At first glance, this looks like any shabby clinic. People walk by unconcernedly; still others mill around the fish being grilled on the roadside barbeque. For a moment I wonder if I’ve come to the wrong place and stop to crosscheck with a couple of passersby. Nope, this seems pretty much it, so I take a deep breath and walk in.
I’m at the Pratunam Polyclinic on Ratchprarop Road. The katoey whom I met on the crossing over from Pattaya to Samet told me about this place. She said this doctor was good, his rates were lower than the big hospitals and that many katoeys opted to go to his clinic.
It’s a small ordinary waiting room that I walk into. There are a couple of katoeys sitting there; I realise much later that they have come to be there for their friends who were having some procedure done. Yet another katoey walks in off the street, with a urine bag casually slung over an arm, clutch purse in one hand and mobile in the other! I learn from the senior nurse that she had her SRS procedure done 12 days ago. Twelve days and still walking around with a bag, huh. It’s beginning to sink in just how involved and irreversible this process is – and how deeply I’m into this now!
So how did I get to this point? Well may you ask. Having gotten the clinic number from off Google, I called only to be told the doc was in surgery and I should call back in the night. I do; before I can properly embark on my rehearsed spiel, this gruff impatient voice says – “you want see operation? Come tomolow 2 o’clock!” Well, wow. And all I wanted to do was ask a few questions and perhaps bum a few photos off the dude. How could I possibly pass up on an opportunity like this that just fell into my lap by fluke?
I can’t quite believe that a doctor would just casually tell a voice over the phone that claimed to be a journalist, to come and witness an actual operation. Anyway, in for a penny, in for a pound, I tell myself philosophically, and haul ass to this place the next afternoon, making sure my camera has been fully charged. I get here and find there is no grand welcome awaiting me; the receptionist is frankly disbelieving when I tell her the doc has summoned me. Well, I’m not leaving without a good fight J so I keep at her till a senior nurse goes to check with the doctor and comes back to tell me yes, he remembers, and he’s asked me to wait.
So I wait. And wait. And wait. I’ve got a book along but that doesn’t seem to be helping much…I go for a walk and come back to find nothing much has changed, except that there’s a surreptitious sorta whispering among the staff when they see me. Uh oh. It’s never a good sign when Thais go all Thai on you! With much cajoling, I manage to get the reason for their agitation – the katoey who was supposed to show up for the scheduled surgery didn’t turn up, so they called the person next on the waiting list (25-year old Miaow) and it turns out she can’t get here before 4.30 and they’re feeling guilty at making me wait for so long.
I ask if I can talk to the doc while I’m waiting, and manage to get him in between surgeries. He’s not in the best of moods as he’s just finished up with some lady who’s complaining he didn’t do a good job on her boobs last time and made them of uneven size! Brother. I wouldn’t want this dude wielding a scalpel on me in the mean mood he’s in!
Dr Thep Vechavisit (this is his real name and he is fine with it appearing in print) has been practicing for the last twenty years. He spends almost 12 hours each day in the clinic and performs between 5-10 procedures a day. “My country pays a lot of money to make someone a doctor, it is heavily subsidised in Thailand. Now it is 10,000 baht a year but in my time the fees was only 1,000 baht a year. So I have to do my job no matter how late it gets. Sometimes people come to me from other countries and I have to help them, it is my duty,” he says. Patients wanting the sex change operation come to him from Dubai and India as well. I tell him his clinic is very popular among the katoeys. “I do good and cheap work that is why it’s popular,” he shoots back. “You go big hospital, they give penis (he means the dildoes) made from different material, I give wood. Does same job but is much cheaper.”
I ask him the main question that’s been running circles around my brain: post the surgery does a katoey feel like a ‘real’ woman during sex, is it like being a virgin? “She doesn’t know,” he says. Although he does attach the penis’ nerve endings to simulate a clitoris, he says the pleasure of an orgasm is more psychological than physical arising from the sex act.
How soon after the surgery can the katoey have sex? “The wound takes two weeks to heal,” says Dr Thep. “She should wait at least two months before having sex.” Each patient is given a set of three wooden penis-shaped things, of varying length and thickness. She is supposed to insert these into the ‘vagina’ to widen the passage, beginning with the smallest and thinnest of course, two weeks after the surgery has been done.
I ask him whether he’s ever done the reverse op – woman to man. He kinda evades giving a direct answer, telling me instead that he doesn’t like to do it. “I don’t like to do woman to man because the result is not good. No satisfaction,” he says.
He decides we’ve talked enough and tells me to follow him. We walk up three flights of narrow stairs – bear in mind that, when a katoey wakes up post the anaesthesia, she has to walk down these same three flights! There is no lift and no concept of attendants carrying a patient down on a stretcher and I am appalled at how much further – and quite needless – pain the poor thing is exposed to.
