PME Guide

Navigation guide for phalloplasty, metoidioplasty, and erectile tissue release surgeries
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This Guide

Gender-affirming phalloplasty, metoidioplasty, and erectile tissue (clitoral) release surgeries are publicly funded for Two-Spirit, transgender, and gender diverse individuals in British Columbia. These surgeries can be done at the Gender Surgery BC at Vancouver General Hospital (GSP BC) or GRS Montreal, a surgical centre in Quebec.

This guide outlines the steps for accessing publicly funded phalloplasty, metoidioplasty, and erectile tissue (clitoral) release.

The additional procedures (i.e. urethral lengthening, vaginectomy, scrotoplasty, insertion of testicular and/or penile implants) may be included depending on a person’s goals and body. The insertion of implants takes place after one has finished healing from the initial surgery, which is usually a minimum of six months later.

Trans Care BC’s Health Navigation team is available to help you at any point in this process.

Explore this guide

To explore this guide, click through the categories listed above.

To use the menu feature, click on the green bar located on the left side of the page (computers), or at the top of the page (mobile devices).

Contact us

Trans Care BC’s Health Navigation Team is available to help you at any point in this process. You can find a link to our contact page in the bottom right corner of this guide.

Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC

Preparing for lower surgery is a physical, emotional, mental and spiritual process. We’ve created the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC to help you along the way. It contains some of the information on this website, along with worksheets, checklists, and exercises.

Procedures

Click on a box below to learn more about the subject.

Erectile Tissue Release & Metoidioplasty

Procedures

Surgical techniques vary from surgeon to surgeon. This is the procedure common at GRS Montreal:

Some people choose to have erectile tissue release surgery without any additional procedures, while others may choose to have it in combination with additional procedures. 

Erectile tissue release:

Surgical techniques vary from surgeon to surgeon. Before surgery, testosterone is taken to enlarge the erectile tissue (clitoris). Some people choose to wait 2-3 years to achieve maximum growth before proceeding with surgery. 

The ligaments holding the erectile tissue (clitoris) in place under the pubic bone are cut, allowing the shaft to fall away form the body, giving it a more pronounced appearance

Fat may be removed from the pubis and skin may be pulled upward to bring your phallus forward.

Urethral lengthening:

Re-routing the urethra up through the tip of the penis, with the goal of allowing urinating from a standing position.

Lengthening may be done using nearby tissue (ie: inner labia) or buccal (cheek) tissue, depending on the individual.

Scrotoplasty:

The external genitals (labia or outer labia) may be shaped into a scrotum. 

Vaginectomy

Removal of internal genital (vaginal) tissue and closing of genital opening (vaginal canal).

Implants

Testicular implants may be placed inside the scrotum at a later stage, usually a minimum of six months after the initial surgery.

Complications

All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and infection. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise and respond to them appropriately. They will also inform you about what you can do to minimize your risks. Some complications are particularly associated with metoidioplasty. 

Below are a list of some possible complications of this surgery. Please note – this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

Abscess formation

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

Decreased sensation

The risk of decreased sensation after metoidioplasty is less than with phalloplasty, but changes to sensation are still possible.

Dissatisfaction…

Some people may be dissatisfied with the size or shape of the penis. You can check with your surgeon to see if surgical revision is possible.

Hematoma

When blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.

Seroma

When clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery.

Wound separation

The partial or complete opening of incisions along the sutures.

Scarring

You can take steps to prevent significant scarring by following your surgeon’s advice about getting rest, avoiding the sun and doing massage exercises. Severe scarring may require surgical revision.

Urological complications

Even with urethral lengthening, some people will not be able to urinate while standing. This can be because of the urine stream (it may spray or dribble), or because the penis does not extend far enough out from the body.

Other urological complications include fistulas (flow of urine to areas other than urethra opening), stenosis (narrowing of the urethra, causing difficulty urinating), strictures (scarring inside the urethra, causing difficulty urinating) and hair growth inside the urethra. If these problems don’t resolve on their own, they may require additional surgery.


Phalloplasty

Procedures

Surgical techniques vary from surgeon to surgeon.

  • Skin, nerves, veins and arteries from your forearm or another site such as the thigh are removed. This is called a graft.
  • A small part of the graft is used to extend your urethra.
  • A larger part of the graft is wrapped around the urethra to create the penis shaft and glans, the head of the penis.
  • The labia are repositioned and reshaped to make a scrotum.
  • The vagina may be removed or closed (if desired).
  • If the forearm is the site used, skin from the thigh is used to cover the graft site.
  • A surgery to reposition the urethra through the penis (urethral lengthening) may be done a minimum of 6 months after the creation of the penis.
  • Testicular implants and an erectile device may be put in at a later stage (if desired).

Complications

All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and infection. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

Some complications are particularly associated with phalloplasty. Below are a list of some possible complications of this surgery. Please note – this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

Abscess formation

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

Decreased sensation or ability to achieve orgasm

There is risk of decreased sensation or inability to achieve orgasm after surgery. 

Dissatisfaction with size or shape

Some people may be dissatisfied with the size or shape of the erectile tissue (penis). You can check with your surgeon to see if surgical revision is possible.

Hematoma

When blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.

Implant complications

Complications associated with penile implants include poor positioning, technical failure and infection. The implant can be either be repaired or surgically removed and replaced. Complications associated with testicular implants include poor positioning and infection.

Numbness in the hand or wrist of the donor arm

Usually resolves in a few weeks. Permanent changes to sensation or function are very rare but possible. Some people require prolonged physiotherapy to recover.

Wound separation

The partial or complete opening of incisions along the sutures.

Scarring

You can take steps to prevent severe scarring by following your surgeon’s advice about avoiding sun and doing massage exercises. Severe scarring may require surgical revision.

Seroma

When clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery.

Tissue transfer complications

Related to the transfer of skin from your forearm to your groin. There is a small risk of a partial or complete loss of the penis if the transfer is unsuccessful.

Urological complications

Very common, though they often resolve with time. Examples include fistulas (flow of urine to areas other than urethra opening), stenosis(narrowing of the urethra, causing difficulty urinating), strictures (scarring inside the urethra, causing difficulty urinating) and hair growth inside the urethra. If these problems don’t resolve on their own, they may require additional surgery.

COVID-19

Planning for gender-affirming surgery during the COVID-19 pandemic

If you plan to have gender-affirming surgery during the COVID-19 pandemic, prepare with pandemic safety in mind. Take time to review the checklist that is right for your situation with your GP or NP and the people who will be supporting you after surgery.


