Vaginoplasty Surgery Guide

Navigation Guide for Vaginoplasty and Vulvoplasty Surgery


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This Guide

This guide outlines the steps for accessing publicly funded vaginoplasty or vulvoplasty surgeries in British Columbia.

There are many diverse experiences people have had with vaginoplasty and vulvoplasty surgery, and it isn’t possible to capture it all in one resource. It is valuable to connect with other people who have had these surgeries and learn from their experiences.

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 Care Coordination 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 to Vaginoplasty and Vulvoplasty Surgery in BC

Preparing for vaginoplasty or vulvoplasty surgery is a physical, emotional, mental, and spiritual process. We’ve created a workbook called the Workbook for Vaginoplasty and Vulvoplasty Surgery in BC to help you along the way. It contains some of the information on this website, along with worksheets, checklists, and exercises.

You may wish to download and print the full passport or individual support tools, which can be found throughout the guide, and on the Support Tools page in the resource section.

Procedures

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

Vaginoplasty

Vaginoplasty – Procedure

The basic steps in a vaginoplasty are:

  • The external genital (scrotum) and gonads (testes) are removed.
  • The external genital (glans) is made into a clitoris.
  • Space for the vagina is dissected between the bladder and the rectum.
  • Skin from the shaft of the erectile tissue (penis) is inverted to create the inner walls of your vagina.
  • Extra skin may be taken from the external genital (scrotum) to line your vagina. The hair roots on the skin graft will be cauterized.
  • The urethra is shortened.
  • Vulva (including a mons, labia, clitoris and urethral opening) are created using scrotal and urethral tissue.
  • A temporary urinary catheter is inserted into the bladder.
  • A temporary prosthesis or stent is inserted in the vagina.

Vaginoplasty – Complications

All surgical procedures involve some risks, including negative reactions to anesthesia, blood loss, blood clot sand 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.

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

Hematoma

when blood collects in the surgical site, causing pain, swelling and redness. Smaller hematomas can be drained, but larger ones require removal through surgery

Injury to the nerves or muscles in the legs

Can lead to numbness or a change of sensation in the skin of the legs. In very rare cases, it can lead to difficulty moving the leg, which needs correction through surgery

Loss of sensation

You may have small areas of numbness. Your ability to achieve orgasm could decrease. Loss of clitoris is a remote possibility

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

Rectovaginal fistula

When an abnormal path between the rectum and vagina is created. Surgery would be needed to correct this

Urological complications

Examples include fistulas (flow of urine to areas other than the urethra opening), stenosis (narrowing of the urethra, causing difficulties urinating) and strictures (blockage of the urethra, causing difficulty urinating). It is common to have spraying or dribbling when urinating until your swelling settles down. If these problems don’t resolve on their own, they may require additional surgery

Unsatisfactory appearance

Outcomes that are quite different from what was expected may require surgical revision

Vulvoplasty

Vulvoplasty – Procedure

The basic steps in a vulvoplasty are:

  • The external genitals (penis & scrotum) and gonads (testes) are removed
  • The sensitive erogenous tissue (glans) is made into a clitoris
  • The urethra is shortened
  • Vulva (including a mons, labia, clitoris and urethral opening) are created using scrotal and urethral tissue
  • A temporary urinary catheter is inserted into the bladder

Vulvoplasty – Complications

All surgical procedures involve some risks, including 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.

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

Hematoma

when blood collects in the surgical site, causing pain, swelling and redness. Smaller hematomas can be drained, but larger ones require removal through surgery

Injury to the nerves or muscles in the legs

Can lead to numbness or a change of sensation in the skin of the legs. In very rare cases, it can lead to difficulty moving the leg, which needs correction through surgery

Loss of sensation

You may have small areas of numbness. Your ability to achieve orgasm could decrease. Loss of clitoris is a remote possibility

Unsatisfactory size or shape

Outcomes that are quite different from what was expected may require surgical revision.

Urological complications

Examples include fistulas (flow of urine to areas other than the urethra opening), stenosis (narrowing of the urethra, causing difficulties urinating) and strictures (blockage of the urethra, causing difficulty urinating). It is common to have spraying or dribbling when urinating until your swelling settles down. If these problems don’t resolve on their own, they may require additional surgery.

