Considering surgery

What surgeries create a penis?

There are three gender-affirming, lower body surgeries that create a penis An erogenous and erectile organ located between the legs that consists of spongy tissue that can fill up with blood and may become firmer with sexual arousal. It is also a means for urination. A person may be born with a penis or have one surgically created. When referring to genitals, the Trans Care BC website uses "erogenous tissue (penis)" for trans people assigned male at birth (AMAB) and "penis" for trans people assigned female at birth (AFAB), but there are many different terms that individuals may use. and scrotum (if desired): erectile tissue release This procedure creates a penis by cutting the ligaments around the erectile tissue (clitoris), so the shaft falls away from the body, giving it a more pronounced appearance. , metoidioplasty A gender-affirming lower surgery to create a penis. Metoidioplasty involves cutting ligaments around the clitoris to add length to the shaft and grafting skin around the shaft to create more girth. Optional additional procedures include scrotoplasty and urethral lengthening. and phalloplasty A gender-affirming lower surgery to create a penis and scrotal sac (phase 1) followed by testicular implants and implants to obtain rigidity/erection (phases 2 and 3). . In B.C., all penis construction An umbrella term for gender-affirming genital surgeries that create a penis, including erectile tissue release, metoidioplasty and phalloplasty. surgeries are done through the Gender Surgery Program B.C. at Vancouver General Hospital (VGH).

There are numerous techniques and options related to these procedures, which we describe in Understanding the Procedure.

Erectile tissue release

Also called “clitoral release” or “simple meta,” this procedure creates a penis by cutting the ligaments around the erectile tissue Tissue that is capable of stiffening or engorging with blood, which typically occurs during sexual arousal. ( clitoris An erogenous and erectile organ located above the urethral opening that consists of a complex network of erectile tissue and nerves, with parts located inside and outside the body. A person may be born with a clitoris or have one surgically created. When referring to genitals, the Trans Care BC website uses "erectile tissue (clitoris)" for trans people assigned female at birth (AFAB), and "clitoris" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. ). With the ligaments cut, the penis is able to  fall away from the body, thus giving it a more pronounced appearance. As part of erectile tissue release, it’s common, but not necessary, to undergo several related procedures including 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. removal, scrotum construction and implants (for the testes).

Metoidioplasty

Also called “meta,” this procedure creates a penis by cutting ligaments around the erectile tissue (clitoris) to release it from the pubis and give the shaft length. Skin from the external genitals ( labia The external genitals (folds of skin) around the vaginal opening. or outer labia) is wrapped around the penis to add girth.  As part of metoidioplasty, it’s common, but not necessary, to undergo several related procedures including urethral lengthening A surgical procedure to extend the length of the urethra to allow for urination out of the tip of the penis. The procedure involves connecting a person's current urethra to the new urethra created in the shaft of the penis. , vagina removal, scrotum construction and implants (for the testes).

Phalloplasty

Also called “phallo,” this procedure creates a penis using tissue from the forearm or thigh (including arteries, veins and nerves). As part of phalloplasty, it’s common, but not necessary, to undergo several related procedures including urethral lengthening, vagina removal, scrotum construction, construction of the penis head ( glans The rounded head (or tip) of a penis or the end of the clitoris. ) and implants (for the testes or penis). 

Making a decision about surgery

A wide range of people choose to have gender-affirming surgery, including people who are transgender, Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) or non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. . While having surgery does not make anyone more or less trans, it can help some people feel more comfortable in their body.

Download the workbook

In addition to the information below, our Phalloplasty, Metoidioplasty, and Erectile Tissue Release Workbook contains strategies to help you on your decision-making path.

Questions to ask yourself

As you consider whether surgery is right for you, it may be helpful to start by asking yourself the following questions:

• Are you okay with having visible scars?
• Is sexual sensation important to you?
• How many operations are you prepared to have?
• What level of risk are you willing to accept?
• Do you have any health issues that may restrict your options?
• What can you afford to do (in terms of aftercare costs, time off work, etc.)?
• Do you want to keep your internal genitals (vagina)?
• Do you want to urinate standing up or sitting down?
• Do you want to have penetrative sex with your penis?

Setting realistic expectations

Penis construction may help you feel more at ease in your body, which can have positive effects on your emotional wellbeing. You may have personal and sexual experiences that are profound and affirming. 

