Below is a list of the possible feminising genital surgeries:

To ensure a safe operation with the best possible outcome, it is important that you stop smoking. Smoking increases the risk of complications following the operation. Complications that may occur more frequently include wound infections, delayed wound healing and tissue necrosis. In addition, smoking can affect the healing of scars. At most healthcare facilities, you will only be eligible for genital surgery if you are not a smoker. This may vary from one healthcare facility to another, so check with your healthcare facility to find out what applies to you.

A healthy BMI is important for a safe operation and the best outcome. BMI stands for Body Mass Index: the ratio of weight to height. Your BMI must be between 18 and 30 to be eligible for genital surgery. Only for orchiectomy is a BMI of up to 35 permitted. It has been shown that people who are underweight (BMI below 18) or overweight (BMI above 30) are at greater risk of thrombosis (blood clots), wound infections and delayed wound healing following surgery. Would you like to calculate your BMI? You can do so on the Voedingscentrum’s website.

Most healthcare institutions apply the rule that you must have been taking hormones for at least one year before undergoing genital surgery. For orchidectomy, vulvoplasty and vaginoplasty surgery, it is necessary that your testosterone levels have decreased sufficiently (<2 nmol/L).

Please note: healthcare providers often require that hormone therapy be supervised by a gender team. If you are self-medicating or receiving hormones via an independent GP, this usually does not count towards the requirement that you must have been on hormones for at least one year. If you are self-medicating or receiving hormones via a GP, make clear arrangements regarding this requirement with your healthcare provider.

Hormone use does not need to be adjusted prior to genital surgery. The combination of estradiol and the testosterone blocker carries a slightly increased risk of thrombosis (blood clots) during the operation. You will be given an injection of blood thinners before the operation to reduce the risk of thrombosis. After the operation, you will no longer need to take the testosterone blocker. You will, however, need to continue taking estradiol. Your hormone treatment will be managed by an endocrinologist after the surgery.

For life after vulvoplasty and vaginoplasty, it is important to be aware of the muscles in the genital area (the pelvic floor muscles) and to be able to tighten and relax them in a controlled manner. In some cases, permanent hair removal from the genital area prior to vaginoplasty is advised.

To gain more control over your pelvic floor muscles, some healthcare facilities will provide you with information and practical tips on how to use these muscles before the operation. A physiotherapist who specialises in the pelvic floor (pelvic floor physiotherapist) can teach you how to relax your pelvic floor muscles. This ensures that you can urinate and pass stools properly without straining. Following a vaginoplasty, relaxing your pelvic floor muscles is also very important for dilation (keeping the vaginal cavity open) and wound healing. You can find further information on this in the animated video from Amsterdam UMC.. You can read more about dilation here.

It is not always medically necessary to have the hair in the genital area permanently removed. Very occasionally, the plastic surgeon may decide during your consultation that hair removal is necessary prior to the vaginoplasty operation. This depends on your skin and hair growth. Permanent hair removal is carried out using electrolysis or laser treatment. The plastic surgeon will refer you to a skin therapist if permanent hair removal is required. You will discuss with the skin therapist which hair removal technique is most suitable for you.

Permanent hair removal is a long-term process that requires several depilation sessions. Hair can be permanently removed by electrolysis or intense pulsed light treatment. In consultation with a skin therapist, you will determine which depilation technique would be the most suitable, in your case.

In preparation for the period following your operation, it will be handy if you buy a few things in advance: a dilator set, water-based lubricant and a mirror on a stand.

To prepare for your recovery after the operation, it is recommended to gather a few things in advance: sanitary towels, loose-fitting underwear, spare bed linens (to deal with stains from fluid and blood loss), paracetamol, ibuprofen, water-based lubricant and a small mirror. If you’re getting a vaginoplasty, you may be given a dilator set by the healthcare facility where the operation is taking place. If this isn’t the case, you’ll need to buy a dilator set yourself. Sitting for long periods can be painful after genital surgery. If your job involves a lot of sitting, it is a good idea to buy a doughnut cushion.

It’s also a good idea to make a plan with your loved ones for the weeks following the operation. It’s helpful if someone can assist you with things such as shopping, cooking and housework.

You can prepare for the operation by maintaining a healthy BMI and a good level of fitness. Eating healthily can also help maintain a healthy BMI: make sure you’re getting enough vitamins, protein and fibre in your diet. If you are a vegetarian or vegan, it’s extra important to pay attention to the amount of protein you consume.

For most people, at least 1.5 to 2 litres of water a day is a good amount. Few people manage to drink that much water. Staying hydrated is important, especially whilst you’re recovering from the operation. If you don’t drink enough water currently, it’s a good idea to get into the habit of drinking at least 1.5 litres of water a day. If you manage to do this before the operation, it will be easier to do this during recovery.

If you’d like to find out more about nutrition and fitness, you can ask your healthcare professional for advice. For general advice on nutrition, you can visit the Nutrition Centre’s website.

Following genital surgery, you will be unable to attend school or work for several weeks. It is important that you make clear arrangements about this with your employer or educational institution before the operation. For example, you should agree on how long you will be absent, how and when you will catch up on lessons, and who you can contact if your recovery takes longer than planned.

With some employers, you may be entitled to special paid transitional leave following genital surgery. Unfortunately, most employers don’t offer this option, in which case you can apply for normal sick leave for the operation and your recovery. If you’re on a zero-hours contract (for example, if you work in the hospitality sector), you often aren’t entitled to any paid leave at all. So, before the operation, consider roughly how long you won’t be able to work, whether you’ll be paid during your recovery or not, and how much money you’ll need to save to get through the recovery period.

Following an orchiectomy, you can gradually return to work after two weeks. If you do physical work (for example, in construction or as a cleaner), you may only return to work around six weeks after an orchiectomy. This is because, following an orchiectomy, vulvoplasty or vaginoplasty, you must avoid heavy lifting or exercise for at least six weeks after the operation. Following vaginoplasty and vulvoplasty, you may return to work after six weeks. If you do physical work, you may need a longer recovery period before you can return to work. It is important to listen carefully to your own body and, if in doubt, to consult your doctor.

In the Netherlands, orchidectomy, vulvoplasty and vaginoplasty operations are covered by health insurance. If the plastic surgeon considers it necessary for the hair in your genital area to be permanently removed, up to 10 depilation treatments with a skin therapist are covered. The Transvisie website provides an up-to-date overview of reimbursements within gender-affirming care.