Meeting with the surgeon
Being as prepared as possible for your surgical consult will ensure you have the information you need to make the best decisions for yourself.
What is a surgical consult?
Your appointments with the surgeon to discuss surgery are called surgical consults. During the surgical consult, the surgeon will ask about your goals for surgery and provide you with information about your surgical options. It’s also an important opportunity for you to ask questions.
Surgical consults at the Gender Surgery Program B.C. (GSPBC)
Before your surgical consult, you’ll receive information about what to expect during this appointment. Sometimes you might have more than one appointment as part of this process.
Intake appointment — First you’ll have an intake appointment over the phone with a nurse. The nurse might:
- Ask questions about your gender, general health and family history
- Talk about what to expect during the rest of the process.
Surgical consult — Your second appointment is with the surgeon and usually takes place in person or via Zoom (or a similar platform). The surgeon 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 (if in person)
- Assess need for medically necessary Treatments, procedures or services that health care professionals determine are essential for diagnosing or treating a medical condition based on established medical guidelines and individual patient needs. hair removal
- Take pre-op photos of the genitals if needed
- Determine if additional assessments or diagnostic tests are needed before proceeding
As part of the process of informed consent, the surgical team (which consists of your surgeon, nurses and may include social workers and physiotherapists) will help you understand:
- The details of the procedure as well as the potential benefits, risks and outcomes
- Permanence of the surgery and how it affects fertility
- The possible need for additional surgery
- Recovery and aftercare in the months following surgery (including when and how to return to physical activity).
You will also be shown pictures of the surgery and examples of results at different points of the healing process.
Being as prepared as possible for your surgical consult will ensure you have the information you need to make the best decisions for yourself.
Download the workbook
In addition to the information below, our Vaginoplasty & Vulvoplasty Workbook contains reflection activities to help you prepare your appointment(s).
A few things you can do to prepare include:
- Research the different surgical techniques and potential complications on our Understanding the Procedure page and review these resources:
- Search online for before-and-after photos of each surgery type, including photos of people who have a body similar to your own.
- Prepare a list of questions (see below) and bring along a pen and notebook to the appointment. You may also want to ask a support person to attend the appointment and take notes so you can focus fully on the conversation.
- Prepare a complete list of any current medications and supplements (including traditional medicines, herbs, vitamins, minerals, etc.) including the dose and frequency.
Here is a list of questions you may want to ask your surgeon:
- How will this surgery affect your options for sex?
- Do they have photos of surgical outcomes of other patients who had this surgery (both successful and unsuccessful outcomes)?
- What medications, vitamins or supplements are safe to take before surgery?
- How long will the swelling last?
- What happens during your time at VGH?
- What are the complications that could occur after the surgery? And what are the surgeon's complication rates for each procedure?
- What are the chances that you will need additional surgery with this type of surgery?
- How do you know your vaginal discharge is healthy?
- What do you need to do to take care of your prostate?
- What should you do if you experience a new symptom after you return home?
- How long will it take to heal? What can you expect from the healing process?
- When can you return to work?
If you choose to go ahead with surgery after your initial consult with the surgeon, you’ll follow these steps:
1. Hair removal (vaginoplasty only)
Medically-necessary hair removal is strongly recommended and in some cases required for people having vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. . In these cases, electrolysis or laser are used to remove hair from the scrotum. This is because this tissue will be used to line the walls of the vagina An internal organ located between the legs. A person may be born with a vagina or have one surgically created. When referring to genitals, the Trans Care BC website uses "internal genitals (vagina)" for trans people assigned female at birth (AFAB), and "vagina" or "vagina with vaginoplasty" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. .
During your consult, the surgeon will let you know if permanent hair removal is recommended for you. If so, they will provide a referral and detailed instructions on how to access public-funding for hair removal.
- In order for hair removal to be publicly funded, you need to receive a referral from the surgeon. Consulting with your surgeon prior to starting hair removal will also ensure that hair removal is done on the part of the body recommended for you.
- In order for hair removal to be publicly funded, you will also need to work with a pre-approved electrologist. If you start hair removal prior to receiving a formal recommendation from the surgeon, you will need to pay for it out-of-pocket and cannot be reimbursed.
- Hair removal for vaginoplasty must be done via electrolysis or a combination of laser and electrolysis.
- Speak with your hair removal provider if you are concerned about pain. Options for pain management can include distraction (through video, music, conversation or virtual reality), oral pain medication or topical anesthetic (such as EMLA, Zensa or compounded creams containing topical anesthetics like benzocaine, lidocaine or tetracaine). These two handouts on pain management may help.
