The Gender Surgery Program B.C.
Related topics: 2SLGBTQIA+ Surgery Transgender care
The Gender Surgery Program B.C., including the Gender Surgery Clinic, opened at Vancouver General Hospital (VGH) in September 2019, making the Gender Surgery Program B.C. Western Canada's only program performing lower gender-affirming surgeries for transgender and gender-diverse people.
What we offer
The Gender Surgery Program is comprised of a multidisciplinary team of health care providers and surgical specialists devoted to providing high-quality gender-affirming treatment and surgical care. Patients will receive care through the Gender Surgery Clinic throughout their entire surgical journey, including pre- and post-operative care, until discharged to their primary care provider.
The Gender Surgery Program offers both feminizing and masculinizing procedures consistent with the guidelines established by the World Professional Association of Transgender Health (WPATH).
Feminizing Procedures
- vaginoplasty
- vulvoplasty
- revision surgery
Masculinizing Procedures
- metoidioplasty
- erectile tissue release
- phalloplasty
- penile and testicular implant surgery
- revision surgery
All procedures will be performed at surgical sites in Vancouver.
For breast construction and mastectomy questions, referrals, and waitlist visit Trans Care BC for more information.
Frequently asked questions
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What is the minimum age for the Gender Surgery Program BC?
The age for access to lower gender-affirming surgery is the age of the majority, which in British Columbia is 19 years of age.
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Can peers/family members attend gender surgery consultations?
Yes, family, friends and peers are encouraged to attend. However, please be mindful of how many people you bring with you as the clinic rooms can only accommodate 1-2 extra support people.
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Why was I discharged from the program and told I must start again?
We hold a three-call policy when needing to reach patients at any point during the GSPBC process. After attempting to contact both you and your referring Primary Care Provider (PCP), we will begin a 4 week waiting period before you are formally discharged from the program. In the event of discharge, a letter will be sent to you and your PCP. Should you be interested in joining the program once more, a full re-referral is needed, and you will be placed at the start of the GSPBC process.
To avoid being discharged, please ensure to respond to communication from the GSPBC in a timely manner. Please also inform the clinic should your contact information change.
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How can I change the type of surgery I’m getting?
A change in the type of surgery may require a patient to undergo surgical readiness assessments specific to their newly requested surgery. Patients may start at the beginning of the GSPBC process. Occasionally, an alternate surgery may be recommended after a surgical consult. In these cases, no new surgical readiness assessments will be required.
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Can I see photos of surgical results?
As our program is currently still relatively new, we are unable to provide photos of past results. This ensures the complete confidentiality of our patients who have already had surgery. Without high volumes of completed surgeries, there is too great of a risk that a photo could be identified as a specific patient. We hope to re-evaluate this policy in the future as our program grows.
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What makes BC the best option for gender-affirming surgery?
Gender-affirming surgery is a complex procedure, and it is not uncommon to experience postoperative complications. These can vary from mild to more significant complications. If complications do arise, having surgery closer to home ensures that you have access to your surgical team for both routine follow-up and if you experience any issues in your post-op healing. Reducing the stress and strain of travel will also help improve surgical outcomes and the overall surgical experience while reducing the uncertainties and expenses involved with long-distance travel out of province.
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Why are revisions listed as a surgery option? Are they inevitable?
Revisions are not inevitable. Many people are happy with the outcomes of their initial surgery and require no further surgery outside of planned surgical stages. However, there are times when the surgical team might recommend a revision surgery if there is an unexpected outcome or complication that can be surgically addressed. This is best discussed with your surgical team during your consult and at your post-op follow-up appointments. In other cases, surgical intervention is intentionally staged for prosthetic implants or urethral continuity.
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Can I access the GSPBC clinic if I had surgery elsewhere and need revisions?
Patients who have received surgery elsewhere should return to their original surgical center for all follow-up and revision requirements. Out-of-country surgeries provided on a recommendation from a GSPBC surgeon may receive post-operative care and revisions in further consultation with GSPBC.
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Can I access the GSPBC program if I had surgery at the GSPBC and need revisions?
