Male to Female FAQ | Vaginoplasty

1. Can I have children after my surgery?

No, a vaginoplasty will not allow you to have children. The main objective of this surgery is to obtain the most natural as possible female external genitals. To have children, it would be necessary to implant internal female structures in your body like a uterus, ovaries, and egg cells, which is not possible at this time.

2. Which methods are used to make having biological children possible?

Depending on your goals and expectations, your doctor will be able to provide you with information and resources. Discuss your options with your doctor before surgery.

3. Why must I stop taking hormones 3 weeks before and for 2 weeks after surgery?

Feminizing hormones predisposes you to the formation of small clots. Because of the position you’ll be in during the procedure and because you will be less mobile during your recovery, taking hormones in the weeks before and after surgery increases the risk of venous thrombosis and pulmonary embolism.

4. Does this surgery necessarily involve the creation of a vaginal cavity?

No, it is possible to have a vaginoplasty without vaginal cavity. Should you choose this option, it is always possible to create a vaginal cavity in the future.

5. Does the length of my penis and the size of my scrotum determine the depth of my vaginal cavity?

No, it rather indicates if there is enough skin to completely cover the vaginal wall. In the event that the amount of skin present is insufficient, the surgeon will take a skin graft in the back, the buttock, or thigh in order to construct a vaginal cavity of satisfactory depth.

6. How can I know if the skin of my penis and scrotum are sufficient to avoid a skin graft?

Skin grafts are rarely necessary. However, following your physical evaluation prior to surgery, the surgeon will determine if a skin graft is necessary or not.

If you have had an orchiectomy before vaginoplasty surgery, a skin graft will be most likely necessary as the scrotal skin may have contracted with time and therefore be insufficient.

7. If I am circumcised, is this a problem?

Circumcision has no effect whatsoever on surgery.

8. Will I have to undergo electrolysis and/or laser treatments to remove the hair on my scrotum before vaginoplasty?

Permanent scrotal hair removal is not required prior to vaginoplasty. During the procedure, the surgeon will meticulously cauterize every hair he sees before proceeding with the scrotal skin graft into the vaginal cavity. However, it is possible to observe hair regrowth in the vaginal cavity if some invisible hair could not be removed.

*Should you still wish to proceed with permanent hair removal it is not contraindicated. However, it is required to observe a waiting period of 3 months between your last treatment and your date of surgery to ensure that there is no regrowth before your surgery. If you are considering treatments, we recommend that you finalize them. Indeed, the hair weakened by permanent hair removal treatments could not be cauterized by the surgeon, because they will not be apparent enough.

The part to be depilated is the skin of the scrotum as well as a 3 cm wide strip between the scrotum and the rectum (stop 2 cm before the anus).

9. Do I have to remove my sutures after surgery?

In the event of hair regrowth in the cavity and when healing is well advanced, your attending physician can remove it with long forceps during a vaginal examination with a speculum. If the hair regrowth is extensive, a gynecologist can burn off these hairs using a surgical cautery. This procedure is normally done under local anesthesia.

*The surgeons of the GrS Montréal team do not practice the cauterization of hairs in the cavity.

10. If hair grows in my vagina after surgery, how do I remove them?

Should hair regrow in the vaginal cavity, your doctor can, one year after surgery, remove them with a long pair of tweezers during your speculum examination. If regrowth is extensive, a gynecologist can burn the hairs with a surgical cautery. This procedure is usually performed under local anesthesia.

*GrS Montréal surgeons do not practice hair cauterization in the vaginal cavity.

11. Which medications will be administered to me after surgery?

Following surgery, you will be prescribed medications such as antibiotics, anti-inflammatories, and medication to relieve your pain. Your medication will be adjusted and modified according to your medical situation.

12. Will I be awake during the surgery?

The surgery is usually performed under regional anesthesia, but you will still be asleep.

13. What is the dilation routine?

The routine includes 4 dilations per day for the first month after surgery. Afterwards, this decreases to 3, then 2, and finally, about 1 year after surgery, you will perform 1 dilation per week. It is important to know that regular dilations will be necessary for the rest of your life. Without them, the vaginal cavity will close. Vaginal dilation is one of the most important treatments after surgery.

14. Will the dosage of my feminizing hormones remain the same after surgery?

You will need to schedule an appointment with your endocrinologist or your hormone therapy’s prescribing physician 2 months after surgery in order to follow-up on the dosage of your medication.

15. How soon after surgery can I begin to simulate my clitoris?

You can begin to explore the clitoral area with your fingers about 8 weeks after surgery. The nerve endings will have been affected during surgery and sensations may feel different or diminished. Take time to explore your new genitals to discover these new sensations. Nerve stimulation through touch and massage contribute to the reconnection of nerve endings, allowing you to rediscover sensations.

16. How soon after surgery can I have sexual relations with penetration?

You should normally wait approximately 12 weeks after surgery before engaging in oral sex or sex with vaginal or anal penetration. Please note, however, that any physical effort involving the muscles that were affected by surgery may cause pain.

17. After surgery, is it possible for the vaginal cavity to tear during sexual relations with vaginal penetration?

No, the vaginal cavity cannot tear.

18. Is it possible to produce natural vaginal lubricant after surgery?

Since the Cowper's glands, responsible for the secretion of pre-ejaculatory fluid, are preserved during surgery, it is possible to observe some lubrication during sexual arousal. Indeed, the glands can secrete liquid which will pass into the urethra and could therefore be present at the level of the vulva and the entrance to the vaginal cavity.

The presence of this liquid varies greatly from person to person. It is not possible to know before the surgery if there will be natural lubrication or not. In the absence of natural lubrication or in case of insufficiency, you can use a water-based lubricant during sex.

19. Which type of lubricant should I use after my vaginoplasty?

GrS Montréal surgeons strongly recommend using an unscented, alcohol-free, water-based lubricant

20. Following surgery, is it possible to remove hair from the genital region by shaving, laser, electrolysis, and/or hair removal cream?

About 6 weeks after surgery, and if your wounds are completely healed, you can begin using a razor and hair removal cream. As for laser hair removal treatments, you must wait at least 8 weeks after surgery and ensure that your wounds have completely healed.

21. Do I need to have gynecological examinations after vaginoplasty?

It is recommended to have a first gynecological examination 1 year after surgery, and annually thereafter, unless your surgeon or doctor prescribes a different frequency. A speculum examination of your vaginal cavity allows for an examination of the inner wall and to verify its integrity. If an examination reveals an abnormality, your doctor can communicate at all times with the surgical team at GrS Montréal by fax or email.

It is not recommended to use a speculum for a vaginal examination before at least 1 year after surgery, unless otherwise directed by your surgeon.

22. Should I ask my doctor to examine my prostate after vaginoplasty?

Since the prostate is not removed during surgery, it is important to continue your prostate examaminations according to your history and the recommendations of public health and your doctor.

23. Is it possible to get vaginitis after a vaginoplasty?

Yes, it is possible to get vaginitis after surgery because the condition is an inflammation caused by an infection in the vaginal cavity. The nursing staff will inform you how to prevent vaginitis as well as of its signs and symptoms so that you may be able to recognize it.

Good vaginal hygiene contributes significantly to preventing this infection. A proper hygiene routine will be explained during your postoperative care.

24. Should I do pap tests after vaginoplasty?

Since the vaginal cavity is covered with skin, the type of cancer that could theoretically develop there is skin cancer. The diagnostic test for this type of cancer is the skin biopsy, not the pap test.

25. I had an orchiectomy but am considering a vaginoplasty. How long should I wait between the two?

If your healing has been without complications, it is recommended to wait at least 6 months between the two surgical procedures.