- Alternate options can be discussed with the surgical team if significant barriers exist with hair removal. For example, manual hair cautery A medical technique that uses heat to burn or seal tissues to stop bleeding or remove unwanted tissue. may be possible during surgery.
- Not having permanent hair removal before surgery increases the risk of complications related to hair growth inside the vagina. Before deciding not to have permanent hair removal, be sure to have a discussion with the surgical team.
The hair removal process takes different amounts of time for each person, depending on the amount and type of hair you have (this can take up to 18 months).
If you have been referred for hair removal, Trans Care BC will contact you to help you get started, stay in touch with you during the process and inform GSPBC once hair removal is near completion. You will then be scheduled for a second surgical consult.
2. Second surgical consult
This consult is a check-in on your surgical readiness and helps to determine if any additional steps are needed. If you are deemed surgically ready, you will be added to a waitlist for surgery. Please note: the second surgical consult is often completed in person and may require a physical examination of your genitals to help plan for your surgery.
3. Surgery
GSPBC aims to provide patients 2–3 months’ notice prior to an available date. They may offer a date sooner than this if there are cancellations. Surgery typically requires a few days in the hospital. The length of stay depends on the type of surgery and follow-up requirements. Generally, patients stay in the hospital for about 7 days for vaginoplasty and 3–5 for vulvoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and remove the penis, scrotum and testes. Vulvoplasty creates the external aspects of a vulva without creation of a vaginal canal. .
It is expected that patients remain in the Lower Mainland for 2 weeks after discharge to attend in-person follow-up appointments with the surgical team.
Surgical consults at GrS Montreal
While GrS Montreal does not typically schedule phone or in-person consults prior to your arrival for surgery, you will have an intake appointment over the phone with a nurse. If you do want to speak with a surgeon to discuss health concerns or gather information to inform your surgery decision, you can request a surgical consult.
In-person consult — Your surgeon will meet you for an in-person consult a day or two before your surgery in Montreal. Each surgeon does things a bit differently, but generally the surgeon will:
- Ask questions about your gender, general health, and family history
- Examine your genitals and determine whether you may need a skin graft A surgical procedure in which one section of healthy skin is removed from a part of the body and used in another location (or in the same location in the case of nipple grafts). to line the vaginal walls (for vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. only)
- Check blood pressure
- Listen to your lungs
- Gently press on your abdomen and lymph nodes
- Take photos of your genitals
- Talk about possible surgical outcomes
- Give instructions for aftercare, including return to physical activity
Being as prepared as possible for your surgical consult will ensure you have the information you need to make the best decisions for yourself.
Download the workbook
In addition to the information below, our Vaginoplasty & Vulvoplasty Workbook contains reflection activities to help you prepare your appointment(s).
A few things you can do to prepare include:
- Research the different surgical techniques and potential complications on our Understanding the Procedure page or use other resources we recommend including:
- Rainbow Health Ontario’s Surgical Summary Sheets
- Vaginoplasty information from GrS Montreal
- Vulvoplasty information from GrS Montreal
- Search online for before-and-after photos of each surgery type, including photos of people who have a body similar to your own.
- Prepare a list of questions (see below) and bring along a pen and notebook to the appointment. You may also want to ask a support person to attend the appointment and take notes so you can focus fully on the conversation.
- Prepare a complete list of any current medications and supplements (including traditional medicines, herbs, vitamins, minerals, etc.) including the dose and frequency.
Here is a list of questions you may want to ask your surgeon:
- How will this surgery affect your options for sex?
- Do they have photos of surgical outcomes of other patients who had this surgery (both successful and unsuccessful outcomes)?
- What medications, vitamins or supplements are safe to take before surgery?
- How long will the swelling last?
- What happens during your time at Asclépiade?
- What are the complications that could occur after the surgery? And what are the surgeon's complication rates for each procedure?
- What are the chances that you will need additional surgery with this type of surgery?
- How do you know your vaginal discharge is healthy?
- What do you need to do to take care of your prostate?
- What should you do if you experience a new symptom after you return home?
- How long will it take to heal? What can you expect from the healing process?
- When can you return to work?
If you choose to go ahead with surgery after your intake appointment with the nurse, you will await your surgery date booking with GrS Montreal (if not already confirmed).
If you provide consent, GrS Montreal will provide your name, contact information and surgery date to Trans Care BC who will arrange for a nurse to reach out to you to help coordinate your pre and postoperative care.
This workbook contains worksheets, exercises and checklists related to vagina and vulva construction
Contact our team of experienced health navigators for information about gender-affirming care in B.C.