Preparing for the genital operation
To be eligible for genital surgery, you must meet several requirements. It is important to be well informed.
Listed below are the possible masculinising surgeries on the internal reproductive organs (gynaecological operations):
- Hysterectomy: removal of the womb
- Colpectomy: removal of the vagina (only possible after or in combination with a hysterectomy
- Oophorectomy: removal of the ovaries (also possible in combination with the removal of other internal reproductive organs)
- Salpingectomy: removal of the fallopian tubes (also possible in combination with the removal of other internal reproductive organs)
In addition, there are masculinising surgeries on the external genitalia:
- Metoidioplasty: creating a penis from your existing genitalia
- Phalloplasty: creating a penis from tissue taken from elsewhere on your body
General conditions for genital surgery
There are several masculinising genital surgeries you can undergo. To gain an understanding of the possible treatment options and the care pathway, you can watch the animated video from Amsterdam UMC.
To ensure a safe operation and the best possible outcome, it is important to meet a number of conditions:
- You do not currently smoke;
- You are at a healthy weight (a BMI between 18 and 30 is usually required);
Additional requirements for metoidioplasty or phalloplasty:
- You are able to urinate normally (good urinary function);
- You have attended an additional information consultation about genital surgery;
- You have had a consultation with a sex therapist; in some cases, this may be your own psychologist;
Additional requirement for urethral lengthening:
- The vagina has been removed (colpectomy).
Smoking
To ensure a safe operation and the best possible outcome, it is important that you do not smoke (anymore). Smoking increases the risk of wound infections, slows down wound healing and (following metoidio- or phalloplasty) increases the risk of (part of) the penis and/or the scrotum becoming necrotic. Furthermore, it may lead to less aesthetically pleasing scars and could result in the penis functioning less effectively, for example due to problems with urination and possible sexual dysfunction.
At most healthcare institutions, you are only eligible for genital surgery if you have stopped smoking. You are often only placed on the waiting list if you have stopped smoking, and you are expected to refrain from smoking until you have fully recovered from surgery. If the hospital has any doubt, a urine test will be carried out to determine if you are still smoking. If it transpires just before the operation that you are still smoking, the operation will be cancelled.
Healthy weight
A healthy BMI is important for a safe operation and the best possible outcome. BMI stands for Body Mass Index: the ratio between your weight and height. Your BMI must be between 18 and 30 to be eligible for genital surgery. It has been shown that people who are underweight (BMI less than 18) or overweight (BMI greater than 30) are at greater risk of thrombosis, wound infections and delayed wound healing during and after surgery.
Want to calculate your own BMI? You can do so on the Voedingscentrum website.
Good urinary function
It is important that you can pass urine without issues before you can undergo genital surgery. The urologist will assess your urinary function using a urine flow test (flowmetry). If it turns out that your urinary function is inadequate, this must first be improved under the supervision of the urologist. If you wish to have your vagina removed (colpectomy), you will be given an appointment with a pelvic floor physiotherapist before the operation.
Vaginal removal (colpectomy) in preparation for urethral lengthening
If you wish to undergo a metoidioplasty or phalloplasty with urethral lengthening, the vagina must be removed prior to the operation. Removing the vagina significantly reduces the risk of complications during a future urethral lengthening procedure. However, the colpectomy itself also has specific requirements, as well as a long recovery period and risks of complications. You can find more information about the colpectomy here.
Hormone therapy and medication
Most healthcare providers will only proceed with genital surgery if you have been taking testosterone for at least one year prior to the surgery. The dosage of the hormones may vary depending on the healthcare provider or the individual.
Please note: healthcare providers usually require that hormone therapy be supervised by a gender team at a healthcare facility. 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 generally does not need to be adjusted prior to genital surgery. Sometimes other medication – such as blood thinners – must be temporarily stopped or adjusted; you will receive instructions on this from your treating practitioner or the anaesthetist.
Additional conditions for phalloplasty
To be eligible for a phalloplasty, you must meet a number of additional conditions, in addition to the general criteria for genital surgery. These conditions determine whether the donor skin is suitable for the phalloplasty. The donor skin is skin taken from your forearm, flank, or thigh, to create the penis:
- The tissue used for the phalloplasty can’t be too thick.
