You will only be eligible for genital surgery if you have stopped smoking. Smoking increases the risk of wound infections, slows down wound healing and increases the risk of necrosis. It also causes more scarring.

For a safe operation and the best results, you will need a healthy BMI value. BMI stands for Body Mass Index: your body weight–height ratio. For genital surgery, in general, your BMI should be at least 18 and not exceed 30, with the exception of orchidectomy, for which a BMI of up to 35 is still allowed. It has been shown that people who are underweight (BMI below 18) or overweight (BMI over 30) run a greater risk of thrombosis, wound infection and delayed wound healing after surgery. More information on the various complications can be found at orchidectomy, vulvoplasty and vaginaplasty.

To calculate your BMI yourself, please see the website of the Netherlands Nutrition Centre: Voedingscentrum NEDERLANDSE SITE.

Most healthcare facilities require that you must have used hormones for at least 1 year before undergoing genital surgery. This ensures that the testosterone levels are suppressed enough. The dosage of the hormones may vary from one healthcare facility to another.

For genital surgery, hormone use will not have to be adjusted. The combination of oestradiol (female sex hormone) and testosterone blockers gives a slightly increased risk of blood clotting (thrombosis) during the operation. This risk is particularly low because it is a short operation, and, in addition, you will receive an injection of blood thinners before the start of the procedure, to prevent thrombosis.

After the operation, you will stop taking testosterone blockers. The endocrinologist will check your hormone levels about three months after the operation.

For vulvoplasty and vaginoplasty, additional preparations will be needed, such as training your pelvic floor muscles and permanent depilation of the genital area.

To gain more control over the pelvic floor muscles, you will be given explanations and practical tips on how to use these muscles prior to surgery. A physical therapist who specializes in the pelvic floor can help you with this. You will learn to consciously relax your pelvic floor muscles. This can ensure that you can urinate and defecate properly without pressing. Additional explanation can be found in the animation video from Amsterdam UMC.

After the vaginoplasty, relaxation of the pelvic floor muscles is important during dilation - to keep the vagina open - and wound healing. More information on dilation can be found here.

In vulvoplasty and vaginoplasty, the genital tract is made of skin from the genital area. Your health care provider may recommend permanent hair removal prior to surgery. To prevent hair from growing in unwanted areas, such as the inside of the labia or the vaginal cavity, this skin should be permanently depilated in the period before surgery. The images below show the places where permanent hair removal is generally necessary. If skin from other areas is used to create the vaginal cavity, these will also need to be depilated.

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 general, permanent hair removal lasts at least four months. Therefore, it is advised to start this early, before you have had appointments with the surgeon. It is important to realize that surgery is done in consultation with the healthcare facility. Therefore, hair removal does not guarantee genital surgery.

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.

In the Netherlands, health insurance will cover orchidectomy, vulvoplasty and vaginoplasty operations. Currently, coverage also includes depilation of the genital area for vulvoplasty and vaginoplasty. Please note that coverage only includes the necessary depilation of the genital area for these operations; hair removal in any other areas will not be covered by health insurance.