How to Access

  • Step 1

    Connect with a practitioner

  • Step 2

    Get A Surgical Readiness Assessment

  • Step 3

    Send Completed Information Package to the Surgical Center(s)

  • Step 4

    Have a Surgical Consult

Step 1

Connect with a practitioner

The first step to accessing vaginoplasty or vulvoplasty surgery is to connect with a doctor (GP) or nurse practitioner (NP). The role of the GP or NP is to support you in accessing the care you need. This includes:

  • completing or referring you for a Surgical Readiness Assessment,
  • helping you meet surgical requirements, and
  • assisting with things you need after surgery.

Your GP or NP can access information about how to refer for surgery on the on the Trans Care BC website.

The criteria for vaginoplasty or vulvoplasty surgery are guided by the World Professional Association for Transgender Health’s Standards of Care. Currently, the standards of care recommend a surgical assessment by a Qualified Surgical Assessor.

Ask your GP or NP to refer you to a qualified surgical assessor. If they don’t know of one, they can refer you to Trans Care BC’s Health Navigation Team. This team will coordinate an assessment appointment for you.

If your GP or NP happens to be a qualified surgical assessor, they can do the Surgical Readiness Assessment with you.

Frequently Asked Questions

I don’t have a doctor or nurse practitioner. What can I do?

Contact Trans Care BC’s Health Navigation team  for help connecting with a doctor or nurse practitioner.

How long is the wait for an assessment?

The waitlist to have a publicly-funded Surgical Readiness Assessment varies widely, depending on the availability of qualified surgical assessors near you.

Are there private pay options for Surgical Readiness Assessments?

Yes. Some people choose to pay for an assessment if they are having difficulty getting an appointment with an assessor. If you are interested in this option, you can contact us for help.

How many assessments do I need?

One readiness assessment is usually needed as part of the referral process. There are times when additional assessments may be recommended by your doctor, nurse practitioner, qualified surgical assessor, or surgeon.

There are no assessors in my area. What are my options?

You can contact  Trans Care BC to confirm whether there are any assessors near you. If there aren’t, we can help you arrange a Telehealth or Virtual Health appointment with an assessor.

Step 2

Get A Surgical Readiness Assessment

You will meet with a Qualified Surgical Assessor for a Surgical Readiness Assessment. The Surgical Readiness Assessment confirms that you meet the criteria for publicly-funded Vaginoplasty or Vulvoplasty. It also helps ensure you are prepared and supported before, during, and after your surgery.

Many people feel anxious about the Surgical Readiness Assessment. They worry about saying the wrong thing and being denied a surgery that is very important to their health and well-being.


These assessments have changed as understandings of gender and human rights have evolved. The focus of the assessment should be on supporting you. To learn more about questions you might be asked in an assessment, checkout the Common Surgical Readiness Assessment Questions in the FAQ section below.

Together, you and the assessor will discuss your gender, your health, your support people, and details about the surgical procedure.

After the appointment, the assessor will write a recommendation for surgery based on the criteria for approval and the information you’ve shared with them.

The assessor will send their recommendation to your doctor or nurse practitioner, who will send your completed referral package to the surgical clinic of your choice: the Gender Surgery Program of BC (GSP BC) or GRS Montreal. At this time, you can be referred to both surgical centers. Your name will then be added to the clinic’s surgical waitlist.

The referral form for the Gender Surgery Program of BC can be found on their website.

A list of documents that must be included in a referral to GRS Montreal can be found here.

  • Brief referral letter from GP or NP. Include any relevant clinical details not covered in the surgical recommendation form, e.g.,
    Body Mass Index
  • Copies of the surgical recommendation form(s) (Form A and Form B) or equivalent narrative letters 
  • Any relevant consult reports (e.g. recent cardiology, endocrinology reports)
  • Consent to exchange information between GRS Montreal and Trans Care BC (if applicable, this will be attached to the recommendation forms)
  • Consent to exchange information between GRS Montreal and GP/NP (if applicable, this will be attached to their commendation forms).

Once your surgical program receives all required documents, your name will then be added to their surgical waitlist.

Frequently Asked Questions

What are the criteria for publicly funded Vaginoplasty or Vulvoplasty surgery?

