening), or may involve excising excess vaginal mucosa together with tightening the muscles of the posterior vaginal wall. Neovaginoplasty may involve taking skin from your thigh & creating a new vagina through it.

C. Labia Majora Fattening

Many factors may contribute to your confidence, sexuality and femininity, but none is more personal or private than the appearance of your genitalia. In women, large, asymmetric or irregular genital labia (lips) can occur naturally or develop with age, childbirth, hormones, or even from sexual intercourse.

As women age, after childbirth or with weight gain or loss, this area can change, becoming enlarged or have redundant skin. In some women with aging the labia majora may undergo a significant atrophy and the dermis under the skin thins out. As a result of these changes the labia majora becomes shrunken, flat, saggy, wrinkled, and darkened. The surgeon can drastically rejuvenate the labia majora with micro fat grafting.

The Procedure

The fat injections add fat to the areas beneath the skin, creating fullness where needed that results in a lasting, youthful appearance of the labia majora. It is the procedure where excess fat is removed from areas such as the abdomen, flanks, hips or thighs and, after special preparation, injected into areas of the body that need filling. The surgeon specializes in the use of the micro fat grafting technique. The process requires gentle fat removal using low-vacuum liposuction and the use of thin, delicate, non-traumatic cannulas to protect the survival of each harvested living fat cell. The fat cells are then purified and slowly injected through tiny skin incisions into the tissue of the recipient site utilizing a small syringe and cannula. Tiny droplets are placed throughout the tissues assuring that each transferred fat cell will have an adequate blood supply to achieve the permanent survival of the injected fat cells.

D. Labia Minora Trimming or Reduction Labiaplasty

The Procedure

Relatively, the procedure is simple, excising an area of the labia minora using a variety of incisions and takes 1 to 2 hours and is performed under local anesthesia as a day care procedure. Some patients prefer the addition of IV sedation or even general anesthesia. You will go home after the surgery; there is no need for an overnight stay in the hospital. Careful placement of the scar is important, however, in order to prevent painful scar contracture along the rim of the labia.

E. Clitoris Hoodectomy or Clitoral unhooding

Clitoral Unhooding, also referred to as Hoodectomy, sometimes also referred as female circumcision, is a minor feminine genital surgical procedure to remove excess Prepuce tissue—the surrounding “hood” that sheaths the clitoral node on three sides. Normally, the Prepuce is anatomically designed to offer the clitoris a degree of protection against undue abrasion or over stimulation. This naturally retracts during sexual intercourse, thereby leaving the highly innervated surface of the clitoral node, what is commonly referred to as the exterior G-spot or Glans, to be more exposed . . . resulting in female sexual orgasms. Sometimes however, women with small clitoral nodes or those that have excess Prepuce tissue (both common conditions) find that they can’t achieve orgasm, or have a harder time reaching climax, because the clitoris is literally covered, or restricted by too much skin tissue, thus greatly lessening tactile sensation, and/or even eliminating it entirely. Clitoral unhooding can greatly help these women by exposing the clitoral node.

Your Recovery

After surgery, you will wear a menstrual-type pad to absorb any little drainage and to provide padding and protection to the area. You can expect some swelling and discomfort for 1 to 2 weeks. Most women return to work in 1 to 3 days, and sutures are dissolvable. Strenuous activity and exercise should be avoided for 3-6 weeks, and you should not use tampons, douches, or have intercourse for 6 weeks to allow the surgical area to heal properly.

Expected Results

The majority of women are thrilled with their new, more aesthetically desirable appearance after Vaginal Rejuvenation, and are more confident, comfortable, and sexually active.