- There must be good blood flow.
- If a urethral lengthening is required, the hair on the donor skin for the urethra must be permanently removed.
Thickness and blood supply of the donor skin ‘flap’
The tissue used for the phalloplasty (the flap) must not be too thick. If you grab and lift the skin in question, the fold can’t be thicker than 1–2 cm. Your plastic surgeon will assess this during the consultation at the outpatient clinic. You can try to reduce the subcutaneous fat layer yourself through endurance training (for example, by cycling or running).
The blood supply to the donor skin is also assessed by the plastic surgeon during the consultation at the outpatient clinic. In addition, any scars and/or tattoos on the skin are examined, and an assessment is made as to whether these pose a problem for the creation of the penis.
Hair removal from the donor skin
Most healthcare providers recommend that the hair from the donor skin used to create the urethra be permanently removed before the operation. This is to prevent hair from growing inside the urethra, as this can impair urinary function. During the consultation at the healthcare facility, the plastic surgeon will determine whether this is necessary for you and can help by referring you to a specialist hair removal clinic.
If hair removal from the donor skin is necessary for you, it is recommended that you start the hair removal process at least 6 months before the surgery. This is because multiple treatments are often required. Permanent hair removal is carried out using a laser, intense pulsed light (IPL) therapy or electrolysis, performed by a skin therapist or beautician. The area to be treated is a narrow strip of skin – approximately 3cm x 17cm.
Advice for at home
To prepare for your recovery after the operation, it is a good idea to gather a few things in advance: tight-fitting underwear or mesh briefs, old bed linen (to deal with stains from fluid and blood loss), paracetamol, and possibly ibuprofen. Sitting for long periods can be painful after genital surgery. If your job involves a lot of sitting, it’s a good idea to buy a doughnut cushion.
It is also a good idea to make a plan with your loved ones for the weeks following the operation. It is helpful if someone can assist you with tasks such as shopping, cooking and housework. You can find more information about recovery at home on the pages dedicated to the operation itself.
Fitness and nutrition
You can prepare for the operation by maintaining a healthy BMI and a good level of fitness. It also helps to eat healthily: make sure you get enough vitamins, protein and fibre. If you follow a vegetarian or vegan diet, it is important to pay extra 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. Very few people manage to drink that much water.
Staying hydrated is important, especially whilst you’re recovering from surgery. If you currently don’t drink enough water, 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 keep it up afterwards.
If you’d like to know more about nutrition and fitness, you can ask your healthcare provider for advice. For general advice on nutrition, you can visit the Voedingscentrum website.
School and work
After genital surgery, you won’t be able to attend school or work for some time; at least 6 weeks. It’s important that you make clear arrangements about this with your employer or educational institution before the operation. For example, agree on how long you’ll be absent, how and when you’ll catch up on lessons, and who you can contact if your recovery takes longer than anticipated.
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 a hysterectomy, colpectomy, metoidioplasty or phalloplasty, you must avoid heavy lifting or exercise for at least 6 weeks after the operation. If you have a physically demanding job, you may need a longer recovery period before you can return to work. It is important to listen to your own body and, if in doubt, to consult your doctor.
Health insurance
In the Netherlands, hysterectomy, colpectomy, oophorectomy, metoidioplasty and phalloplasty are covered by health insurance (2026). Permanent hair removal from the donor skin used to create the urethra is also covered. You will need to pay for the hair removal on the skin used to create the shaft of the penis yourself. An up-to-date overview of what is covered under gender-affirming care can be found on the Transvisie website.
This text was edited on 3-11-2026
Next Step
We recommend that you go through all the information chapters step by step to get a complete picture of the various treatment options and the process involved!We strive to keep this information up to date. Do you have any additions or comments regarding the information above? Please email us at [email protected]
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Hysterectomy (removal of the womb)
A hysterectomy is a gynaecological operation in which the womb is removed. You can read all about the operation and the recovery process here.