The criteria for Vaginoplasty or Vulvoplasty are guided by the World Professional Association for Transgender Health’s most current
Standards of Care. In British Columbia, the criteria are:

  • Persistent gender dysphoria
  • Age 18 years or older
  • Ability to understand and consent to the surgery
  • One year of hormone therapy
  • Physical and mental health conditions are reasonably well-managed.
  • One year of living in a way that is aligned with your gender. This means that you are actively expressing your gender in your daily life – it does not mean that your gender expression has to conform to the gender binary or a stereotype

What kind of questions will the assessor ask?

The assessor may ask questions…

… about your gender:

  • What pronouns do you use?
  • How would you describe your gender?
  • When did you start living outwardly as yourself?
  • How long have you been thinking about gender-affirming treatment?

…about your physical and mental health:

  • Have you ever been diagnosed with a physical health condition?
  • Have you ever been diagnosed with a mental health condition?
  • What is your height and weight?
  • What medications are you on?
  • Have you had any surgeries before? Did you receive anesthesia? Did you have any problems with it?

…about your support people:

  • Who are your main support people? Will they be able to help you after surgery?
  • Do you have a GP or NP, and are they supportive?
  • Is there anything you think would be important for me to know to help with your care planning?

Here is a downloadable list of common question that you may be asked, during a readiness assessment for gender-affirming surgeries.

What do I need to know to make an informed decision about getting surgery?

It’s important to understand the following information:

  • details related to the procedure,
  • potential benefits and risks of the surgery,
  • permanence of the surgery and how it affects fertility,
  • possible need for revisions,
  • timeline for healing, and
  • what to expect for aftercare in the months after surgery.

Your assessors and your surgical team will help you understand these details. You should ask them any questions you have. To learn more about the procedure, see GRS Montreal’s website:

  • Vaginoplasty
  • Vulvoplasty 

Rainbow Health Ontario has excellent Transition-Related Surgery information too:

  • Vaginoplasty

I don’t identify as feminine or female. Can I still get Vaginoplasty or Vulvoplasty?

Yes.The most current WPATH Standards of Care support access to Vaginoplasty or Vulvoplasty for people who have a non-binary gender and/or people who do not dress or identify as feminine or female

I have a non-binary gender. Can I still get Vaginoplasty or Vulvoplasty?

Yes. The most current WPATH Standards of Care support access to Vaginoplasty or Vulvoplasty for people who have a non-binary gender and/or people who do not dress or identify as feminine or female. 

I am Two-Spirit and seeking gender-affirming surgery. Can I still get Vaginoplasty or Vulvoplasty?

Yes. The most current WPATH Standards of Care support access to Vaginoplasty or Vulvoplasty for people who are Two-Spirit and seeking gender-affirming surgery.

How long will the assessment take?

Surgical Readiness Assessments are usually completed in two sessions (one with each assessor), but it is sometimes possible to have them done at the same time (one session with two assessors). An assessment lasts for 1-2 hours and there is no physical exam. Extra visits may be booked for individuals that need extra support.

What happens if the assessor(s) decide I’m not ready for surgery?

If there are areas of your health or well-being that need attention to make sure you recover safely after surgery, the qualified surgical assessors will recommend that you make a plan with your doctor or nurse practitioner to address them. This can include managing acute or chronic health conditions, getting help with housing, or finding mental health supports that you may not already have.

This does not mean you will be denied surgery. Instead, you will be presented with ways you can work towards a safer surgery and recovery. By addressing these areas, you start your healing process before your surgery and reduce the chances of having complications.

Step 3

Send Completed Information Package to the Surgical Center(s)

In BC, publicly-funded gender-affirming vaginoplasty and vulvoplasty surgery are primarily done at Gender Surgery Program of BC (GSP BC) or GRS Montreal. At this time, you can be referred to both surgical centers.

Select the centre below where you will be having surgery.

  • GSP BC (Vancouver)
  • GRS Montreal

GSP BC (Vancouver)

Steps to set up a surgery date

STEP 1

Once your assessments are complete and your referral has been sent, the Gender Surgery Program of BC will contact your GP or NP to confirm they received it.

You can also call GSP BC directly and confirm that they received your referral package.

  • 1-604-875-5060

STEP 2

GSP BC will contact you to book a surgical consult. This can take upwards of a year.

STEP 3

Once you have had your surgical consult appointment, you will be placed on a waitlist for a surgery date.