Gender-affirming surgery in BC

Here are some things to consider if you are having gender-affirming surgery in BC, during the COVID-19 pandemic.  

Gender-affirming surgery in Montreal

Here are some things to consider if you are travelling to Montreal for gender-affirming surgery, during the COVID-19 pandemic. 


How To Access

  • Step 1

    Decision-making
  • Step 2

    Connect with a practitioner
  • Step 3

    Get Two Surgical Readiness Assessments
  • Step 4

    Be Referred to the Surgical Center(s)
  • Step 5

    Have a Surgical Consult
  • Step 6

    Get Hair Removal from your Donor Site

Step 1

Decision-making

Should I get surgery? Which procedures are right for me? These are big decisions. Below is a list of strategies that can help you make a decision you feel confident about.

Trans Care BC’s Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC contains reflection activities that can help you in this process. Choose any strategies you like.

Step 2

Connect with a practitioner

The first step to accessing phalloplasty, metoidioplasty or erectile tissue release 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:

  • referring you for Surgical Readiness Assessments,
  • helping you meet surgical requirements, and
  • assisting with things you need after surgery.

Ask your GP or NP to refer you to two qualified surgical assessors. If they don’t know of any, 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.

If you are having surgery in GRS Montreal, it is recommended that your healthcare provider also refer you to an urologist prior to your surgery so you can see them as part of your post-operative care.


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?

Two readiness assessments are 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 3

Get Two Surgical Readiness Assessments

You will meet with two qualified surgical assessors for a Surgical Readiness Assessment. The Surgical Readiness Assessment confirms that you meet the criteria for publicly funded phalloplasty, metoidioplasty or erectile tissue release surgery. 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. It may ease your fears to know that these assessments have changed as understandings of gender and human rights have evolved. The focus is on supporting you.

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

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

The assessors 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 BC or GRS Montreal. At this time, you can be referred to both surgical centers. You will be added to the waitlist for a consult appointment.  


Frequently Asked Questions

What are the criteria for publicly funded phalloplasty, metoidioplasty, or erectile tissue release surgery?

The criteria for phalloplasty, metoidioplasty or erectile tissue release surgery are guided by the World Professional Association for Transgender Health’s (WPATH) 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 (there may be occasional exceptions, based on surgeon’s assessment),
  • Physical and mental health conditions are reasonably well-managed, and

One year of living in a way that is aligned with your gender. This means that you are actively expressing your gender in yourdaily life – it does not mean that your gender expression has to conform to a stereotype.

What kind of questions will the assessors ask?

The assessors 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 Rainbow Health Ontario’s resources

I don’t identify as masculine or male. Can I still be approved for phalloplasty, metoidioplasty or erectile tissue release surgery?

Yes. The most current WPATH Standards of Care support access to phalloplasty, metoidioplasty, or erectile tissue release surgery for people who have a non-binary gender and/or people who do not identify as masculine or male.

I have a non-binary gender. Can I still get phalloplasty, metoidioplasty, or erectile tissue release surgery?

Yes. The most current WPATH Standards of Care support access to phalloplasty, metoidioplasty and erectile tissue release surgeries for people who have a non-binary gender and/or people who do not dress or identify as masculine or male.

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 assessors 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 4

Be Referred to the Surgical Center(s)

In BC, publicly funded gender-affirming phalloplasty, metoidioplasty or erectile tissue release surgery can be done at the Gender Surgery Program BC or GRS Montreal. At this time, you can be referred to both surgical centers.

For help with making decisions about lower surgeries, including location and procedures, refer to the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC.

Select the centre(s) below to learn more about the referral process.

  • GSP BC (Vancouver)
  • GRS Montreal

GSP BC (Vancouver)

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

Once your assessments are complete and your referral has been sent, the Gender Surgery Program BC will contact your GP or NP to confirm they received it. You can also call the GSP BC directly and confirm that they received your referral package.

  • Tel: 604-875-5060

GSP BC will contact you to book a surgical consult.

Erectile Tissue Release and Metoidioplasty

Once you have had your surgical consult appointment, the GSP BC will contact you to book your surgery date. The wait time for this can vary and your surgical team will give you up-to-date information during your consult appointment.

Phalloplasty

Once you have had your surgical consult appointment, the GSP BC may recommend you for medically necessary hair removal at your donor site (this may not be required for everyone).

If the GSP BC surgeons provide a written recommendation for medically-necessary hair removal, you will also receive detailed instructions on how to move forward with getting publicly-funded hair removal.

The GSP BC will meet with you to assess how the hair removal is coming along. Once the hair removal process is complete, they will contact you to book your surgery.

GRS Montreal

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

GRS Montreal referral documents

  • Brief referral letter from GP or NP. Include any relevant clinical details not covered in the surgical recommendation form
  • 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 TCBC (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 the recommendation forms).

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

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.


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

  • This 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

Where can I learn more about GRS Montreal?

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.

Step 5

Have a Surgical Consult

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

  • GSP BC (Vancouver)
  • GRS Montreal

GSP BC (Vancouver)

Tips for preparing for this consult:

  • Attend a GSP BC Surgery Education Class 
  • Read up on the surgery you are interested in-some resources include:
  • Search online for before-and-after photos, including photos of people who have a body similar to your own.
  • 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 GSP BC.
  • Consider inviting someone to write notes so you can focus on the conversation.
  • Make a list of questions for the surgeon. You can find common questions in The Workbook for to Phalloplasty, Metoidioplasty and Erectile Tissue Release Surgery in BC.

What should I bring?

  • A pen for taking notes
  • 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
  • A list of questions for the surgeon.

Click this support tool to review both lists.

These lists are included in the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC.


What to expect from this visit

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 you will:

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
  • check height and weight
  • 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 checking the blood supply in your donor site 
  • do an internal genital exam (using a speculum to assess the genital depth and health of internal tissues)
  • assess need for medically necessary hair removal to donor site (for phalloplasty with urethral lengthening only)
  • take pre-op photos of the genitals, if needed
  • determine if additional assessments or diagnostic tests are needed

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, and
  • what to expect for aftercare in the months after surgery, including return to physical activity.

You will also be shown a slide show about your surgery- this will include pictures of the surgery happening, and examples of post-operative results at different points of the healing process.