Scarring

May be correctable with various treatments, including additional 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

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

    Connect with a practitioner
  • Step 2

    Get Two 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:

  • 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 the referral form for vaginoplasty or vulvoplasty (NOTE: Is there a publicly accessible version?)  and a checklist for referring a patient for gender-affirming surgery, 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 two Qualified Surgical Assessors.

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 Care Coordination 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 a Health Navigator at Trans Care BC. They may be able to help connect you 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 for Vaginoplasty or Vulvoplasty. 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 Two Surgical Readiness Assessment

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 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 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 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?

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, you may be re-directed to GSP BC.

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.


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 Vaginoplasty and Vulvoplasty Surgery, or you can download the checklist by itself.

Frequently Asked Questions

What costs associated with surgery are not covered by MSP?

While MSP pays for the cost of vaginplasty or vulvoplasty surgery, there can be additional costs that are not covered. These include costs associated with:

  • Travel and accommodation
  • Wound care supplies
  • Any extra supplies you would like to have while you heal

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 support garments 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 vaginoplasty, vulvoplasty or 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, childcare, elder care, laundry, pet care, or garbage and recycling.

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. For air travel, Hope Air does provide limited exceptions. See their Travel Request Help page.


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

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.

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

You’ll find an activity in the Workbook for Vaginoplasty and Vulvoplasty Surgery to make a plan around asking for help.


Support Checklist

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

The checklist is included in the Workbook for Vaginoplasty and Vulvoplasty Surgery.

You can also send people to the Tips for Family and Friends page, in the Resource section.

Make travel arrangements

Select the centre below where you will be having surgery.

  • GSP BC (Vancouver)
  • GRS Montreal

GSP BC (Vancouver)

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

Transportation

Book your mode of transportation (bus, air, rail, or ferry). If you are travelling by car, you will need someone else to drive you from the surgical centre to your accommodations and again later on, back home.

If you qualify for the First Nations 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.

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.

If you are travelling by plane:

  • 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.

Accommodations

Sometimes people choose to stay in town before or after their hospital admission. If you qualify for Hope Air, you may also qualify for the “Open Homes Medical Stay Program” (a partnership between Hope Air and Air BnB to provide 7 nights of free accommodation). To apply, fill out the “Air BnB Request” section of the Hope Air Application.

Find out how long your surgeon requires you to stay nearby. Around three days is common. Book your lodgings 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.

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. GRS Montreal will typically arrange your accommodation and provide transportation from and to the airport.

  • If you qualify for the First Nations 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.
  • If a support person travels with you, MSP will not cover this person’s travel and accommodations. For air travel, Hope Air does provide limited exceptions. See their Travel Request Help page.
  • 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.
  • If you live far from the BC airport that will take you to Montreal, you might qualify for the Travel Assistance Program, which can reduce some of the costs associated with traveling within BC. To access the program:
    • Ask your doctor or nurse practitioner to fill out a Travel Assistance Program (TAP BC) form.
    • Two weeks before surgery, call TAP BC to get your confirmation number. Write it on your form.
    • Show your form at the time you make air, rail, or ferry reservations.

Accommodations

  • 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.
  • Confirm in advance with GRS Montreal that they will be able to arrange your accommodations and provide transportation from and to the airport.
  • Sometimes people choose to stay in town before or after their hospital admission. If you qualify for Hope Air, you may also qualify for the “Open Homes Medical Stay Program” (a partnership between Hope Air and Air BnB to provide 7 nights of free accommodation). To apply, fill out the “Air BnB Request” section of the Hope Air Application.
  • If a support person comes to Montreal with you, they will need to book their own accommodations. See GRS Montreal Frequently Asked Questions for more information. If you arrive a few days before surgery, you may want to stay with them until your surgeon requires you to stay at the clinic or the convalescent home.

Frequently Asked Questions

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.

