Dr. Aguilar and Dr. Mendez perform sex reassignment surgery (SRS, also knows as GRS – gender reassignment surgery or also often referred to as “gender confirmation surgery”) in one step construction by using the penile inversion and scrotal graft technique, this technique learned from one of the top surgeon in United States in SRS Dr. Marci Bowers. This will provide gender reassignment surgical results that have anatomical appearance and physiological function.
The surgery time is around 4 hours, and it performed by Dr. Aguilar and Dr. Carlos Mendez, who is a board certified Plastic Surgeon, to achieve the best aestetic and natural look of external genitalia.
Penile Inversion SRS with Scrotal Graft
Sigmoid Colon SRS
The ideal reconstructive procedure should provide a vagina that has an appropriate length and that requires minimal, if any, dilatation. It should not scar, stenose or contract and should provide a satisfactory cosmetic result. Reconstructing the vagina using intestinal segments creates an aesthetically pleasing vagina, which seems to be more compatible with sexual activity.
After penile inversion skin flap, sigmoid colon technique presents the method of choice in transsexual surgery. Advantages of this procedure include adequate vaginal length, natural lubrication, early intercourse and a low rate of shrinkage. Sigmoid colon is particularly useful because it is anatomically similar to the perineum, with sufficient length and mobility of the segment that allows it to be easily brought into the perineum.
The neovagina will be packed for 7 days, and an indwelling Foley catheter will be left in place for 4 days. At discharge from hospital, patients are instructed to irrigate the neovagina once a day for 2 months and weekly thereafter, and to dilate the introitus of the neovagina on a daily basis with a vaginal dilator.
Cosmetic SRS (Limited-Depth SRS)
Mexico Transgender Center also offers a more conservative surgical approach than the standard SRS which is called “Cosmetic SRS” or a “Limited-Depth SRS”. The operation time of the cosmetic SRS is shorter than standard SRS, it has faster recovery time and the vaginal dilation is no longer required.
Prospective SRS patients who do not wish to have a functional vagina for the use of sexual penetration, the cosmetic SRS should be taken in consideration.
Cosmetic SRS consists of elimination of male genitalia, penis shaft and testes, creation of all external female genital structures which are clitoris, clitoral hood, labia majora and minora, and urethral and vaginal opening. The vaginal opening of up to 1.5 – 2 inches deep is needed to maintain the natural look of female genitalia and make an illusion that it has a vaginal canal.
Sensitivity and orgasm are achievable with cosmetic SRS as the nerves responsible for sensation are carefully preserved during the surgery. Colon technique or skin graft can be used, should the patient decide to create vaginal canal at a later time.
Nullification (Male-to-Nullo)
Dr. Aguilar is the only surgeon in Latin America who offers Nullification surgery, also well known as Male-to-Nullo.
Many Gender Non-Binary patients opt for this more conservative surgical approach than the standard SRS. This surgery is focused on providing no sexual internal and external genitalia, giving the patient an external appearance of no penis or vagina.
What makes Nullification SRS different from the standard SRS in the case of Male-to-Nullo, is that it does not include the creation of a vaginal canal so there will be no functional depth for penile penetration, includes the testis removal and the highly reconstructive procedure to reroute the urethra.
For those patients seeking to preserve sensitivity and an ability to orgasm, we can preserve the part of the glans, embedded under the skin surface.
Post-Op Image Gallery
Frequently Asked Questions (FAQ)
The clitoral hood is a fold of skin that surrounds and protects the clitoris. It is vital not only in protecting the clitoris, but also in achieving pleasure during sexual arousal, this hood is constructed with the penile skin and the urethra mucosa to achieve this sensation.
Dr. Aguilar expertise is to preserve specific sensory nerve to provide excellent sensation and successful achievement of orgasm, the neo-clitoris is made from the dorsal part of glans pens, the most sensitive area of the glans and the preservation of the neurovascular bundle will ensure the sensation and achievement of orgasm guarantee.