Next Steps

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 initial consult and others may need to complete a few additional assessments and have medically-necessary hair removal first.

Closer to the time of your surgery, you will be booked for an in-person appointment or phone call with the Pre-Admission Clinic (PAC), which is a clinic that provides support for patients having surgery at Vancouver General Hospital and UBC Hospital.

During this appointment, the nurse will review your health history, your current medications and your planned surgical procedure. You will be given information about any pre-op tests that are needed. You will also be reminded about instructions about diet and medications to take the day of surgery. You will spend time with the GSP BC nurse and health navigator to review the Enhanced Recovery After Surgery guide. This booklet will guide you through each step of the process and provide answers to common questions you may have.

GRS Montreal

GRS Montreal will work with you to arrange an in-person consult with your surgeon.

Tips for preparing for this consult:

  • Attend a GSP BC Surgery Education Class
  • Read up on the surgery you are interested in and do some reflective exercises – some resources include:
  • Search online for before-and-after photos, including photos of people who have a body similar to your own.
  • 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 GSP BC.

What should I bring?

  • A pen for taking notes
  • 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
  • A list of questions for the surgeon. You can find common questions in The Workbook for Phalloplasty, Metoidioplasty and Erectile Tissue Release Surgery in BC (hyperlink to pdf)

Click this support tool to review both lists.

These lists are included in the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC.


What to expect from this visit

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:

The surgical team will take a detailed health history. This may include:

  • questions about your gender, general health, and family history
  • questions about your hopes and surgical goals
  • a physical exam, which might include checking the blood supply in your donor site, checking your blood pressure, listening to your lungs, and gently pressing on the abdomen and lymph nodes
  • an internal genital exam (using a speculum to assess the genital depth and health of internal tissues)
  • pre-op photos of the genitals if needed
  • a discussion about possible surgical outcomes
  • information about whether additional assessments or diagnostic tests are needed

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

  • details about 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
  • instructions for aftercare, including return to physical activity.

Frequently Asked Questions

What if the surgeons recommend a type of surgery that is different from the one I want?

The surgeons 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.

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

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.

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. 

Are the costs of travel and accommodation covered for my surgical consult in Montreal?

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

How can I care for my mental health during 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.

Step 6

Get Hair Removal from your Donor Site (for urethral lengthening only)

For patients having phalloplasty or metoidioplasty with urethral lengthening, medically-necessary hair removal may be required. Hair is removed from the part of the donor tissue that will become the new urethra.

GSP BC:

At the time of your surgical consult, the GSP BC surgeons will assess your donor site to determine if you need medically-necessary hair removal for this area (this may not be required for everyone).

If the GSP BC surgeons provide a written recommendation for medically-necessary hair removal, you will also receive detailed instructions on how to move forward with accessing publicly-funded hair removal.

  • Many people choose to wait to start hair removal until they have received a recommendation from the GSP BC surgeons during their consult appointment.  This ensures that the all expenses will be publicly-funded and the hair removal will be done in the correct place.
  • If you start hair removal prior to your consult, any out-of-pocket expenses cannot be reimbursed.
  • All publicly funded hair removal needs to be done by PHSA pre-approved Electrologists.

GRS Montreal:

Information about hair removal can be found on their Frequently Asked Questions web page.

At this time, the Ministry of Health has not yet approved funding for hair removal for patients who are accessing surgery outside of BC.



How to Prepare (COVID-19 Disclaimer)

  • Buy, borrow, and do
  • Arrange help
  • Make travel arrangements
  • Make a self-care plan
  • Know what to expect before surgery

Buy, borrow, and do

There are lots of items you’ll need to gather and prepare in advance of your return from surgery.

A comprehensive checklist is included in the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC, or you can download the checklist by itself here. 

Frequently Asked Questions

What costs associated with surgery are not covered by MSP?

While MSP pays for the cost of certain surgeries, there can be additional costs that are not covered. These include costs associated with:

  • Travel and accommodation
  • Supportive garments
  • Compression garments
  • Wound care supplies for dressing changes at home
  • Any extra supplies you would like to have while you heal
  • Costs associated with travel to and from your appointments

Important: You may want someone to travel with you. Keep in mind that this person’s travel and accommodations will not be covered by MSP.

How do people pay for the extra costs associated with surgery?

Here are some funding strategies people have used to cover these costs:

  • First Nations Health Authority benefits:
    • Individuals who are Indigenous, have status, and live in BC are able to access FNHA benefits.These benefits can provide coverage for gender-affirming resources, like binders and post-operative supplies, like compression vests.  To learn more about how to access gender-affirming products available through FNHA benefits, you can call the FNHA Benefits Program call 1-800-317-7878 and select option 2.
    • FNHA benefits can also cover the costs of travel, accommodation and meals when you need to travel for medically necessary care (including chest construction and revision surgeries). You can learn more about this by:
      • calling the FNHA Benefits Program call 1-800-317-7878 and select option 2
  • If you are on provincial disability assistance, you can contact the Ministry of Social Development and Poverty Reduction to discuss funding for travel,support garments and other medically necessary supplies. Your GP or NP can write you a letter of support to access these funds
  • Medical EI can be an option for individuals who are working and meet the eligibility criteria
  • Speak with your employer or Human Resources department about any Short Term Disability, sick time, or vacation time you can use during your time off work for surgery
  • Check your extended benefits program if you have one
  • Consider organizing online or in-person fundraisers

Arrange help

You’ll likely need some support after surgery. For example, you might need someone to help with meal preparation, child care, elder care, laundry, pet care, or garbage and recycling.

Important: If you have erectile tissue release surgery at the GSP BC, you will need someone 18 years or older to escort you back to your home or accommodations. You won’t be able to drive. You will also need someone to supervise you for 24 hours following surgery.


If you find it hard to ask for help, you aren’t alone. Many people have a hard time with this.

People often feel flattered and happy to pitch in, especially if you ask for help with something specific.

Fortunately, lots of people like to help.It gives the helper a chance to feel good about themselves and a way to show they care.

To make a plan around asking for help, try out this activity in the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC.


Support Checklist

Here is a checklist that you can give people looking for ways to support you before and after surgery.

This checklist is included in the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC.

You can also send people to the Supporting Someone Having Surgery handout, in the Resources section.

Make travel arrangements

If your surgery is taking place outside your home community, you will need to arrange transportation and accommodations.

