Vulvoplasty

Vulvoplasty is a gender-affirming, lower body surgery that creates the vulva (including mons, labia, clitoris, and urethral opening) and removal of penis, scrotum, and testes.

Vulvoplasty means you may be able to stop or reduce testosterone blockers or reduce estrogen dose, be able to urinate sitting down and will no longer need to "tuck" genitals. Vulvolplasty is best for people who are not interested in the ability to have receptive vaginal sex or those who don't want to, or are unable to, maintain the rigorous dilation & aftercare regime associated with vaginoplasty.

Referral & consult

Referral & consultation process

1Complete surgical readiness assessment

To get started, you will need to complete one surgical readiness assessment by a qualified assessor, and and meet the eligibility and criteria required for this surgery. After you have completed your assessment, your primary care provider will direct your referral to the surgeon of choice. Additional assessments may be requested at the discretion of your surgeon.

2Review referral options

Your primary care provider will direct your referral to the surgeon office at GRS Clinic in Montreal. Visit the surgery referral page for steps required in the referral options for vulvoplasty.

3Speak to your surgeon

You may want to speak to your surgeon about:

Your gender-affirming surgery goals
The hair removal requirement prior to surgery - some surgeons do not recommend removing hair from the genitals before this surgery; others require it. Follow the advice of your surgeon.
The need to stop taking hormones - the surgeons at the GRS clinic Montreal typically ask patients to stop taking hormone therapy medication three weeks before vulvoplasty
The different surgical techniques available
The advantages and disadvantages of each technique
What your options are if you are not satisfied with the appearance of your vulva, labia or clitoris
What your options are if you are having difficulty with sexual function
Whether they have before-and-after photographs of their own patients, including those of both successful and unsuccessful outcomes
The risks and possible complications of the various techniques
The surgeon's own complication rates for each procedure

Surgery

The 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

Preparing for surgery

Be sure to review the pre-operative surgical package provided by surgeon's office before surgery. For more information about preparing for this surgery and about your post-operative care, contact the GRS clinic directly.

While you wait for your referral to be processed, you might want to keep your personal information updated with all of your health care providers, including any change of name or contact information. This will ensure your health care professionals can reach you to schedule consultation and surgery appointments.

You may also want to visit the Preparing for Surgery page to help you create a plan for success after surgery.

Complications

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 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 the 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.

After surgery

Post-operative care

You will be admitted to the recovery residence in Montreal two days before your surgery. After your surgery, you will stay in hospital for up to three nights. Then you will return to the recovery residence for about seven days.

You will likely receive painkillers and antibiotics to prevent infection. Your surgeon will provide you with a list of medications to avoid for the first month. Do not resume taking hormones until your surgeon has advised you to do so.

During the healing process, you can expect:

bleeding from incisions during the first 48 hours following surgery
itchiness and small shooting electrical sensations as nerve endings heal
bruising, which can spread from your belly to your thighs and which takes 3 to 4 weeks to settle down
a bit of spraying when you urinate, which usually improves over time
swelling of your labia, which can take up to 6 weeks to resolve
your vulva to approach its final appearance at 4 months
numbness, which will improve over the first few months, and can take up to 18 months to resolve
red, dark pink or purple scars, which take up to one year to fade

Check-ups

The number of check-ups needed varies from person to person. If possible, see your primary care provider about a week after you return from Montreal and then every 2-4 weeks for the first few months. When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound healing problems. They will ask questions about bleeding, fever, pain and how you are feeling emotionally and physically.

Recovery time

Recovery time varies from person to person, so always follow the advice of your surgeon. Many people begin to feel more comfortable during the second week after their surgery. You'll need plenty of rest in the first two weeks. It's common to be back to your usual activities, including work, in six to eight weeks. Some activities, such as driving, heavy lifting, exercise, sex, and soaking in hot tubs, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities. Complete recovery can take up to one year.

Surgical revision

A surgical revision of a vulvoplasty, if needed, would typically take place 6 to 8 months after your surgery is complete. With a letter of recommendation from your surgeon stating the revision is medically necessary, the cost of your revision will be covered by the BC MSP.

Common reasons for a surgical revision include:

To adjust the size, shape, location or hooding of the clitoris
To adjust the size or shape of the labia minora or majora

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