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

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

  • The nurse will provide you with instructions on any preparations you need to do before your surgery.
  • The day before surgery, a nurse will call to confirm the time of your surgery and the time you need to arrive at the hospital.
  • The night before the surgery, follow the instructions from the 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.
    • HOT TIP: The team at GSP BC will work 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 to 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 and check your blood pressure and assist you into the hospital bed.
  • The surgeons may visit you 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 nurse 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 take you through going under anesthesia.
  • Once the anesthesia has made you fall asleep, the surgeon(s) will begin the procedure. The procedure will take 9-12 hours. 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.
  • You will then be discharged home or to your local temporary accommodations.

GRS Montreal

Below is description of what generally happens when you arrive in Montreal.

  • 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 enemas, showering, hair removal, and removing make-up and 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. Get a wristband with your name, date of birth, PHN and the gender that is listed on your BC Services Card. If this is different from the name you use and your gender, you can ask for an extra “Name Alert” wristband with your correct name and pronouns.

  • 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. The procedure usually takes about two hours.

  • 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.
  • After your surgery, you will stay at GRS Montreal’s surgical centre (called the CMC) for 2-3 days.
  • The nurses will typically have you stand completely upright, the first night of your surgery. The next day, they will have you walk around a small amount. This improves blood flow and the speed of healing.
  • You will then move to GRS Montreal’s post-operative centre called the Asclépiade for about 1 week. This building is next door to the clinic, and a nurse will usually bring you over in a wheelchair. Nurses are on-site to provide 24-hour post-operative care, support, and education.


Frequently Asked Questions

If you are having surgery at GRS Montreal and have any questions about vaginoplasty or vulvoplasty at their centre, we recommend that you read the Frequently Asked Questions page on the GRS Montreal website.


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

It is important to follow your surgeon’s instructions for aftercare.

The information in this guide is a brief summary and does not replace the information you receive from your surgeon. If there are any differences between your surgeon’s instructions and the content found in this guide, you should follow your surgeon’s instructions.

GSP BC (Vancouver):

Before your surgery, the Gender Surgery Program of BC will provide you with a booklet called “Enhanced recovery After Surgery” for Vaginoplasty. 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

It takes about one year to fully recover from lower surgery. During this time, expect the appearance of your genitals to continue to change quite a bit.

The Surgical Site

For the first few days after surgery, you will have:

  • a large gauze dressing over your vulva,
  • a surgical drain in your mons to stop fluid from building up in your body,
  • A urinary catheter to drain pee,
  • A stent inside your vagina to help maintain depth (for vaginoplasty only). The labia will be temporarily sewn together to hold the stent in place.

Bruising and Swelling

It is normal to have bruising and swelling after surgery. The bruising may go from your hips to your knees. You may have more swelling on one side than the other and it can change throughout the day. It will go down gradually, taking up to 6 months to resolve.

Your vulva will get smaller as your swelling goes down. This might make it seem like you are losing vaginal depth because your vulva will cover less of the dilator when you are looking down at it. Keep in mind that the depth of your vagina is measured from your vaginal opening to the back, and not from the outer edge of the labia.

Blood Clot on Clitoris

It is normal to have a blood clot on your clitoris. Do not pull it off. It will fall off on its own.

Vaginal Discharge (for vaginoplasty only)

Vaginal discharge is made up of lubricant and skin cells. It may be tinged with small amounts of blood. It is normal for vaginal discharge to have a healthy smell. If the smell changes significantly, or becomes very strong, speak with your surgeon, doctor or nurse practitioner.

Fibrin

Fibrin is the yellowish stuff that builds up around your wounds. It should dry up and falloff on its own. If your wound is too moist, it won’t dry up and fall off. This is why you’ll be asked to expose your surgical site to air as much as possible. If the fibrin is building up a lot and not falling off, speak with your healthcare provider.

Peeing

In the first few months after surgery, your urine may spray or dribble rather than come out in a straight line. This is caused by swelling around the urethra, the opening that pee comes from. As the swelling goes down, the spraying and dribbling should stop.

Incisions and Scars

Your incisions will be closed with sutures. These sutures will dissolve within 1-3 months. Talk to your surgeon if you find that your scars are starting to thicken up.