If you plan to have gender-affirming surgery during the COVID-19 pandemic, prepare with pandemic safety in mind. Take time to review the pandemic checklist that is right for your situation with your GP or NP and the people who will be supporting you after surgery. You can find the checklists on the home page of this guide.

Select the centre below where you will be having surgery.

  • GSP BC (Vancouver)
  • GRS Montreal

GSP BC (Vancouver)

Transportation

Book your mode of transportation (bus, air, rail, or ferry). You will need someone else to drive you from the hospital to your accommodations and later on, back home.

If you qualify for the First National Health Authority’s Health Benefits Program, you may be able to access Medical Transportation Benefits.

If travel costs are a barrier, you might qualify for the Travel Assistance Program (TAP BC). To access the program:

  1. Ask your doctor or nurse practitioner to fill out a Travel Assistance Program (TAP BC) form.
  2. Two weeks before surgery, call TAP BC to get your confirmation number. Write it on your form.
  3. Show your form at the time you make air, rail, or ferry reservations.

If you are approved for TAP BC, you may also qualify for Non-Local Medical Transportation Assistance to help with food and accommodation costs. Ask your doctor or nurse practitioner to fill out a Request for Non-Local Medical Transportation Assistance form.

If you are flying, find out if you qualify for Hope Air, a Canadian charity that arranges free flights for low-income Canadians who must fly to get healthcare. 

Otherwise, book your flight early to get the best deal.

Accommodations

Find out how long your surgeon requires you to stay nearby. This will differ based on which procedure you had. Book your accommodations early to get the best deal. Some hotels provide lower rates for people travelling for medical reasons. You can contact hotels directly or search the Government of BC’s Medical Travel Accommodation Listings

If you qualify for Hope Air, you may also qualify for their Hope Air Accommodations Program- details are available on the Hope Air Frequently Asked Questions page, in the Accommodations section.

You can also check out this page from Vancouver Coastal Health that has information on places to stay.

Frequently Asked Questions (GSP BC)

I don’t have a ride from the hospital in Vancouver – are there any patient transportation services available?

You are expected to arrange a ride when you are discharged from the hospital. If you do not have someone who is able to drive you, speak with GSP BC’s Health Navigator before your surgery and they can help you organize your hospital discharge transportation. There are usually a few options to consider:

  • If you qualify for the First Nations Health Authority’s Health Benefits Program,you may be able to access Medical Transportation Benefits.
  • Hospitals often contract local patient transfer services. There is usually a fee (about$50-$100) for this service. This fee is waived for people on Income Assistance or MSP Premium Assistance.
  • If you have private insurance, you can call your insurer to see if your plan covers the cost of this service.

GRS Montreal

GRS Montreal will recommend that you arrive in Montreal a couple of days before your surgery. You will need to arrange your flight. They will arrange your accommodation and provide transportation to and from the airport.

  • If you qualify for the First National Health Authority’s Health Benefits Program, you may be able to access Medical Transportation Benefits.
  • Find out if you qualify for Hope Air, a Canadian charity that arranges free flights for low-income Canadians who must fly to get healthcare.  Otherwise, book your flight to Montreal early to get the best deal.
  • Ensure you have the necessary ID documents or passport.
  • Ask your doctor or nurse practitioner for a travel letter if you feel worried that your appearance differs from the picture on your ID documents or passport.

Frequently Asked Questions (General)

I’m travelling by plane. What else do I need to arrange?

  • Ensure you have the necessary ID documents/passport.
  • Ask your doctor or nurse practitioner for a travel letter if you feel worried that your appearance differs from the picture on your ID documents/passport.
  • Ask your doctor, nurse practitioner or surgeon for a letter indicating that you just had surgery and should not raise your arms when going through security.

Make a self-care plan

It is important to follow your surgeon’s instructions for how to prepare for surgery. The information below is a brief summary and does not replace the information you receive from your surgeon. If there are any differences, you should follow your surgeon’s instructions.

You can reduce complications from surgery by starting the healing process beforehand. Below are some steps you can take before surgery to help your body recover. For most of us, these strategies are easier said than done. Remember that self-care includes doing what is manageable and trying to love ourselves no matter what. 

  • Enjoy foods that promote wound healing. Look for foods with protein (meats and nuts); zinc (whole grains, spinach, nuts); vitamin A (carrots, broccoli, eggs); & Vitamin C (citrus fruits, strawberries, peppers).
  • Do simple and fun exercises to build strength and support your heart and lung health, like dog walking, dancing, hiking, stretching or weight training.
  • Drink enough water to have clear, light yellow-coloured urine.
  • Get 7-9 hours of sleep each night. If you have any trouble sleeping, speak with your doctor or nurse practitioner about strategies for better sleeping.
  • Take time to slow down and relax before your surgery. Practice the deep breathing or coughing exercises, since this can help with relaxing and will speed up your recovery after surgery.
  • Work towards your personal health goals- this might include controlling blood sugar or improving anemia (low iron). Good iron stores allow you to heal better and have more energy when you go home. Maintaining blood sugar helps with wound healing after surgery.
  • Quit smoking. We know – it’s a big ask. Lung health is an important helper in healing, and smoking cigarettes can disrupt the healing process. This is why surgeons and healthcare providers recommend avoiding cigarettes before and after surgery. Smoking cessation supplies are provided at no-cost to people with MSP at any pharmacy in BC. If avoiding smoking for 2-3 months will be hard for you, call Trans Care BC for more information on your options.
  • If you smoke marijuana and going 2-3 months without it will be hard for you, consider switching to edibles, concentrates, or tinctures.
  • Other substances like methamphetamines, cocaine, heroin and alcohol also disrupt the healing process. It is recommended to avoid these substances before and after surgery. If you need help with this, your healthcare provider can help you make a plan.

Self-care planning exercises

Here are some holistic self-care planning exercises to help you prepare for before and after surgery. These exercises are also included in the Surgery Workbook.

Know what to expect before surgery

It can be helpful to have an idea of what to expect on the days before your surgery. You can ask your surgical team about this and connect with others who have had this procedure. Here is some general information about what you might expect on the days before your surgery.

This information does not replace the information you receive from your surgical team. If there are any differences, you should follow the guidance of your surgical team.


Select the centre below where you will be having surgery.