GRS Montreal

Steps to set up a surgery date

STEP 1 

Once your assessments are complete and your referral has been sent, contact GRS Montreal to request an information package.

STEP 2

GRS Montreal will send you a package that includes information and a number of documents that they want you to fill out and send back to them.

STEP 3

Once GRS Montreal receives your completed package, they will contact you to book your surgery date.

  • The above process can take some time.
  • You may want to follow up with GRS Montreal to make sure they have received your completed package and to ask if they require any additional documentation.
  • If you experience any challenges with this process, contact Trans Care BC.

Frequently Asked Questions

Where can I learn more about the Gender Surgery Program of BC (GSP BC)?

The GSP BC website has a “resource” section with the following:

  • a recording of their Information Session from September 18, 2019
  • a Frequently Asked Questions document

Are the costs for travelling for this surgery covered?

No, but you can apply for financial support. Please see the Make Travel Arrangements section for details.

Are the costs of staying in Vancouver (before or after my hospital stay) funded?

Some people may prefer to stay in Vancouver for a couple days before and/or after their surgery. These accommodation costs are not funded, though GSP BC surgical team will give you a list of hotels with reduced medical rates.

Are the costs for staying at the aftercare facility in Montreal covered?

Yes. The costs for staying at the Asclepiade aftercare facility are paid by Trans Care BC.

Where can I learn more about the surgeons at the GSP BC?

The GSP BC website has a “Meet the Surgeons” section that introduces the surgeons. If you have questions about requirements or would like up-to-date estimates of wait times, you can call the GSP BC.

Where can I learn more about the surgeons at GRS Montreal?

To learn more about the surgeons, check out GRS Montreal’s The Surgeons.

If you have questions about a surgeon’s requirements or would like up-to-date estimates of wait times, you can call GRS Montreal.

What if GSP BC is not able to do my surgery?

If you are not medically eligible for surgery in BC, your surgical team will work with you to determine if other surgical centres may be an option. Clients can call Trans Care BC for more information.

What if GRS Montreal is not able to do my surgery?

At this time, people can be referred to Gender Surgery Program BC and/or GRS Montreal.

Certain medical conditions may put someone at higher risk for experiencing complications during surgery. It might be recommended that a person have surgery in a hospital operation room rather than the GRS Montreal private surgical centre. If GRS Montreal is not able to do your surgery, your GP or NP can refer you to the Gender Surgery Program BC to discuss your options.

If you are not medically eligible for surgery in BC, your surgical team will work with you to determine if other surgical centres may be an option. Clients can call Trans Care BC for more information. 

Step 4

Have a Surgical Consult

A surgical consult is an appointment with your surgeon to talk about your goals for surgery and your options in terms of procedures. It’s also an opportunity for you to ask questions.

Some people do travel for in-person consults when possible or when required by the surgeon. If you cannot make a separate trip to Montreal, your surgeon will meet with you for an in-person consult a day or two before your surgery in Montreal.

  • GSP BC (Vancouver)
  • GRS Montreal

GSP BC (Vancouver)

The Surgical Consult

Before the appointment for your surgical consult, you will receive information about what to expect during this appointment. Sometimes you might have more than one appointment as part of this process. Each visit is a bit different, but generally the process will include:

Meet the nurse and have a detailed health history. The nurse might:

  • ask questions about your gender, general health, and family history
  • check blood pressure and heart rate
  • listen to your lungs, if needed
  • talk about what to expect from the rest of the process

Meet the surgeons and have a focused health history. The surgeons might:

  • ask more detailed questions about your health, if needed
  • ask about your hopes and surgical goals
  • do a physical exam, including a genital exam
  • assess need for medically necessary hair removal
  • take pre-op photos of the genitals if needed
  • determine if additional assessments or diagnostic tests are needed before proceeding

The surgical team will review the process of informed consent by helping you understand the:

  • recommended procedure
  • details about the procedure
  • potential benefits and risks of the surgery
  • permanence of the surgery and how it affects fertility
  • possible surgical outcomes
  • possible need for revisions
  • timeline for healing
  • what to expect for aftercare in the months after surgery, including return to physical activity

The next step is for the surgical team to initiate the process of filling out the OR Booking Package. This is done when someone is medically ready to proceed with surgery. Some people will fill out the OR Booking Package at their consult and others may need to complete a few additional assessments first.