Changes in Sensation

It is common to have numbness or less sensation in some areas. It can take 6-12 months for the nerve endings to heal or grow back in these areas. Once in a while, you might even feel prickly, stinging, or burning sensations as the nerves heal and grow. There can be permanent changes to sensation, including areas of complete numbness or hypersensitivity.

Take good care of your body

Check for Signs of Infection

Talk to your healthcare provider if you experience:

  • Redness around your incisions
  • Heat around the incisions
  • Foul-smelling yellow or green discharge
  • Chills or a fever over 38.5 degrees Celsius (101.3 Fahrenheit) by mouth
  • An increase in pain at the surgical site

Check for Signs of Urinary Tract Infection

Talk to your healthcare provider if you experience:

  • Burning sensation when peeing
  • Peeing often in small amounts
  • Pee that is cloudy, pink, or brown and foul-smelling
  • Pain in your pelvis, back, or rectum
  • Chills or a fever over 38.5 degrees Celsius (101.3 Fahrenheit) by mouth

Check for Signs of Hypergranulation tissue

Talk to your healthcare provider if you experience:

  • Blood in your discharge or on your dilator
  • Areas of bright red tissue that bleed easily

It is not uncommon to develop hypergranulation tissue within weeks or months after surgery. There are various treatment options that your health care provider can suggest.


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 your dilation schedule.

  • Stick to a pain medication schedule. Don’t wait to take medication once the pain is overwhelming, as your pain will be harder to control.
  • You may wish to use the pain medication tracking chart in the Workbook for Vaginoplasty and Vulvoplasty Surgery.
  • You can also apply ice to the area as recommended by your surgeon.

Wash Hands Frequently

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


Take Sitz Baths

About four days after surgery, a nurse will show you how to take a sitz bath. A sitz bath involves bathing your genitals with warm, soapy water. There are two methods:you can sit in a bathtub or you can place a special sitz bath bin on your toilet seat. Follow your surgeon’s instructions about how to bathe yourself, type of soap to use, and air drying your genitals afterwards. You’ll have a sitz bath twice a day for two months.


Dilate (for vaginoplasty only)

About five days after surgery, a nurse will show you how to dilate. A dilator is a device used to keep the width and depth of your vagina. You will be given a set of dilators with many different sizes and a schedule for using them. It is important to follow your dilation schedule because once width or depth has been lost, it cannot be regained again. Dilating can be uncomfortable, especially in the beginning. You may want to:

  • Time your pain medication so that discomfort is well managed during dilation
  • Urinate or have a bowel movement before you dilate
  • Drink a small glass of water first
  • Distract yourself with some music or a podcast, movie, or guided meditation.

Dilating will become part of your regular routine throughout your life.

HOT TIP: You may find this guided mindfulness activity for dilation by Dustienne at YourPlace Yoga to be helpful.


Douche (for vaginoplasty only)

About five days after surgery, a nurse will show you how to cleanse your vagina by douching. A douche is a device used to squirt saline solution (and later, water) into your vagina to clear out dead skin so that your body heals properly. Your surgeon will provide details about how often  to douche. Douching will become part of your regular routine throughout your life.

Expose Vulva and Perineum to Air

The vaginal opening and perineum (area between the vulva and anus) are often the slowest to heal. This is caused by pressure on the area when sitting; friction from dilation; and dampness from discharge, lube, and aftercare activities. Keep this area exposed to air as much as possible to help it dry out and heal well.


Walk

Walk for 15-20 minutes at least 4 times a day. Walking helps to relieve pain, improve blood flow and prevent blood clots. It can also be good for your mood. If walking is not an option for you, speak with your health care providers about alternative options, like leg and deep breathing exercises.


Get Lots of Rest

You may feel very tired after vaginoplasty. 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 the healing process.


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. Drinking a glass or two of cranberry juice each day also helps.


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.

Massage Your Scars

Massage your scars once your incisions close (usually around Week 4) using a cream recommended by your surgeon. Remember to wash your hands with soap before and after to prevent infection.


Avoid Alcohol and Tobacco

Avoid alcohol for at least two weeks and tobacco for at least 6 weeks after surgery.

Attend Your Check-Ups

It is a good idea to have appointments booked with your health care provider 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. They will also ask questions about how you are managing your dilations and aftercare activities.