  • GSP BC (Vancouver)
  • GRS Montreal

GSP BC (Vancouver)

Your surgical team will provide you with many opportunities and resources to prepare for your surgery. This will include:

  • Pre-operative education sessions
  • Enhanced Recovery After Surgery guide. This booklet will help guide you through each step of the process and provide answers to common questions you may have


Below is a description of what generally happens when you access surgery at the Gender Surgery Program BC. This information is provided to help you start imagining what the hospital experience could be like- you will be given more detailed and up-to-date information once you meet the GSP BC surgical team and receive your Enhanced Recovery After Surgery guide.

  • The GSP BC nurse and Health Navigator will provide you with instructions on any preparations you need to do before your surgery.
  • The day before surgery, a nurse from the hospital’s Admitting Department will call to confirm the time of your surgery and the time you need to arrive at the hospital.
  • The night before your surgery, follow the instructions from your surgeon for when to stop eating and drinking.

  • The day of your surgery, arrive at the hospital’s Admitting Department at the time advised by the surgeon’s office.
  • Check in with the Admissions Desk. Get a wristband with your name, date of birth, PHN and the gender that is listed on your BC Services Card.
    1. HOT TIP: The team at GSP BC works with other hospital departments to ensure that your correct name and pronoun are used during your hospital stay. Hospital Admission staff will write the name you go by on your wristband ID.

  • You will be given some privacy to wash and change into a hospital gown.
  • A nurse will talk with you about what to expect. You’ll be reminded to remove your jewelry. You can ask any questions you have.You may be given some medications.
  • The nurse may start an IV, check your blood pressure, and assist you into the hospital bed.
  • The surgeons may visit you, do some assessments on the blood vessels in your arms and legs, and make some drawings on your body to guide the procedure. 
  • The anesthesiologist may visit you to talk about the anesthetic and answer questions.

  • You will be taken to the Operating Room in your hospital bed.
  • The nurses will assist you onto the surgical table and put on a blood pressure cuff and some monitors.
  • The Operating Room team will confirm with you the name that you go by, the name on your BC Services Card (if different), and the type of surgery you are having.
  • The anesthesiologist will talk you through going under anesthesia.
  • Once the anesthesia has made you fall asleep, the surgeon will begin the procedure. The procedure usually takes about 9-12 hours for phalloplasty and 5-6 hours for metoidioplasty. Your friends and family can wait for you in the waiting room.

  • When the surgery is over, you will be taken to a recovery area. Nurses will monitor you closely until the anesthesia wears off.
  • You will be taken back to your hospital room and the nurses will help you get settled. They will continue to monitor you, help you with pain management, and talk to you about your bandages and drains. Once you are settled, your friends and family can visit you.
  • After your surgery, you will stay in the hospital for 6-7 days if you have had phalloplasty and 2-3 days if you have had metoidioplasty.
  • You will then be discharged home or to your local temporary accommodations. 

GRS Montreal

If you have any questions about having phalloplasty, metoidioplasty, or erectile tissue release surgery at GRS Montreal, we recommend that you refer to their website.

It can also be helpful to speak with others who have had surgery at GRS Montreal, if they are comfortable sharing about their experience.


Below is a description of what generally happens when you access surgery at GRS Montreal. Each situation is a bit different and processes change over time, but generally the process will include:

  • Have an in-person consult with your surgeon 1-2 days before your surgery.
  • Follow the instructions for the night before your surgery related to bowel preparation, showering, and removing jewelry.
  • Follow the instructions from your surgeon for when to stop eating and drinking.

  • Arrive at the surgical centre on the day of surgery. Some people are advised to come the night before.
  • Check in with the Admissions Desk.


  • The staff will show you to your room. There will be a vault to store your valuables.
  • A nurse will talk with you about what to expect.You’ll be given a hospital gown to change into. You’ll be reminded to remove your jewelry. You can ask any questions you have.
  • The nurse will start an IV and check your blood pressure.
  • The surgeon may make some drawings on your skin to guide the procedure. 
  • The anesthesiologist may visit you to talk about the anesthetic and answer questions.

  • You will be taken to the Operating Room in your hospital bed.
  • The nurses will assist you onto the surgical table and put on a blood pressure cuff and some monitors.
  • The anesthesiologist will talk you through going under anesthesia.
  • Once the anesthesia has made you fall asleep, the surgeon will begin the procedure.


  • When the surgery is over, you will be taken to a recovery area. Nurses will monitor you closely until the anesthesia wears off.
  • You will be transported back to your hospital room and the nurses will help you get settled. They will continue to monitor you, help you with pain management, and talk to you about your bandages and drains.
  • After your surgery, you will stay at GRS Montreal’s  surgical centre (called the CMC) for 2-3 days.
  • You will then move to GRS Montreal’s post-operative centre called the Asclépiade for about 1 week. Nurses are on-site to provide 24-hour post-operative care, support & education.

ATTENTION: During the COVID-19 Pandemic, having surgery may require extra considerations and safety precautions.


Post-Surgical Care (Disclaimer)

  • Post-surgical instructions
  • Know what to expect after surgery
  • Take good care of your body
  • Beat the post-surgery blues
  • Mindfully return to usual activities

Post-surgical instructions

GSP BC (Vancouver):

Before your surgery, the Gender Surgery Program BC will provide you with a booklet called “Enhanced Recovery After Surgery” for phalloplasty, metoidioplasty or erectile tissue release surgery. This booklet will provide detailed information about what to expect before and after your surgery, and instructions on how to care for yourself when you go home.

GRS Montreal:

You can find examples of GRS Montreal’s post-surgical instructions on their website:

Know what to expect after surgery

Below is a description of what generally happens when you wake up from phalloplasty, metoidioplasty and erectile tissue release surgery. This information is provided to help you start imagining what the hospital experience could be like- you will be given more detailed and up-to-date information once you have your surgical consult and meet your surgical team.

Each surgical centre is different and your surgical team will provide you with more detailed information about what to expect when you wake up from surgery.

In general, here is what you may expect: 

After surgery, you will be moved to the Post Anesthesia Care Unit (PACU). You will feel quite drowsy when you wake up -this is normal. It is also normal to feel sick to your stomach (nauseated) or to throw up after surgery.

Erectile Tissue Release & Metoidioplasty

Some people choose to have erectile tissue release surgery without any additional procedures, while others may choose additional procedures. Information about what to expect for each procedure is below:

Medical equipment

You may have some or all of the following:

  • an oxygen mask
  • an IV line
  • calf compressors to prevent blood clots

Erectile tissue release

You may have bruising and swelling in the groin area (abdomen and thighs).

You will have small incisions on each side of the groin, where the ligaments have been cut.

