MAF Techniques



The methods of Sexual Reassignment Surgery available in the specialized transgender clinic CTRANS regarding the procedures of construction of a new vagina and clitoris are the following:

Sexual Reassignment Surgery

In the case of penile skin deficiency and scrotum or limitation of skin in the genital area, optional procedures may be needed.

Penis Skin Reversal

This surgery involves the inversion of the skin of the penis to create and beautify the vagina. This method is widely popular.


  • The advantage is that this method is relatively simple. For an experienced and specialized surgeon, this technique of sexual resignation surgery lasts about 4 hours.


  • The disadvantage is that this process is not suitable for men with penises of 4 inches or shorter so it would result in a not very deep vagina (in general, the depth of the vagina is equivalent to the length of the skin that covers the penis less one inch (this includes the skin needed to build the Labia Minora).
  • On the other hand, some patients may need a second plastic lip. Because most of the skin of the penis is reversed inside the vagina for full depth, there is insufficient skin to build the labia minora and the clitoris cap. In this way, patients may need a second plastic lip and reconstruction of the clitoris cap.

Sexual Reassignment Surgery without graft skin

The technique involves using the skin of the penis and scrotum to build the external genitals such as labia majora and labia, neo clitoris and the clitoris cap, and the female urethra. Because the skin of the penis is used to build the labia minora and the clitoris cap, vaginal depth is insufficient unless the grafted skin is used to cover the vagina. This procedure is suitable for those who do not need transvaginal sex and do not want vaginal procrastination for life.

Sexual Reassignment Surgery with scrotal graft skin

This technique involves the use of the skin covering the penis for the construction of the labia minora, part of the glands of the penis to build the neo clitoris and the scrotal graft skin to cover the vaginal wall. This results in a sufficient and functional depth of the vagina to the patient's need. If after the use of scrotal graft skin, the depth of the vagina is not satisfactory to the patient then the plastic surgeon may consider using graft skin from other areas such as the groin or lower abdomen to deepen the vagina.


  • The advantage is that this technique provides a single-stage operation resulting in total and aesthetic function. Most patients do not need to touch up the procedure.


  • The disadvantage is that the operation is difficult and complex, and is not appropriate for those skin conditions. For this technique, a specialist surgeon with experience in sexual reassignment will take 4 - 6 hours to complete the procedure.



Sigmoid Colon Vaginoplasty

This technique is used in the case where patients have short penises, or to assist patients whose vagina has been blocked. This method can also be used in patients who have never had sexual reassignment surgery. The vagina that is part of the colon will have good lubrication and optimal depth.

There are 2 options for Sigmoid Colon Sexual Reassignment Surgery:

Open Technique

The Sigmoid colon is cut like a pedicle with an intact neurovascular bundle via an incision in the lower transverse abdomen, such as the bikini line. The average segment length extracted from the Sigmoid colon is 7 inches. The rest of the colon is reconnected to create a normal passage of the large intestine, separately from the neo-vagina. The duration of the operation is approximately 7 hours.

Laparoscopic technique

The Sigmoid colon is harvested through 4 small incisions with laparoscopic techniques such as a pedicle with a neurovascular lump. The colon is repositioned by means of staples. The Sigmoid colon is sealed at the top and pulled through the neo-vaginal canal. The average segment length extracted from the Sigmoid colon is 6-7 inches. The operation lasts about 7 hours


  • This technique helps patients who have previously had surgery to reassign it to sex, whose vaginas have been blocked and are not able to have sex.
  • It also helps patients with too short penises. In this regard, the surgeon has already decided that other methods of surgery for sex reassignment are not feasible.
  • The vagina has natural lubricant.
  • It is possible to determine the depth of a new constructed vagina.


  • In the open technique, a scar may be visible on the bikini line, just above the left side of the pubis.
  • Surgery is complicated to complete, with invasive procedures that require cutting of certain parts of the colon. The colon should be thoroughly cleaned by enema one day before the operation.
  • The patient may suffer from indigestion 3-5 days after the operation.
  • Sigmoid colon sex reassignment surgery is not suitable for those who are overweight or have a fatty abdomen. Patients for this procedure need physical examination before their final decision on surgery.

Patients of Sigmoid Colon Sexual Reassignment Surgery should refrain from drinking water or eating food until the specialist tells them later, she can drink small sips of water or soft food.  If food is consumed too quickly, you will suffer symptoms of indigestion. For this reason, the patient of this technique must rigidly obey the recommendations of their doctor and nurses.