However, like with any other surgical intervention, there are risks associated with penis construction. Many people are very happy with the outcomes of their surgery, but some also experience complications or results that don’t meet their expectations. Being prepared for the limitations of what surgery can achieve and the possibility of disappointment are part of ensuring you have realistic expectations. For example:

• You may not be satisfied with the shape or size of your penis
• You may experience some loss or changes in sensation
• You may not be able to pee while standing or have penetrative sex
• Recovery may be longer than you had anticipated

We recommend familiarizing yourself with the complications associated with penis construction surgery.

When to have surgery

Timing is also an important consideration for surgery. You may be heading off to school, starting a new job or have other important life events. Commitments like these make it difficult to accommodate the down time needed to recover from surgery. Picking the right time for surgery is as important to your recovery as any other pre or postoperative activity your primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. recommends. 

This guide is meant to help you decide

There are several emotional, spiritual, physical, social and financial considerations that may impact your decision to have surgery. This guide was prepared to help you understand the costs, the procedure, the risks and the recovery associated with penis construction surgery. 

Surgical costs — who pays for these?

Public funding

The B.C. Medical Services Plan ( MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. ) will pay for the cost of penis construction surgery.

Private pay option

Some people choose to have their penis construction surgery done outside B.C.’s public system. The reasons that someone may choose private-pay surgery include:

• Not having health care coverage
• Wanting to undergo surgery outside of B.C.
• Possible reduced wait times

If you choose that option, you would be required to pay for all of the costs, including the surgery itself. In some cases, your employer’s extended health benefits may provide some coverage. This varies significantly, though, so be sure to confirm with your health insurance provider.

Please note: There are no private pay options for penis construction within B.C. This is because this surgery is an MSP-funded benefit. Options for private pay include GrS Montreal (in Canada) or clinics outside Canada. 

Other surgery-related costs

While MSP pays for most of the costs associated with penis construction surgery in B.C., there are other costs you should consider, including:

• Time off from work — You will need time off for both your surgery and recovery period. Recovery times are unique to each person, but here are some rough guidelines for your first surgery. (If your work is physically demanding, you may need more time.)
  • Erectile tissue release: 3–6 weeks
  • Metoidioplasty: 6–8 weeks
  • Phalloplasty: 6 weeks – 6 months (depending on the complexity of the procedure and complications) 
• Medical supplies and other post-surgery items — These include wound care supplies, mesh underwear and medications. Download the Phalloplasty, Metoidioplasty, Erectile Tissue Release Workbook for a full list of recommended post-surgery items.
• Travel and accommodation — If you don’t live near the surgical centre, you will need to cover the costs of travel. You may want to arrive a day ahead of your surgery and may need to stay in Vancouver for several days or even weeks after you are discharged from hospital. Ensure that you budget for accommodations, meals and parking.
• Costs for your support person — If someone is coming with you to help with your care before and after surgery, you may need to account for their travel and accommodation costs as well.

Financial support available

There may be some financial help available depending on your employer and your income bracket. 

• Paid leave — Speak with your employer or Human Resources department about any short-term disability, sick leave or vacation time you can use during your time off. 
• Extended benefits —  If you have one, check your extended benefits program to see what is covered.
• Disability assistance — 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 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. supplies. Your primary care provider can write you a letter of support to access these funds.
• EI Sickness Benefits — EI Sickness Benefits can be an option for individuals who are working and meet the eligibility criteria.
• First Nations Health Authority (FNHA) Benefits Program — Individuals who are Indigenous, have status and live in B.C. are able to access FNHA benefits. These benefits can provide coverage for gender-affirming resources and postoperative supplies, like wound care supplies.
• Fundraising — Consider organizing online or in-person fundraisers.

There are also several programs in place that may help you cover transportation costs, including:

• Hope Air — A Canadian charity that arranges free flights for low-income Canadians who must fly to get health care.
• Travel Assistance Program (TAP) — If travel costs are a barrier for you, you may qualify for this program. You can apply for the program through your primary care provider. Visit the TAP website to learn about the application process. 
• First Nations Health Authority (FNHA) Medical Transportation Benefit — FNHA benefits can also cover the costs of travel, accommodation and meals when you need to travel for medically necessary care (including erectile tissue release, metoidioplasty, phalloplasty and revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. surgeries).