Considering surgery

What surgeries create a vulva and vagina?

There are two lower body surgeries that create a vulva and 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. : 

1. 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. — Which creates a vulva and little or no vaginal depth
2. Vaginoplasty A gender-affirming genital surgery to create a vulva (including mons, labia, clitoris and urethral opening) and vagina. — Which creates a vulva and a vagina with depth that allows for receptive sex

Both of these surgeries remove the 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. , testes and scrotal sac. Tissue is used from the penis and scrotum to create the vulva, including the labia The external genitals (folds of skin) around the vaginal opening. , 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. and urethra opening. In the case of vaginoplasty, skin from the shaft of the penis is inverted to create the inner walls of the vagina. For more information on these surgeries, visit Understanding the Procedure.

The goal of both these surgeries is to create genitals with sexual sensation and a urethra that enables urination while sitting. Some people may be able to stop or reduce testosterone blockers or reduce their estrogen dose after these surgeries.

B.C. residents can access vulva and vagina construction surgeries at two locations in Canada: the Gender Surgery Program B.C. (GSPBC) at Vancouver General Hospital (VGH) and GrS Montreal (Quebec).

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 Vaginoplasty & Vulvoplasty 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.)?
• Are you okay with having to dilate your vagina multiple times a day for one year or more after surgery?
• Do you want to have receptive sex with your vagina?

Setting realistic expectations

Like with any other surgical intervention, there are risks associated with vulva and vagina 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. 

Limitations of vulva and vagina construction

• You may not be satisfied with the depth of your vagina
• You may not be satisfied with the appearance of your vulva
• You may experience some loss or changes in sensation
• Recovery may be longer than you had anticipated
• You may experience lingering pain or discomfort 

We recommend familiarizing yourself with the complications associated with vulva and vagina 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 vulva and vagina 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 vulva and vagina construction surgery through the Gender Surgery Program B.C. (Vancouver General Hospital) or GrS Montreal in Quebec.

Private pay option

Some people choose to have their vulva and vagina 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 somewhere besides Vancouver or Montreal 
• 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 vulva and vagina construction within Canada. This is because this surgery is an MSP-funded benefit. Options for private pay exist outside Canada. 

Other surgery-related costs

While MSP pays for most of the costs associated with vulva and vagina 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 most people require six to eight weeks off work. (If your work is physically demanding, you may need more time.)
• Medical supplies and other post-surgery items — These include wound care supplies, mesh underwear and medications. You can find a full list of recommended post-surgery items in the Vaginoplasty & Vulvoplasty Workbook.
• Travel and accommodation — If you don’t live near the surgical centre, you will need to cover the costs of travel. 
  • If you are having surgery at GSPBC: 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.
  • If you are having surgery at GrS Montreal: You will need to cover the cost of travel to Montreal. GrS Montreal arranges accommodations for you (a hotel before surgery and an aftercare facility post surgery) and PHSA provides funding to cover the costs. Ensure you budget for travel, meals and incidentals. Note: Meals are provided at the GrS aftercare facility, but not at the hotel. 
• 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 vulva and vagina construction and revision A follow-up procedure or adjustment to a previous surgical operation or treatment to correct or improve its outcome. surgeries).