The erectile tissue will be puffy and swollen. This swelling tends to go away in two-to-four weeks, but could take longer for some.

The tissue may feel tender and uncomfortable while it is healing.

If you did not have urethral lengthening, you will not have a catheter in place. You will be able to urinate as you did before the procedure.

Urethral lengthening

If you had urethral lengthening, you may also have a catheter that starts in your bladder and comes out the tip of your penis to help keep your urethra open- this is called a urethral catheter. You may also have a catheter that starts in the bladder and comes out of your lower abdomen, near the pubic bone- this is called a supra pubic catheter.

Your surgical team will let you know when you can start urinating through your new urethra – this generally happens between 1-3 weeks after surgery.

Experiences of having a catheter can vary. For some people, the catheter may be very uncomfortable. It is important to speak with your surgical team if you have any challenges with your catheter.

While you have your catheter, it is very important to drink enough water to make your urine a pale yellow colour.

Scrotoplasty

It is common to have bruising and swelling in the groin area (abdomen and thighs).

You will have several incisions on the scrotum, including along each side and at the mid-line. It is normal for there to be some dried blood and clearish fluid present at the incisions.

You may also have 1-2 drains at the scrotum to help extra fluid leave your body.

If you are getting testicular implants, this procedure tends to take place around six months after your first surgery.

Vaginectomy

You will have an incision at the site of your vaginectomy. These incisions may feel ‘tight’.

You may experience a sense of aching where the internal tissue was removed.

It is normal for there to be some dried blood and clearish fluid present at the incisions.

Other details

Members of your surgical and post-operative team will check on you frequently.

You may be given some breathing, leg, ankle and arm exercises to do throughout the day. You may feel emotional and very tired- these are normal responses to having a big surgery and if you follow your surgeon’s post-operative instructions, your body will recuperate with time.

Phalloplasty

Medical equipment

You may have some or all of the following:

  • an oxygen mask
  • an IV line
  • calf compressors to prevent blood clots

Bruising

It is normal to have bruising in the groin area (abdomen and thighs)

Penis

Your penis will be swollen. It may be supported in a sling to reduce swelling. It will feel numb.

You will have incisions at the point where your penis connects to your body, and along the underside of the shaft. You will also have some incisions on your scrotum and at the vaginectomy site.

You may have a drain in your groin to help fluid drain from your body.

There may be a small device called an “implanted doppler ultrasound” embedded into the skin of your penis to measure blood flow to the area.

If you had urethral lengthening, you may also have a catheter that starts in your bladder and comes out the tip of your penis to help keep your urethra open- this is called a urethral catheter. You may also have a catheter that starts in the bladder and comes out of your lower abdomen, near the pubic bone- this is called a supra pubic catheter.

Penile donor site

Your penile donor site may have a special dressing called a vacuum assisted closure (VAC)  to your penile donor site, which is connected by a drainage tube to a small, portable vacuum pump.

Skin graft donor site

This area can be quite sensitive or painful, as the nerve endings here are exposed to the air as you heal. It may have some drainage and be covered by a bandage.

Other details

  • Members of your surgical and post-operative team will check on you frequently.
  • You will be on bed rest and nurses will help you with all your care needs.
  • You may be given some breathing, ankle and arm exercises to do throughout the day.
  • You may feel emotional and very tired- these are normal responses to having a big surgery and if you follow your surgeon’s post-operative instructions, your body will recuperate with time.

Take good care of your body

It is important to follow your surgeon’s post-operative instructions. The information below is a brief summary and does not replace the information you receive from your surgeon. If there are any differences, you should follow your surgeon’s instructions.

Everybody recovers at a different pace and it can take several months before you feel like you have all your energy back.

Caring for your incisions

Follow your surgeon’s instructions for how to care for your incisions and donor sites. If you have any questions, don’t be shy to ask. This is a new skill to learn and your surgical team wants to support you to feel comfortable and knowledgeable.

Generally speaking, you should contact your surgeon (or go to the Emergency Room) if you experience the following:

  • Increased swelling in the penis
  • Worsening or spreading redness around your incisions
  • Your incisions become red, swollen or hot to the touch
  • Foul-smelling yellow or green discharge
  • Cloudy, smelly urine
  • Chills or a fever over 38.5 degrees Celsius (101.3 Fahrenheit) by mouth
  • An increase in pain or pain that does not go away with pain medication
  • Persistent severe diarrhea

Take care of your catheter

If you had urethral lengthening, you will have a catheter in place to allow urine to drain from your bladder while your new urethra heals. Many people say that having a catheter in place for a prolonged period of time is one of the most challenging aspects of the overall experience. Here are some general tips that can make having a catheter a bit more comfortable:

  • Drink enough water to have clear, light yellow-colored urine. This will likely mean about eight to ten 8-ounce glasses of fluid every day. This will help to reduce bladder spasms and dilute your urine.
  • Avoid spicy, acidic or citrus foods
  • Avoid alcohol
  • Avoid caffeine
  • Follow any other advice from your surgical team

Manage Pain

It is important to manage your pain well so that you can sleep through the night, slowly re-start your usual daily activities, and follow the aftercare instructions from your surgeon.


Wash Hands Frequently

Always wash your hands with soap before and after touching your genitals. This will help prevent infection.


Get Lots of Rest

You may feel very tired after your surgery. Plan to do less activity during the day and allow yourself to nap. Your body needs extra sleep while you are healing. Relaxation techniques can help your body heal from surgery, too. They reduce the effects of stress on your body, letting your body’s systems focus on healing.

Many people share that they were surprised by how exhausted and weak they felt after lower surgery. This is a very complex surgery and it can take 6-8 weeks to recover. Remember that your body does its healing while you are resting. Take naps or rest breaks during the day and trust that you will slowly build up your energy and strength again. 


Walk

Walking helps to relieve pain, improve blood flow and prevent blood clots. It can also be good for your mood. However, it is important to be gentle and not push yourself. Your surgical team will provide you with instructions about when and how you can start walking. Begin with short walks and slowly increase how far you walk. Many people find that using a walker or a cane at first is helpful. If walking is not an option for you, speak with your health care providers about alternative options, like leg and deep breathing or coughing exercises.


