MTFの睾丸（こうがん）摘出切除・女性器形成SRS（性適合手術 性別適合手術）のパスウェイ

第一段階：

形成外科にて睾丸（こうがん）摘出切除

第二段階：

(1)Non Penile Approach（反転法ではない）による膣形成及び外性器形成

(2)反転法

(3)Ｓ字結腸法

Non Penile Approachの特徴（スポーン先生もNon Penile Approach）

１．陰嚢とそけい部表皮を移植片として使うので造膣の長さが長い（最大１８センチ）

２．海綿組織と筋肉を除去して造膣を行うので，内部が血流で締まり過ぎない

３．陰核包皮・陰核・小陰唇（亀頭周辺の皮膚を使う）に神経を残すので物理的快感が残る

４．陰唇の製作には陰茎の不要部位の皮膚を裏返して使うので，外観がピンク

５．Ｓ字結腸法のような移植片の潜在汚染がない。反転法のように陰茎の長さの要件がない

６．Ｓ字結腸法ほどの「命がけ」感はない。

Natural looking result of female genitalia from Dr. Chettawut’s unique SRS technique

Doctor Chettawut performs sex reassignment surgery (SRS) in one step construction by using the non-penile inversion technique（反転法ではない）.
His non penile inversion technique will provide gender reassignment surgical results that have the most correct anatomical appearance and physiological function.

For labiaplasty, Dr. Chettawut utilizes both penile and prepuce skin (a hood that covers the glans penis in non-circumcised patients or a part of skin between the neck of glans penis（包皮と亀頭周りの皮膚の両方を使う） and the incisional scar in circumcised patients) to form the well-defined inner lip (inner labia or labia minora).

The constructed inner labia is normally pink in color（小陰唇はほとんどピンクにできる） and extends to the bottom of the vulva vestibule （外陰部前庭まで延長して形成）to become the posterior fourchette which is similar to the appearance of inner labia in biological women.
Dr. Chettawut creates a natural shape of vaginal opening in vertical orientation for the best realistic look and function.

The vaginal opening can also expand appropriately to accommodate pleasurable sexual intercourse and vaginal dilators in varied sizes.
Excellent depth and function of neo-vagina
Dr. Chettawut spends unlimited time and carefully dissects the vaginal canal to achieve the maximum depth of vagina.

An excellent 6.5-7 inches depth of the vagina can be expected even in SRS patients whose penis size is small and short.

Since the end of penile skin is no longer inverted inside vagina, the vaginal lining is made from only scrotal（陰嚢） and/or groin skin graft （そけい部皮膚グラフト）which is absolutely hairless as a result of meticulous removal of all hair root during skin graft preparation.
Individualized self-lubrication can be also expected by preservation of specific secretory glands（分泌性器官の温存により、形成した膣内部は自然な潤滑性をもつ） around the urethral & vaginal opening.

The urethral orifice is set above the vaginal opening at the correct anatomical position to allow female pattern of urine flow（尿道位置は膣口上部に形成され、正しい解剖学的位置関係を保持する。）.

All spongiosum (spongy) muscles around urethra are completely removed to prevent tissue engorgement during sexual arousal which can narrow the vaginal opening or cause difficulty during sexual intercourse（膣口の狭窄化を起こす海綿状組織と筋肉は除去される。）.

Sex-Reassignment-Surgery-how Dr.Chettawut do SRS Dr. Chettawut is well known for his ability to preserve specific sensory nerve to provide excellent sensation（亀頭周りの感覚のある皮膚と包皮を温存するため、反転法とは異なり快感皮膚感覚が温存される） and successful achievement of orgasm even just within a short period of time after SRS.
The neo-clitoris made from the dorsal part of glans penis is considered the primary sensate organ innervated by branches of pudendal nerve（形成陰核は亀頭背側部で作られるため、主要な感覚は残る）.

The part of vulva vestibule made from the ventral part of glans penis is considered the secondary sensate organ（外陰部前庭は亀頭腹側部から作られ、そけい部の皮膚を反転させて形成することで、陰部神経が温存されて反転される。） innervated by branches of pudendal nerve.
Not only pudendal nerve, Dr. Chettawut can preserve 3 more specific nerves which innervate the created sensate genital structures as follows（形成陰核・陰唇・膣壁の３つの領域に快感神経が温存され移植される。）:
- Clitoral hood and clitoral frenulum
- Inner labia and its frenulum (posterior fourchette)
- Vaginal wall adjacent to the intact prostate (G-spot area compared to biological female anatomy)
A clitoral orgasm differs from a vaginal orgasm because different sets of nerves are involved.
The sex reassignment surgery lasts around 6 hours to complete all delicate processes and Dr. Chettawut is the only surgeon who performs the surgery from the start to the end.
All stitches are made meticulously to attain the best possible new genital structure with minimal scarring.