PD Dr. Richard Fakin / Gender Reaffirming Surgery (GRS) / Vaginoplasty

Vaginoplasty for trans women (GRS M-to-F)

Madrid | Zurich

The goal of surgical gender reassignment is to achieve a physical image consistent with your gender identity and inexorably improve your quality of life. Vaginoplasty represents a crucial and highly demanded intervention in the spectrum of surgical reassignments, contributing to the cure of gender dysphoria.

PD Dr. Richard Fakin performs the reassignments using the Thai surgical technique, based on the experience he gained with Dr. Preecha Tiewtranon at the Preecha Aesthetic Institute (PAI) as well as King Chulalungkorn University Hospital in Bangkok . Since his return to Europe he has directed the gender reassignment program at the University Hospital in Zurich .

The main advantages of these techniques are the excellent aesthetic and functional results that are achieved in a single intervention with a standardized postoperative protocol. Professionalism, respect, security and confidence are our maximum premises.

This intervention can be combined with other reassignment surgical procedures such as; facial feminization (FFS) , body feminization and breast augmentation . At Doctor Richard Fakin ‘s clinics in Madrid and Zurich, we know that our knowledge and our commitment to using the most advanced techniques allow us to ensure that reconstructive and aesthetic surgery are inseparable, and we are proud to be able to change the lives of our patients.


3 – 5 hours (including breast augmentation)

Discharge from the clinic

1 week

Fit to go back to work

4 – 6 weeks

Fit for everyday activities

14 days



Recovery time

2 – 3 months

Existing techniques in vaginoplasty for trans women

Intervenes according to the Thai method, which in a single intervention provides for the creation of the labia majora, minora, clitoris, urethral orifice, mons pubis and the neo-vaginal cavity.

There are mainly two techniques for reconstruction of the vaginal cavity:

Penile Inversion (PSI)

The dermis from the penis is inverted in order to reconstruct the neo-vagina. Likewise, it is possible to use a dermis graft, which is acquired from the scrotal area.  Due to the dermis graft, the depth of vaginal penetration can be independent of the size of the penis.  The purpose is to obtain a depth of penetration that is at least 12 to 14 cm, taking into account that the natural depth of women ranges from 8 to 11 cm.

Interposition of sigmoid colon

The vaginal cavity is built thanks to a segment of the large intestine (sigma colon) of about 14 cm. The inner part is occluded and the vaginal opening (introitus) is reconstructed adapting the colon with the skin. The colon reconnects and recovers its original functionality. This surgical intervention is carried out by PD Dr. Richard Fakin together with the team of colorectal surgeons, who simultaneously and with the laparoscopic method (closed surgery with a camera that leaves only small scars) attend the neovaginal deconstruction with the segment (interponate) colon. 

The right method for each patient

From the outside, both methods, explained above, are identical in the final aesthetic result, however, the construction of the vaginal cavity is subordinated to the predilections of each patient and to their own anatomy.

We suggest that patients with a smaller penis opt for neovaginal reconstruction with the segment of intestine (sigmoid colon interposition). For patients with an  average size, the most common choice is to opt for the penile inversion technique (PSI) combined with skin grafting. For patients with a large penis size  , the most common choice is to opt for the penile inversion technique (PSI) without the need for skin grafting. Likewise, the colon technique has an additional advantage that consists of greater natural lubrication, since the secretion from the intestine is similar to vaginal discharge. To choose the ideal method for each patient, it is essential to assess the advantages of each technique.

Learn more about Vaginoplasty interventions belonging to the field of Female Genital Surgery aimed at Transgender women on our  Facebook profile.

Post-operative care

Post-operative care as well as the necessary materials are essential to obtain optimal aesthetic and functional results. Regular dilation is a crucial part, especially over the course of the first 12 months. Likewise, our team of nurses will exclusively and personalizedly provide our patients with all the necessary support, a set of our dilators and pre- and post-operative instructions.

Over the years, it is essential to have regular checkups with your gynecologist. From our clinics we can contribute by offering our suggestions and guidance in order to carry out an optimal and rigorous clinical examination.

Learn more about Vaginoplasty interventions belonging to the field of Female Genital Surgery aimed at Transgender women on our  Instagram profile.

PD Dr. Richard Fakin's experience in sex reassignment surgery

PD Dr. Richard Fakin is recognized as one of the foremost international experts in the field of transgender surgery. He has organized and participated in numerous international conferences and is the author of multiple scientific publications.

Its statistics show a minimal complication rate of up to 10 times lower compared to some international studies. Her introduction of the Thai technique to Europe has contributed to a successful concept that has changed the lives of many trans women.

Her long experience with trans patients is accompanied by understanding, respect and confidentiality towards them.

Learn more about Vaginoplasty interventions belonging to the field of Female Genital Surgery aimed at Transgender women on our Facebook profile.

Real cases before and after

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