Closer to the time of your surgery, you may be booked an appointment with the Pre-Admission Clinic (PAC), which is a clinic that provides support for patients having surgery at VGH and UBC.

During this appointment, the nurses and anesthesiologists will review your health history, your current medications and your planned surgical procedure. You will also be reminded about instructions for before your surgery about diet and medications to take the day of surgery.

You will be given instructions about what to bring with you for this appointment. 

GRS Montreal

Some people do travel for in-person consults when possible or when required by the surgeon. If you cannot make a separate trip to Montreal, your surgeon will meet you for an in-person consult a day or two before your surgery in Montreal.

The Phone & In-Person Consult

The Surgeon will review the process of informed consent by helping you understand the:

  • details about the procedure
  • potential benefits and risks of surgery
  • permanence of the surgery and how it affects fertility
  • possible need for revisions
  • timeline for healing
  • what to expect for aftercare in the months after surgery

The In-Person Consult

Each surgeon does things a bit differently, but generally the surgeon will:

  • ask questions about your gender, general health, and family history
  • examine the genitals to determine if there is enough tissue to do the surgery without an extra skin graft
  • check blood pressure
  • listen to your lungs
  • gently press on the abdomen and lymph nodes
  • take pre-op photos of the genitals
  • talk about possible surgical outcomes
  • give instructions for aftercare, including return to physical activity

Here are some tips on how to prepare for this appointment:

  • Attend a GSP BC Surgery Education Class
  • Read up on the surgery you are interested in:
  • Search online for before-and-after photos, including photos of people who have a body similar to your own
  • Have a list of your current medications and supplements (including traditional medicines, such as herbs and teas; vitamins; minerals; amino acids; and probiotics). Include the dose and how often you take them
  • Have a list of questions for the surgeon.
  • You can find both lists in The Workbook for Vaginoplasty and Vulvoplasty Surgery in BC, or you can click the support tool on this page.
  • Have a pen for taking notes.
  • If there are any updates on your health since your initial referral was made, ask your GP or NP to send any relevant information to your surgical centre.

Frequently Asked Questions

What if the surgeon(s) recommends a type of surgery that is different from the one I want?

The surgeon will recommend the type of surgery that they think will provide you with the best surgical outcomes. Their recommendation is based on their extensive training, research, and experience. In some instances, the surgeon may recommend vulvoplasty instead of vaginoplasty.

If this is different from the surgery you want, you are encouraged to let them know. This will lead to a conversation about the pros and cons of the different techniques as they apply to your goals.

If you would like to have a consult with another surgeon to explore other options, you can contact Trans Care BC. Booking a consult with another surgeon will require extra wait time.

I have been referred for an anesthesia consult. What does this mean?

Before surgery, you will be given anesthesia. Some health conditions can put you at higher risk for complications from anesthesia. In this case, your surgeon may refer you to an anesthesiologist for further assessment.

Having a consult with an anesthesiologist is a normal part of the surgical process for many people. We are all complex beings and some of us need more support than others. The purpose for anesthesia referrals is to make sure all measures are taken to keep you safe both during and after surgery. Because there are a number of different of anesthesia options, meeting with the anesthesiologist will help determine which one will best suit you and your health needs.

The anesthesia consult can be different based on the provider, but the doctor generally looks at a number of factors, including blood pressure, Body Mass Index and the presence of other medical conditions such as asthma or diabetes.

Depending on these factors, some patients with higher anesthetic risks may need to have surgery in a hospital operating room (rather than a private surgical centre) for safety reasons. In this case, having surgery in the US may be possible by applying to the Out-of-Country program. If appropriate, a qualified surgical specialist can complete an application for Out-of-Country Surgery. Clients can call Trans Care BC for more information.

Waiting and having challenges accessing surgery can be stressful. Many people find it helpful to connect with others who have gone through similar experiences. You might meet people who have had gender-affirming surgery through friends, support groups, or online networks.You may also find it helpful to talk to a counsellor during this time.

If you are experiencing challenges accessing surgery, or if you have questions about this process, call Trans Care BC.

The waiting process:

Waiting and having challenges accessing surgery can be stressful. Many people find it helpful to connect with others who have gone through similar experiences. You might meet people who have had gender-affirming surgery through friends, support groups, or online networks.You may also find it helpful to talk to a counsellor during this time.

If you are experiencing challenges accessing surgery, or if you have questions about this process, call Trans Care BC.