The vulva is made from the ventral part of the penis when is inverted and a lining of the urethra mucosa, will provide lubrication and pleasure sensory, due to its pudendal innervation and the inner labia is normally pink in color and extends to the bottom of the vulva vestibule to become the posterior fourchette which is similar to the appearance of inner labia in biological women.
Dr. Aguilar do not depend on the inversion of the penile skin totally, the scrotal skin, will be remodeled and will create a natural shape of vaginal opening in vertical orientation for the best realistic look and function, this scrotal graft will provide a 6 to 8 inches depth vagina, allowing Dr. Aguilar to use part of the penile skin for the creation of the labia. The vaginal opening can also expand appropriately to accommodate pleasurable sexual intercourse and vaginal dilators in varied sizes.
The process of skin graft technique is delicate as the donor skin from scrotum and groin will be converted to be the intermediate thickness of skin graft which means the superficial part of dermal layer is preserved to maintain skin durability.
To ensure that the skin graft will be 100% hairless, the hair follicles of the scrotal skin will be cauterized, so if the patient did not got a proper laser hair treatment or Hydrolysis, Dr. Aguilar will take care of the hair follicles during the surgery.
Self-lubrication can be also expected by preservation of specific secretory glands around the urethral & vaginal opening, but Dr. Aguilar recommends lubricant for intercourse, for less vaginal discomfort.
The urethral orifice is set above the vaginal opening at the correct anatomical position to allow female pattern of urine flow, being Dr. Aguilar a reconstructive urologist, the urethra reconstruction is guarantee it won’t close, major complication seeing in plastic surgeons urethroplasty.
All spongiosum muscles around urethra are completely removed to prevent tissue engorgement during sexual arousal which can narrow the vaginal opening, create the sensation of cystocele or cause difficulty during sexual intercourse.
Our highly qualified surgical nurses will assist you after the operation, they will be with you 24/7 in the hospital at your bedside, after you are discharged they will come to visit your daily at the hotel and they will do their best to provide all necessary after care for you, it is our policy to provide only well-trained and specialized surgical nurses who know all the details of your surgery to closely monitor and take care of you during your recovery.
Upon discharge, we will provide you with all necessary oral medications including the detailed instruction on how to take the medications correctly, post-surgical garment to retain the vaginal package (Special Diaper), SRS certificates containing the original handwritten signatures of Dr. Aguilar and Letter of Postoperative Care Management.
For Penile Inversion SRS you will be required to purchase a set of dilators:
Sensitivity and orgasm are well achievable with all types of SRS as the nerves responsible for sensation are carefully preserved during the surgery.
Like with any surgical intervention, complications do happen but they are rather rare. Mainly, complications are related to vaginal canal, that may lose depth or even close up, if dilating regimen is not closely followed or done improperly. We have performed hundreds of SRS surgeries to date and are only aware of 2 patients who lost depth due to failure to dilate. Rectal injury is also a possible risk with certain patients. In over 10 years of practice, we only had one (1) such case.
Remember, after you leave hospital, it is your sole responsibility to closely stick to dilation regimen, to avoid closure of vaginal canal.
Note that none of these risks are present for cosmetic SRS, which does not involve creation of a vaginal canal or any dilating at all. More and more of our patients choose cosmetic SRS.
Yes, absolutely! Our doctors are available for private consultations via WhatsApp (up to 30 minutes per patient, Please see schedule and instructions on how to join).
IMPORTANT: All patients will also have a private consultation with our doctors one day before surgery.
Yes, gender reassignment surgery is a serious procedure that potentially carries certain risks, especially for older patients or patients with special health conditions. To protect our patients from unexpected expenses in an event of unexpected complications, while they are undergoing medical treatment in Mexico, all patients are required to purchase travel health insurance:
Purchase Novamar Medical Tourism Insurance Policy
Yes. Just like any other SRS surgery clinic, we are no exception. In some cases we can help obtain the letter while you are already in Mexico, for patients coming from countries where obtaining such letter can be difficult.