Enjoy foods that promote wound healing

Look for foods with protein (meats, eggs and nuts); zinc (whole grains, spinach, nuts); vitamin A (carrots, broccoli, eggs); & Vitamin C (strawberries, peppers). Your body will need extra calories, proteins and nutrients to heal. If you have questions, you may find it helpful to speak with a dietician. You can contact a dietician by calling 8-1-1 (Health Link BC). 


Drink Lots of Water

It is important to drink lots of water (2-3 litres/day) and empty your bladder regularly. This helps to prevent urinary tract infections.


Manage Constipation

Constipation is a common side-effect of pain medication. If you experience this, try increasing the number of walks you take, drinking more water, eating more fruits and vegetables, eating prunes, or taking a stool softener. Get protein from food sources other than dairy. If constipation continues for several days, speak to your healthcare provider.

Avoid Alcohol and Tobacco

Avoid consuming alcohol and tobacco. If you have any questions about this, speak with your surgical team.

Attend Your Check-Ups

GSP BC:

You will be given your post-operative follow up plan before you go home. If you traveled to Vancouver, you will be expected to stay in the Lower Mainland for 3-4 weeks after discharge so you can attend in-person follow up appointments with your surgical team. All your follow up care will be completed by the surgical team at GSP BC.

You may want to arrange to see your NP or GP within a week of going home as well. They will review your post-operative baseline and see how you’re feeling.

GRS Montreal:

It is a good idea to have appointments booked with your healthcare provider in advance for when you get home from Montreal.  Your health care provider will make sure your incisions are healing well. They may ask about pain, bleeding, bowel movements, fever, and how you are feeling physically and emotionally.

Beat the post-surgery blues

The after-effects of medications, surgery and the activity limitations required during recovery can lead to something called ‘post-operative blues.’ This can include feelings of low mood, loss of appetite, difficulty concentrating and even self-doubt. This is a temporary and normal part of the healing period. Here are some suggestions for making it easier.

  • Put your self-care plan from your Surgery Workbook into action. See below.
  • Before surgery, ask yourself:
    • What does it look like when I start to feel low?
    • How will people know that I’m feeling that way?
    • Who can I share this information with in advance?
  • Make lists of things you love and reflect on how you can experience more of what you love while you heal from surgery (eg. lists of activities that bring you joy, ways that you connect with others, ways that you show yourself love, foods you love to eat, smells that calm & refresh you, sounds that inspire you, textures that you love to feel on your skin).
  • Write letters expressing thanks to people who helped you during surgery
  • Keep a journal

Self-Care Planning Exercises

Here are some holistic self-care planning exercises to help you prepare for before and after surgery. These exercises are also included in the Surgery Workbook.

Mindfully return to usual activities

Ask your surgeon when you can resume your usual activities. The information below are some common post-operative recommendations and does not replace the information you receive from your surgeon. If there are any difference, you should follow your surgeon’s instructions.

Driving

Avoid driving until you are no longer taking any opiate pain medication or feeling distracted by pain. Only drive if you are able to:

  • Put pressure on the break quickly and without pain
  • Safely do a shoulder check
  • Wear your seat belt

Start with short trips so as not to put too much pressure on your genitals. If you drive long distances, take frequent stops & pee often.

Lifting, Pulling and Pushing

Avoid lifting objects over ten pounds until 4 to 6 weeks after surgery, including carrying children, pets and groceries.

Work

Plan to take at least 6-8 weeks off work, or longer, depending on type of work and how you are healing.

Exercise

A general rule is to wait until 6-8 weeks after your surgery before participating in intense physical activity. Speak with your surgeon about how you can restart any activity, including exercise.

Rest

Rest is important for your recovery. Your body does its healing while you rest. Take naps or rest breaks during the day.


Sexual Activity

Lots of people have questions about returning to sexual activity after surgery. This can include, but is not limited to, masturbation and sex with other people. As with all other activities, speak with your surgeon about when it is safe for you to be sexually active after surgery.

Exploring how your body feels and responds after surgery is an important step in your healing process. It stimulates the nerve endings, helping them heal and reconnect, and allows you to begin the process of finding where and how you enjoy being touched. It also helps your brain to create a new “map” of your body.

First 10 days after surgery

First 10 days after surgery:

Avoid activities that can lead to elevated blood pressure and the risk of internal bleeding (hematoma).

This includes:

  • Having any kind of sex (alone or with a partner)
  • Having an orgasm
  • Other activities that create risks for bleeding, increase the risk of discomfort or pain or that may disrupt your anatomy while it heals

8 weeks after surgery

  • Your genitals will be numb at this time and your incisions are still vulnerable. It is important to follow all the post-operative instructions and be very gentle with your penis.
  • Do not place anything inside your genitals or rectum beyond what has been recommended by your surgeon(s).
  • Workbook for Phalloplasty, Metoidioplasty and Erectile Tissue Release Surgery in BC for some suggested mindfulness activities.

12 weeks after surgery

12 weeks after surgery:

If you have had metoidioplasty or erectile tissue release surgery, your surgeons will give you customized information about when it is safe to start using a pump for getting erections.

Once your surgical team tells you that you’re ready to use your genitals for sexual activity, here is some general information for returning to sexual activity after surgery:

  • Follow your surgeons’ recommendations regarding return to sexual and other physical activities.
  • Take time to learn your body’s needs and preferences.
  • Ease back into your sexual activities.
  • You may find your sex drive is different from before surgery. It might be lower during your healing period or you might find it’s higher.
  • Everyone is different. It’s important to know that changes to your sex drive are a normal part of your healing journey and will balance out over time.
  • Do not place anything inside your genitals or rectum other than what has been recommended by your surgeon(s).
  • You may find that your endurance or tolerance for different activities and sensations is affected by your surgery or pain medications.
  • Stop or take a break if you feel pain, or you feel anxious or scared.
  • Pay attention to whether your swelling or tenderness increases after sex. If so, you may want to wait until you are a bit further along in your healing before having sex again.
  • Pee before and after sexual activity to reduce the chances of urinary tract infections.
  • Avoid activities that can lead to internal or external bleeding, compromised blood flow, and injury to nerves and healing tissues. This includes:
    • tiring and repetitive movements
    • activities that could affect (stretch/tear) incisions (inner or outer) until your surgeon confirms that your incisions have healed
    • sudden or vigorous movements
    • lifting more than 10-15 lbs
    • strenuous activity (including sex)
    • bondage, suspension, pinching, squeezing, vigorous massage
      flogging, spanking, and paddling buttocks, thighs and other non-genital areas
    • very hot and very cold temperatures until nerves have fully healed
  • It can be helpful to speak with your surgeons before starting any kink activities in the months after surgery. Your surgeon will likely welcome these questions. If you are shy, you can be creative and ask about returning to full contact sports, swinging a tennis racket, receiving vigorous massage, riding a horse, using a heating pad or wearing restrictive or body-shaping clothing.

