GRS with Dr. Preecha at
Bangkok Nursing Home Hospital

By Sara

This is a short account of my gender reassignment surgery, which was performed in June 2002 by Dr. Preecha Tiewtranon at Bangkok Nursing Home Hospital. I hope it may be helpful to those considering GRS in Bangkok.

I chose Dr. Preecha for my GRS for many personal reasons, and I'm sure that everyone who undergoes GRS has different considerations and requirements when making their choice of surgeon. In my own case, I am familiar with the Far East, and the long trip to Thailand was not the drawback for me that it might be for others. I travel to Japan once or twice a year and have many close friends there. On this particular trip, I stayed in Japan for two weeks before surgery and a Japanese friend traveled to Bangkok with me. After GRS I returned to Japan for another five weeks of recovery, with friends to look after me all the time. In that environment, with no phones and daily business to worry about, I felt very relaxed. I didn't have to cope with jet lag, and I didn't have to worry about the long flight home until I was nearly fully recovered.

Bangkok is a disorienting place (no pun intended). The language is nearly impenetrable, and though many people speak English, they tend to do so with a heavy accent. Though my guidebook stated that Japanese (a second language for me) was also commonly spoken, I did not find that to be true at all. In any case, the language barriers sometimes make for mix-ups and misunderstandings and it is important not to take these kinds of problems too seriously. At the same time, it is a good idea to be prepared for them, too.

I flew from Osaka to Bangkok on the afternoon of June 10 (about a five hour flight) with my friend Tomoko. We at first missed our contact person at the airport, as there are two exits and we took the wrong one. Eventually we figured this out and soon we were on our way to the hospital. I thought I was going to the lavish Bumrungrad Hospital, so I was disappointed when we drove up to the far less impressive Bangkok Nursing Hospital (BNH). But the next day when we met Dr. Preecha, he explained that he has now moved all his GRS business to BNH -- the Preecha Aesthetic Institute occupies the top floor there -- because the cost is less for the patients and the nursing care is superior to Bumrungrad. In the weeks that followed I found this to be absolutely true. The nurses are really incredible at BNH, caring and attentive and available immediately upon request. And the hospital, while not luxurious, is certainly very pleasant and comfortable, and the food is frankly superb.

The day after arrival I had my appointment with Dr. Preecha. He is often described as charming, but I would say rather that he is an extremely energetic and optimistic man. Like many Thais, he wears a broad smile at all times. I had prepared a long list of questions and he patiently answered them all thoroughly. He looked over my therapist's letters and medical records, gave me a cursory examination and then sent me downstairs for an EEG and chest X-ray. Dr. Preecha helped me feel more relaxed about the whole procedure.

In the evening, a sweet and very beautiful Thai nurse with atrocious English helped me to shave my pubic hair. The next morning before surgery she gave me an enema that made me want to fly right back to New York. There are unpleasant ordeals to cope with in GRS, and this was just the first of them.

I was very nervous before surgery -- part of me excited and confident, the more religious part of me still deeply questioning my decision. Lying on a hospital gurney wearing just a gown in a cold and sterile room, waiting for the surgeons to enter, was scary. Many visions of my childhood and scenes of my lifelong transgender struggles flashed through my head. Eventually Dr. Preecha's assistant, Dr. Saran Wannachamras, came in. His English pronunciation is excellent, and we conversed easily before I went under. He comforted me greatly at that time. Dr. Saran has a wonderful bedside manner and one of the things I treasure most about my GRS experience is the memory of his kind words and thoughtful advice.

When I came to after the surgery I was deeply happy and immediately felt the comfort of knowing I had taken the right step. I felt that the worst part of the ordeal was over. For five days my groin was wrapped in heavy packing with a drainage tube and catheter. This was the most uncomfortable time for me. It was hard to sleep, and one gets restless from lying in bed. Walking around with the packing is also awkward, and I got tired quickly. I slept a lot, watched too many bad movies on HBO and played cards with Tomoko. Reading, one of my great loves, actually felt too exhausting. At times there was great pain, and I requested pain-killers almost every day at some point. Either Dr. Preecha or Dr. Saran came to see me every day to check on my progress, which was very reassuring.

On the morning of the fifth day, Dr. Preecha came with some nurses to remove the packing. This too was painful (especially the removal of packing from inside the vagina), though it was over quickly. I looked down on my new body with real awe and admiration. Bright red and huge and messy, but unmistakably girl.

At that time the catheter was also removed, and then began the only truly upsetting part of my experience. Though it is not the experience of most people, in my case the post-operative swelling was sufficient to block the new urethral opening. I waited all day and tried to urinate three or four times but could not. By early evening I was in great pain and called the nurses. An emergency doctor was brought in, as neither Dr. Preecha nor Dr. Saran could come immediately. I was given a lot of pain-killer as this doctor tried, at first unsuccessfully, to re-insert the catheter. Eventually he was able to do so. It is the greatest pain I ever hope to endure in this lifetime.

