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Hysterectomy with Bilateral Salpingo-Oophorectomy

This information is intended to assist surgical assessors in discussing gender affirming surgery with patients and to ensure patients receive adequate information about the specific surgery they are seeking.

The role of the surgical assessor includes:
  • Confirming the patient meets WPATH criteria for this procedure
  • Confirming the patient is ready for surgery from a psychosocial perspective
  • Confirming the patient can consent to this procedure
Informed consent in this context involves a discussion of what the procedure involves, the benefits and risks and what to expect post-operatively. This process does not replace the surgeon’s informed consent process. 

One assessment is recommended for most patients undergoing hysterectomy bilateral-salpingo-oophorectomy although additional assessments may be requested at the discretion of the surgeon and some surgeons do not require a formal assessment for this procedure.


Some trans people have a hysterectomy with bilateral salpingo-oophorectomy as part of gender-affirmation treatment. Some benefits of this procedure may include prevention of monthly bleeding, possible reduction in testosterone dosage, elimination of the risk of ovarian, uterine and cervical cancer, as well as the need for cervical screening and decreased gender dysphoria.

This procedure involves removal of the uterus, ovaries and fallopian tubes usually via laparoscopic surgery. Three to five tiny incisions are made on the abdomen through which the surgeon uses long, narrow instruments to detach the uterus, fallopian tubes, ovaries and cervix. These tissues are removed through the vagina, and the top of the vagina is closed with stitches. At times, the procedure must be done through a larger abdominal incision. This procedure results in permanent infertility.

Additional information about hysterectomy with bilateral salpingo-oophorectomy can be found on the Transgender Health Information Program website: transhealth.phsa.ca.

Hysterectomy with bilateral salpingo-oophorectomy is performed by many obstetrician/gynecologists in BC and usually involves one to two nights in hospital. 


Primary care providers will make the referral to a surgeon of their choice and include the assessment documents and any other relevant clinical information. 


Pre-operative consultation and post-operative care will be provided by the surgeon.

Hysterectomy/ bilateral salpingo-oophorectomy is fully funded by MSP for treatment of gender dysphoria. 

 
Smoking cessation is strongly recommended six months prior to surgery and is required by some surgeons.  

The need to discontinue hormone therapy prior to surgery is at the discretion of the surgeon.

Hope Air is a charity that may be able to assist with travel costs and the Travel Assistance Program is another option to assist with travel costs within BC. 

 

Contact details can be found in the "Referring a Patient for Gender Affirming Surgery" document. 

 
Patients should check with their surgeon for more specifics, such as rates of each complication.

  • Risk related to general anesthetic (including death)
  • Excessive blood loss and need for transfusion
  • Blood clots
  • Damage to surrounding structures (bladder, intestine, blood vessels) with possible need for further surgery
  • Nerve damage and loss of sensation
  • Hematomas, seromas 
  • Infection or abscess 
  • Wound dehiscence with delayed healing
  • Hypertrophic or keloid scarring
  • Post-op regret
  • Pain, bruising, swelling, vaginal discharge, numbness and or shooting/burning pains, constipation (from pain medication)
  • Need to reduce activities & take time off from work for three to four weeks or longer (expect longer healing time if laparoscopic approach not used)
  • Need for a support person in the post-operative period to assist with daily activities such as grooming, meal preparation, laundry, etc.
  • Need for follow-up with surgeon at four to six weeks post-op
The primary care provider (GP, NP, or in some cases endocrinologist) is the person responsible for making the referral to the surgeon. In some cases the person doing the assessment is also the primary care provider, but if not, assessment documentation should be sent to the primary care provider (not to Trans Care BC).

Assessors can better ensure a smooth pathway for the patient by:

SOURCE: Hysterectomy with Bilateral Salpingo-Oophorectomy ( )
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