Overview of MTF GRS Procedure

Male to Female Gender Reassignment Surgery

• a complex and irreversible sex change surgery.

• requires referral to a psychiatrist, determining if a patient has true gender dysphoria, before one is accepted as a candidate for GRS.

• CARA surgeons perform gender reassignment surgery (GRS) as a penile and scrotal skin inversion for the creation of vagina

• The average vaginal depth will be 4-5 inches.  Additional skin may be obtained from the buttocks/thighs if your penile and scrotal skin are not sufficient.

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Surgery Schedule Details

The following is an approximate schedule for your GRS.  Kindly click the bulleted item to view description.

• Arriving in Manila

  • Our CARA Liaison will pick you up at the airport or wherever you may be staying nearby, and take you to CARA clinic for consultation and full evaluation

• Psychiatric evaluation
  • If you haven't been evaluated by a psychiatrist to determine true gender dysphoria, you will be referred to two (2) different psychiatrists for proper determination.  Only when the two psychiatrists have determined true gender dysphoria will we proceed with the procedure.
• Cardio-pulmonary evaluation
  • Upon admission at the hospital, you will be asked to fill out some forms. Chest X-ray, EKG, and other laboratory tests will be done, unless you have had a prior evaluation with acceptable test results from your physician back home.
• Pre-operative evaluation
  • On the day before surgery, Our GRS surgeons will evaluate your fitness for surgery. He will review your personal and medical history, including allergies, do a complete physical examination, evaluate the amount of the penile and scrotal skin and estimate your vaginal depth.
• Anesthetic consultation
  • The anesthetist may visit you the day before your operation for proper evaluation

• Preparations the day prior to surgery

  • The day before your operation, you should eat only light, easily digested, low-fiber meals such as soup, sandwiches, fruit juice, etc. Avoid hot/spicy or hard-to-digest food such as meat. In the evening, the nurse will give you strong laxative solution. After midnight, you must not eat or drink anything. To have any food or liquid in your stomach during the operation is to risk life-threatening aspiration. You will then be placed on IV fluids.

• Day of surgery

  • Before going to the operating room (OR), medications will be given through your IV to make you relaxed and sleepy.  In the OR, epidural catheterization (a catheter is inserted near the spine in your lower back) is done for regional anesthesia. We then proceed with the surgery.

• Post-operative care

  • After the surgery, you will be transferred to the recovery room for close monitoring before you are brought back to your room.  You will be given oral painkillers. Intravenous or intramuscular analgesic injections may be given upon your request.

• Days 2: Recovery

  •     You must remain in bed for the first couple of days after surgery. Your legs must be spread apart to prevent compromising the blood supply of the inverted skin.
    Two tubes emerge from your surgical dressing. One is to drain the urine (Foley's catheter) and the other is a suction drainaige catheter (Jackson-Pratt drain) to drain excess blood from the operative field.
        Administering ice packs can help reduce swelling after surgery. The nurses will provide gel packs, which can be kept cold in your room refrigerator.
        A silicone prosthetic is inserted in your new vagina and maintained for the duration of your recovery

• Day 3 : Continued recovery

  • Recovery will mostly be on your bed.  You are still maintained on nothing by mouth except for the oral medications and little water. 

• Day 4 or 5 : Diet Resumption

  • Diet is now started and progressed in the following days. Mobilization is now better tolerated with lesser pain.

• Days 5 -7: Continued rest

  • You can resume light activity by walking around the hospital, though you might still spend most of your time in bed.

• Day 8: Removal of prosthetic

  • Skin inverted is given time to heal and create new blood vessels and this usually takes at least seven (7) days. After 7 days, you are brought to the clinic for inspection and dressing of the operative site.  He will inspect the new organs and skin graft. He will familiarize you with the anatomy of your new vulva and instruct you how to give it proper care. If you have difficulty urinating, he may retain the Foley's catheter until everything is okay.
    
    You will begin vaginal dilation while still at the hospital. You will be provided a set of dilators free of charge and guidelines for their use. You will need to practice dilation regularly for 6-12 months.

• Discharge from the Hospital

  • Depending on your medical status, upon final general check-up of our GRS surgeons, you may now be discharged from the hospital. Our "CARA van" will serve as your transportation from the hospital to your hotel or airport. Our CARA Liaison will coordinate your departure plans. We will also provide several copies of your medical certificate verifying you have successfully undergone GRS with CARA Philippines.

• Recuperation

  • we recommend that you stay in the Metro Manila area for about a week following discharge, if possible. Part of our services is to provide accommodation arrangements for you. We may also make an appointment for a follow-up examination with our GRS surgeons before you leave Manila, free of charge of course.

• Activities Limitation

  • Even most patients can start light activities a few weeks after surgery, but we advise the patient to leave a work for 8 weeks after GRS. They need to do vaginal dilation 3 times a day regularly for 6 months to maintain the vaginal depth and width. For best results, sexual intercourse is not advised until 6 months after surgery.

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Cost of Gender Reassignment Surgery

Gender reassignment surgery fee is packaged and includes the following:

• preoperative consultation and evaluation

• surgeon and assistant's fee

• anesthesiologist fee

• 15 days hospitalization

• operation and anesthesia fee

• transportation between hospital and hotel (and airport)

• follow up

Package price starts at US $ 5,400. Package does not include hotel room before admission and after release from the hospital, phone call outside Metro Manila and international phone call made from the room.

Psychiatric evaluation fee will be added if prior consult has not been done.

Payments may be made via traveler's check, Major credit cards or cash in US dollars or Philippine peso. An advance deposit may be needed depending on the package chosen.

 

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