I have a friend who had this same complication in Montreal, so I was not completely surprised about it, though of course I was upset. Dr. Saran came later in the evening and discussed the problem with me. The next morning Dr. Preecha came as well and examined me again. He decided to leave the catheter in another two days as the swelling subsided.

It was disheartening to have this experience, as all around me I saw other patients whose surgery was the day before or after mine, walking around happily with no complications at all. It is worth remembering that no two surgeries are ever the same, and as Dr. Sheila Kirk told me in a telephone conversation, no surgery is minor. Complications can and do occur all the time, no matter who the surgeon. Dr. Kirk said that she had performed corrective surgery on patients of all the major GRS doctors.

Dr. Preecha asked me to stay at BNH an extra week to make sure that everything resolved properly, and of course I did so. When I finally checked out of the hospital I found that the extra time had been paid for in full by Dr. Preecha.

Two days later the catheter came out again, and I waited in trepidation for the unavoidable bathroom visit. Ta-da! As the first trickle of warm urine came running down I nearly cried in joy. I had also been constipated -- a more common complaint from all my fellow GRS patients -- and a day or so later when my bowels emptied, I again wanted to cry for joy. All systems were finally "go."

The healing process for me has been slow, and I suspect that may be due to age. The young transgendered I met at BNH, mostly Filipina sex workers, healed quickly and even remarkably, able to fly home after eight days of recovery. Whereas two fellow Americans closer to my own 42 years described more pain and various problems; and an older Japanese woman had excess bleeding after her operation. I should add, however, that we all came out fine in the end.

I left Bangkok on July 4 -- Independence Day! The flight back to Osaka was not too uncomfortable, though I was happy it was only five hours, not the fifteen back to the US. I never found inflatable doughnuts to be of much help in sitting, so I coped with some small pillows instead. Later I found a much better solution: an inflatable neck rest (the type you see airline passengers sleeping with), half-inflated and then used as a seat. This elevates the buttocks and allows you to shift easily, with no possibility of anything pressing against the vagina.

As of now I am two months post-op. I am very happy with the appearance and function of my new vagina. I am not keen as yet to use it for anything sexual, though I have felt the unmistakable feelings rising in the appropriate parts. Direction of urinary spray improves with time and a little practice. Having a full bladder helps, too: The increased force of the spray helps with its direction. Incidentally, Japanese toilets (not much more than a porcelain hole in the ground) are also a big plus in this regard: When you are squatting instead of sitting, the urine has less chance to dribble around and you can direct the spray better.

I would unhesitatingly recommend Dr. Preecha and his clinic to anyone considering GRS. He is an excellent surgeon, his assistants are thorough and professional, and the staff and service of BNH is wonderful. The cost of my GRS was $5000, though Dr. Preecha has now increased the price to $6000. Additional hospital charges, food and the extra bed for Tomoko brought the total to about $8000, and my round-trip airfare from Japan was $400.

Here is an itemized list of advice I would give to anyone going to Bangkok for GRS:

  1. Do not go alone. Bring a friend. He/she will be of assistance in countless ways, whether in getting a newspaper, bringing in something extra to eat, making sure you are not running a temperature, assisting in a walk around the courtyard, just talking things out, or even helping the nurses with their many duties. Knowing there is someone there at all times is worth whatever cost it takes.

  2. Be prepared for surprises, changes, irritations and concerns. Try not to lose your cool. The Japanese say, "ichi-nichi-ju, ichi-nichi-ju," or "one day at a time." It takes time and patience to recover from GRS. Measure your progress by the long haul, and appreciate the incremental improvements.

  3. Spoil and pamper yourself. Bring anything and everything that you think may make you comfortable. Books, magazines, laptop, DVD player. Bring heavy sanitary pads and big, comfy undies. Bring cosmetics to pep up your looks and conditioner to pep up your hair. Indulge yourself as best you can, even just to take your mind off the times of discomfort.

  4. Remember that you are in a foreign country. People in Thailand speak a different language, have different ways of expressing their feelings, relate to others in a different manner, have different concepts of life, death, emotion and spirit. In Thailand a smile is your best friend. A smile to us indicates joy, but to many Orientals, including Thais, a smile also indicates that you are cooperating with others and doing your best to help everyone achieve their goals. It is a small and good thing to smile at a nurse who is cleaning discharge out of your new orifice and wiping up your bodily secretions.

  5. English is as strange to Thais as Thai is to Americans. They do not understand the titles "Mr." and "Mrs.", as their language, like many other oriental languages (including Japanese and Korean), does not have this equivalent. They pronounce everything with stress on the last syllable, as that is how everything is pronounced in Thai. When my nurse kept referring to my "bra-DUH" I had to stop her until I could figure out she was referring to my bladder, not my brother. My name was often misspelled, and sometimes I was called "Lisa" instead of "Sara" -- it sounds similar to them. No problem! Nothing malicious is happening. Smile and keep asking until you figure out what is really going on.

  6. Be grateful for the wonders of medical science. One hundred years ago you couldn't get GRS anywhere. Today I feel like the luckiest woman on the face of the earth.

© 2011 by Anne A. Lawrence, M.D., Ph.D. All rights reserved.