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 the surgical passport into action. See below.
  • 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.

Rest

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

Driving

Avoid driving for 2-4 weeks and until you are no longer taking any opiate pain medication or feeling distracted by pain. 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

Avoid lifting objects over ten pounds until 4-6 weeks after surgery.

Work

Take at least 8-12 weeks off work, or longer, depending on the type of work and how you are healing. Check with your surgeon, GP, or NP before going back to work.

Exercise

Ask your surgeon about when it is safe for you to resume exercising. It is usually recommended to wait for 8-12 weeks after surgery before participating in physical activity.

Your surgical team may recommend you have a session with a pelvic floor physiotherapist prior to/or after surgery. This will help teach you how to relax the muscles in your pelvic area, which can help with dilations and future sexual activity. You may be surprised how tired you feel when you start exercising again- this is a normal feeling. Your energy levels will improve as you continue to heal.

  • Continue with your deep breathing and coughing exercises
  • Begin by taking short walks, and gradually increase how far you walk
  • You may notice a connection between exercise and the feelings of increased tenderness or swelling the next day
  • Adjust your activity levels according to the feedback from your body

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:

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
  • 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:

  • You can usually begin to gently explore the clitoral area
  • Using vibrators on different settings (low, medium, or high) or with different motors (rumbly or buzzy) may be helpful
  • Many of your sensitive nerve endings are located just above and at your clitoris, so touching, massaging, or using a vibrator in this area can be useful
  • Do not place anything inside your vagina or rectum beyond what has been recommended by your surgeon(s)
  • See the Workbook for Vaginoplasty and Vulvoplasty Surgery in BC for some suggested mindfulness activities.

12 weeks after surgery:

Wait until 12 weeks after surgery before having oral, vaginal, and anal sex. Some people may need to wait longer depending on their healing and pain levels.

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 vagina or rectum other than what has been recommended by your surgeon(s).
  • Most people need to use lubricant during vaginal sex- this helps to increase sensations of pleasure and also prevent uncomfortable friction or skin tearing.
    • Some people like to use a different kind of lubricant than the one they use during dilation, though this is optional.
    • If you and your partner(s) use condoms, choose water- or silicon-based lubricant.
  • You may find that your endurance or tolerance for different activities and sensations is affected by your surgery or pain medications.
  • You may feel gentle stretching of your vagina or vaginal opening during sex- this can be normal.
  • 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 (your urethra is shorter now and bacteria can easily get pushed inside during sexual contact).
  • 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, 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 BDSM 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 partner sex if they have spoken with their partner(s) about sexual health and STI screening.

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

  • Ask your partner(s) to wear condoms during sex (including vaginal and anal sex)
  • Ask your partners to have STI screening, including chlamydia, gonorrhea, HIV and syphilis.
  • Avoid having vaginal sex (or use condoms) if you have vaginal irritation or inflammation (for example, hypergranulation tissue)
  • 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: This section is to supplement what you receive from your surgeon. If there are any differences, you should follow the advice provided by your surgeon.


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.


A checklist to help support people prepare

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. 

  • 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.

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 checklist

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

Support tools

Here are the  worksheets, checklists, and exercises found throughout this online surgery navigation guide. Most are included in the Workbook for Vaginoplasty and Vulvoplasty Surgery.

Assessments

Assessment Questions

Surgical Consult


Buy, Borrow, and Do

Self-Care Before

Self-Care After


Supporting Someone

COVID-19: Surgery in BC

COVID-19: Surgery in Montreal 


GSP BC – Surgery 

GRS Montreal – Surgery

Track Your Medication

Additional resources

Further information about gender-affirming surgeries and surgical complications can be found on the Trans Care BC website.

Additional helpful information and contacts:

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 the Chest Construction and Vaginoplasty Surgery Navigation Guides, we would love to hear from you!

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-centered surgery navigation guide to be a helpful resource?
  • Do you have suggestions on how to improve the Chest Construction and/or Vaginoplasty Surgery Navigation Guides?
  • Would it be helpful for Trans Care BC to create more surgery navigation guides?

Share your feedback by survey:

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

SURVEY LINK

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