A note on safer sex and STI screening

Many people find that they are better able to relax and enjoy sex with others if they have spoken with their partner(s) about sexual health and STI screening.

It is possible to get sexually transmitted infections (STIs) after phalloplasty, metoidioplasty or erectile tissue release. The following recommendations can help reduce the chance of getting an STI. These recommendations are general and apply to anyone, whether they have had a genital surgery or not. Not every recommendation will apply to you, but they are helpful to be aware of:

  • Wear a condom during sex.
  • Make a habit of regularly checking that the condom has not torn or fallen off. The shaft of your penis will likely be numb for the first 12 months after surgery, so you may not feel it if this happens.
  • Ask your partner(s) to wear condoms during receptive sex (including genital and anal sex).
  • Ask your partners to have STI screening, including chlamydia, gonorrhea, HIV and syphilis.
  • Avoid having genital sex (or use condoms) if you have genital irritation or inflammation.
  • Speak with your GP or NP about how often you would benefit from getting STI screening (this is based on your sexual activities).

Learn about HIV Pre-Exposure Prophylaxis (HIV PrEP) and speak with your GP or NP if you think this might be a good option for you.


Attention: The information on this website is a brief summary of what you might expect after surgery and does not replace the information you receive from your surgeon. If there are any differences, you should follow your surgeon’s instructions.


Resources

  • Tips for family and friends
  • Support tools
  • Additional resources
  • Guide feedback

Tips for family and friends

It can be very helpful for people having surgery to have support from family members and friends. This section is to learn more about how to help.

Support person

We suggest that everyone getting surgery ask someone to be their support person. The support person can coordinate a team of friends or family to help out. Here are some important things to know.

As a support person it will be important for you to also make sure you are taking care of yourself, in order to offer support to others. Here are a few considerations to help support people prepare. 

Considerations for support people

  • I have scheduled time to take care of myself (eat, shower, have some quiet alone time, participate in meaningful activities, go to work, etc).
  • I have a good sense of what to expect leading up to, during, and after my friend or loved one’s surgery.
  • I have spoken with my family or loved one and we have the same understanding about what kind of support I will be providing.
  • I feel as prepared as I can be to handle supporting someone after they have surgery.
  • I feel as prepared as I can be to care for myself during this time.
  • I have a plan for what to do if I feel stressed while my friend or loved one is healing from surgery.

Supporting someone having surgery

Here’s a checklist for people supporting someone having surgery. This checklist is also included in the Surgery Workbook.

Some helpful ideas for support

Help in advance

It can be a lot of work to prepare for surgery. Here some suggestions on how to help your friend or loved one leading up to surgery:

  • offer rides to and from appointments
  • offer to take notes during appointments
  • pick up supplies and helpful items
  • help prepare food and groceries
  • help coordinate a group of people that can prepare meals, help with chores and visit after surgery
  • ask if there are any specific ways you can support them as they get ready for surgery
  • remember that it can be hard to ask for help, so check-in regularly to see how they are doing and what they need

Take over some of their responsibilities

After surgery, your friend or loved one will not be able to take care many of their day-to-day responsibilities for many weeks. This includes physical tasks like household chores and taking care of family members or pets, as well as more subtle activities, like re-arranging pillows, putting fresh sheets on the bed and preparing food.

Doing these things or helping to organize friends who can help, is one of the best ways to support someone after surgery. Keeping a schedule to make sure these things are taken care of can be a huge help in avoiding restricted activities and focusing on resting and healing.

Be present after surgery

Letting people know you are thinking of them is a great way to show how much you care. This can include visiting them, bringing a card or some games, or simply sitting with them and watching a show.

When a person knows they are cared for, it reduces stress and helps with healing, and it also just feels good!

Be a positive distraction

Distractions help people manage pain, avoid boredom and recover more quickly.

This can include listening to an audio book together, going on walks, sending texts and pictures, and dropping in for short visits.

Take care of yourself

Caring for yourself is one of the most important things you can do as a caregiver. When your needs are taken care of, the friend or loved one you are helping will benefit too.

If you are a primary support person, it is important to regularly take time to be alone or to go out and do something you enjoy. There may be other people who would be more than happy to help out if they knew what was needed, so just ask.

Preparing yourself

Seeing someone you care about feeling pain or discomfort can be hard, and taking on extra responsibilities can, at times, be stressful.

This is a temporary and normal part of the process of care giving, and it can be made easier by reflecting in advance about what’s ahead and thinking of ways to also care for yourself during this time.

How to be there

It’s also helpful to remember that your role isn’t to be a magician and fix everything or make all pain or discomfort disappear – it is just to be with your friend or family member on their healing journey.

Just knowing someone understands can be a really big help. Even though it doesn’t “fix” anything, empathy creates connection and makes it just a little easier to live through the harder parts of healing.

Support tools

Here are the  worksheets, checklists, and exercises found throughout this online surgery navigation guide. Most are included in the Workbook for Phalloplasty, Metoidioplasty, and Erectile Tissue Release Surgery in BC.

Decision-making

Assessments

Assessment Questions


Surgical Consult

Buy, Borrow, and Do

Self-Care Before


Self-Care After

Arrange Help

Supporting Someone


COVID-19: Surgery in BC

COVID-19: Surgery in Montreal 

GSP BC – Surgery 


GRS Montreal – Surgery

Track Your Medication

Guide Feedback

We believe your feedback is one of the best ways to improve our resources. If you have any comments, suggestions, or questions related to one of the Trans Care BC client-centred navigation guides, we would love to hear from you!

Share your feedback by survey:

We have created a short survey about the layout of these client-centered navigation guides. We would be ever so grateful for your feedback!

SURVEY LINK


Share your feedback by email:

Please send us any comments, suggestions, or questions to trans.edu@phsa.ca.

Here are some general questions we’d love your feedback on:

  • Do you find this client-centred navigation guide to be a helpful resource?
  • Do you have suggestions on how to improve the navigation guides?
  • Would it be helpful for Trans Care BC to create more client-centred navigation guides? If so, for what content?

Click here to contact Trans Care BC’s Care Coordination Team