Yes, revisions for those who have received surgery through the GSPBC program will be prioritized. If you require a revision or care after an extended period since your GSPBC surgery, please complete a re-referral back to our program through your primary care provider. We will flag the re-referral and have this prioritized.
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What complications are common after a vaginoplasty?
Possible complications vary with each case and depend on the individual. At the initial consultation, your surgeons and clinic staff will explain the surgery and associated complications, including:
- infection
- hematoma
- tissue loss or necrosis
- urinary retention
- urinary infection
- urethral meatal stenosis
- neovaginal prolapse
- rectovaginal fistula
- urethroneovaginal fistula
- loss of depth and width of the vaginal cavity
- hyper granulation tissue
- anesthetic and other medical/general surgical complications
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What complications are common after a phalloplasty?
Possible complications vary with each case and depend on the individual. At the initial consultation, your surgeons and clinic staff will explain the surgery and associated complications, including:
- infection
- hematoma
- tissue loss or necrosis
- urinary retention
- urinary infection
- urethral stricture
- urethral fistula
- retained vaginal remnant
- anesthetic and other medical/general surgical complications
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Where am I on the waitlist?
Unfortunately, we cannot provide your standing number as you wait for surgery. The waitlist changes are dependent on the complexity of surgeries, OR availability, differences in patient hair removal times, etc. We can, if needed, provide a general sense of where you fall in each stage of the process on request.
Resources
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Lower surgery referral form (Print)
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Lower surgery referral form (Fillable)
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FAQ Vaginoplasty Hair Removal Template Change
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Vaginoplasty and Vulvoplasty Workbook
TransCare B.C.
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Phalloplasty, Metoidioplasty, ET Release Workbook
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Metoidioplasty
Enhanced Recovery After Surgery (ERAS) workbook
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Phalloplasty
Enhanced Recovery After Surgery (ERAS) workbook
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Vaginoplasty
Enhanced Recovery After Surgery (ERAS) workbook
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Vulvoplasty
Enhanced Recovery After Surgery (ERAS) workbook
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Vaginoplasty: Dilation Handout
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Vaginoplasty: Rinsing Handout
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If You Need Emergency Care Post Phalloplasty
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The referral and surgical journey
- Obtain a referral - Your primary care provider sends a referral, including your completed surgical readiness assessment, to the Gender Surgery Program’s clinic at VGH.
- After completed referral - After the GSPBC receives a fully completed referral, patients are placed on an extensive, first come first serve waitlist dependent on their surgical type.
- Intake and surgical consult - Patients will be booked for an intake appointment over the phone with one of the GSPBC Nurses. The purpose of this session is to confirm your medical history, and get a full sense of how best we can support you. At a later date, you will then meet with a surgeon either in person, or via zoom. They help provide more information about your surgery, answer questions, and help determine steps to move towards surgical readiness. For many, this includes starting on the process of hair removal.
- Hair removal - The process of hair removal takes different amounts of time for each person, dependent on the type of surgery and your individual body (this can take up to 18 months). GSPBC is working with Trans Care BC to track hair removal progress. Trans Care BC will connect with patients and inform GSPBC once hair removal is near completion. Patients are then scheduled for a second surgical consult. *Please note that if Trans Care BC and GSPBC cannot reach you this may result in a discharge from the surgical program. To avoid this, please keep your contact information up to date and check your voicemail and email regularly.
- Second surgical consult - This consultation is a check-in on your surgical readiness and helps to determine if any additional steps are needed. If all steps are completed, you are deemed surgically ready and added to a wait list for surgery. Please note the second surgical consult is often completed in person and may require a physical examination that can include one of the surgeons looking at your current genitals to help plan for your surgery.
- Preparing for surgery - This stage involves multiple Allied Health professionals depending on your needs. You will meet with the GSPBC Social Worker for an assessment, and to help prepare multiple kinds of supports, travel, accommodation, and a post-surgery support plan. You will also check-in with the GSPBC Pelvic Floor Physiotherapist for an assessment and ongoing support as needed. When a surgical date is offered to you, you will receive further education on your surgery. An Enhanced Recovery After Surgery (ERAS) booklet will be reviewed with the clinic nurse.