So. The doc escorts me to a small room and gestures casually at a mask lying on a bed and I gather I’m to garb up. Miaow is already in the adjoining operation theatre; a small room which has the anaesthetist seated at her head, two nurses on either side of the operation table, the doc at the foot of it, and a helper who’s there to wipe the sweat off the doc’s brow! With me and my camera, it’s quite a crowd and the doc keeps warning me not to bump into stuff. I notice he hasn’t bothered scrubbing up, just slipped on a gown, mask and gloves. The hygiene factor is so basic it’s almost negligible – and I’m wearing no shoes! I have to keep watching out for some blood drops on the floor; the word ‘AIDS’ flashes across my mind’s eye in big neon letters!
Miaow is out for the count; she’s had her breast augmentation surgery done already. Dr Thep lifts the penis and draws two lines on either side of the scrotum with a blue marker. He then uses a scalpel to neatly incision and pull back the skin, thus exposing the testicles. Next, he cuts the skin on either side of the penis; this skin is then pulled back, leaving the inner flesh of the penis. He injects more anaesthesia into the yellow fatty tissue and then cuts through various layers of fat. Pulling the penis towards him, which looks like nothing more than a long rubber tube now, he makes a long cut down the middle and snips away at the head, isolating the nerve endings that cause sensation and pleasure; this will later be fashioned into a ‘clitoris’ to ensure the katoey will still have some feeling in her private parts. The urethra is now separated from the rest of the penis and a catheter is attached to it by one of the nurses.
It’s time now to remove the scrotum and penis. Pulling the penis more firmly, Dr Thep uses a cauterizer rather than scissors, and burns his way through, thus effectively sealing off the nerve endings as he works and ensuring there is minimal blood, although he still needs to put in some quick stitches. Next, he burns away the testicles and yanks – there is no other word for it – them out even as I wince. He now pushes in a curved metal instrument as deep as he can into this space which will simulate the vaginal canal, attaching clamps to blood vessels as he works. These are later cauterized one by one. The metal instrument is now removed.
The doc wants the patient’s legs spread wider apart. He asks one of the nurses what the katoey’s name is and they all start asking each other and look clueless. I suddenly cue in to the conversation going on over my camera and speak out her name. The nurse nearest me looks daggers at me; the doc impatiently tells Miaow to spread her legs wider, the nurse thumps on Miaow’s thigh and she spreads her legs more. I am horrified – “she can hear?” I ask the doc. “No,” he grunts. “She has anaesthesia.” “But, but, but,” I sputter. I don’t get an answer from anyone and yet, I have just seen Miaow move her legs in answer to an instruction. I don’t understand any of it!
Next, Dr Thep takes the skin that was the penile covering and cuts a slit in the centre of it; this is going to be the ‘vagina.’ The urethra with the catheter still attached is now taken through this slit and the doc starts stitching up around it – voila! A vagina. He now pulls down the rest of the top skin and starts stitching along the side, near the right inner thigh. He moves the penis nerve endings to the top of the vagina before stitching along the left side.
Right – we’re still left with the flap of skin that covered the scrotum. The doc stretches this out and quickly sews along the sides. Once that’s done, he pushes it back into the gap that had been created by using the metal instrument earlier. He follows up straight through by pushing in a wooden dildo as far up as it will go; given that it measures 7 inches, that’s a lot! He says this way the katoey will be able to accommodate penises of varying lengths. While this remains in place, he goes to work on moulding the ‘clitoris’ and stitching it at the top of the vagina. The clitoris looks suspiciously tiny to me and I ask him about it. He says he can make it larger if he is asked however, as he’s got all the nerve endings in, it doesn’t really matter as to the size. The dildo is now removed; I ask him what if the flap of skin (the scrotal skin) were to come out during sex, seeing as he’s just pushed it in and it isn’t anchored to anything, and he says that doesn’t happen.
Well, the surgery is all done with; we started at close to 9pm and it’s almost midnight now. Just three hours for a life-changing operation, for an irrevocable act that removes an intrinsic part of your body forever, that gives you, at least for the outside world, a new identity. While I’m proud of myself for not gagging or fainting or anything, I have to say it’s the most efficient piece of butchery I’ve ever seen and not particularly neat either. I guess this is what you get at this price; Dr Thep charges THB 65,000 for the sex change surgery, while mere castration is at THB 5,000 only and breast enlargement is at THB 45,000. Some other clinics charge THB 80,000 for the SRS while well known hospitals can charge up to THB 150,000.
I sure hope Miaow thinks it’s all worth it. There is going to be some incredible pain when she wakes and the healing process is going to be long and hard; remember she has not only got the SRS done but also the boob job. Also, this clinic doesn’t strike me as being particularly hot on compassion; when I called back the next day asking how she was, nobody seemed to know whom I was talking about! I hope she is happy being ‘her’ within her skin now; I hope society accords her the right to be that which she has been seeking all these years; I hope men stop being such cruddy pricks and, above all, I hope her family continues to support her the way they have.
*Katoey name changed to protect identity.
Punam Mohandas asserts her right to be identified as the author of this work. All copyright and pictures are the property of the author.