- Surgery - Our aim is to provide patients 2 - 3 months’ notice prior to an available OR date for your surgery. We may offer an OR date sooner than this should there be cancellations. Surgery typically requires a few days of hospital stay, with the length of stay dependent on the type of surgery and follow-up requirements.
- Post-op follow-up - Follow-up is provided by our team of surgeons, nurses, social worker, and physical therapist. This will look different for each person but requires multiple check-ins and support sessions for the first six weeks, followed by ongoing support as needed. Depending on your type of surgery you will be asked to stay local in Vancouver for a given length of time after you leave the hospital.
- Discharge - When your post-operative care is complete, you will be discharged from the Gender Surgery Clinic to your primary care provider for any required ongoing care.
Preparing for surgery
Gender-affirming surgery does involve additional planning, and we encourage you to think ahead in your surgical journey. To learn more about how you can prepare for your upcoming surgery, read our guide to preparing for gender-affirming surgery.
Cost
MSP pays for surgery at GSPBC for BC and Yukon residents. While the surgical procedure and all appointments, including pelvic floor physical therapy, are covered by MSP, we do not have funding for your travel, accommodations, or supplies.
We ask that patients stay in Vancouver for various lengths of time following their surgery, depending on the type of the surgery. Please visit the preparing for surgery page for more information on the length of your local stay.
Our social worker will meet with you one-on-one to help determine if you qualify for any financial support (Hope Air charity foundation, ministry support for persons with disabilities). Some surgery types may require lifelong purchase of supplies, such as lubrication after vaginoplasty.
Wait times and waitlist
Unfortunately, we cannot provide a clear timeframe for when to expect surgery. Multiple factors influence movement through each program stage, making wait time extremely hard to predict. The first wait for an intake and consult varies based on the volume of referrals and amount of surgeries being completed. The second wait is found within the process of hair removal. Depending on the type of surgery, hair removal may be required and can take a variable amount of time for each person.
Once hair removal has been completed (if necessary), and you’re deemed ready by a surgeon, the provincial goal is to limit the wait for surgery to 6 months. Unfortunately, this timeline often changes based on staffing and OR availability and can be longer. We aim to give you 2 - 3 months' notice before an available OR space for your surgery. We may offer an OR date sooner should there be cancellations.
Hair removal
Those electing to undergo vaginoplasty or phalloplasty may need to complete permanent hair removal. This is to limit or prevent post-operative hair regrowth in places where hair removal would be difficult or impossible, such as deep inside the vagina or inside the urethra. Electrolysis or laser hair removal is utilized as these are the two types of hair removal deemed to be permanent. Your hair removal provider will determine the type of hair removal you receive in partnership with your surgeon’s assessment.
After you meet with a surgeon, you will receive information on if you are required to undergo hair removal and which areas you may need hair removal. If you are deemed to need hair removal, the clinic will provide you with a template as well as a list of hair removal providers that Trans Care BC has approved. All medically necessary hair removal will be covered and funded.
As the hair removal process can be long (12-18 months on average), we recognize that some individuals may wish to begin their hair removal before their surgical consult. Hair removal can be self-initiated, but please note hair removal completed before surgical consultation will be paid out of pocket and not reimbursed or covered. If you do wish to self-fund hair removal before your surgical consult, please contact the GSPBC clinic, and a hair removal template will be provided.
The clinic team
The GSPBC consists of a multidisciplinary team of nurses, surgeons, and allied health providers, such as a physiotherapist and a social worker, who will work together to support you through the various stages of your surgical journey. All our clinicians are experienced in working with transgender and gender-diverse individuals.
VCH Partners in Care
Our team strives to provide you with high quality care. Quality care is best achieved when you, the patient, along with your friends and family, become “partners in care” with us, your health care providers. Please review what you can expect from us, and what we expect from you in the VCH Partners in Care document found here. Please note, deviating from this may result in reduced care and discharge from the program.