Preparing for the genital operation
To be eligible for genital surgery, you must be well informed and meet a number of criteria. A summary of the various genital surgeries for masculinisation are described below, followed by the related criteria.
- Hysterectomy: removal of the uterus
- Colpectomy: removal of the vagina (only possible after or together with a hysterectomy
- Metoidioplasty: making a penis from your own genitals
- Phalloplasty: making a penis out of tissue taken from other locations on your body
Preconditions for the operation
There are several masculinizing genital surgeries you can undergo. To get an understanding of the possible treatment options and care path, you can watch Amsterdam UMC's animation video.
For a safe operation and the best results, you will need meet the following criteria:
- You have stopped smoking;
- You have a healthy weight (BMI value > 18 and ≤ 30);
- You are able to urinate properly (good urinary function);
- For urethra extension, your vagina needs to have been removed
Smoking
For a safe operation and the optimal result, we only operate on people who do not smoke. You will therefore only be eligible to enter the waiting list for genital surgery if you are a non-smoker. Smoking increases the risk of wound infections, slows down wound healing and increases the risk of necrosis (of part or all of the penile skin and/or scrotum). It also causes more scarring and may result in a less well-functioning penis, leading to problems related to urination and possibly to certain sexual functions.
Healthy weight
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. It has been shown that people who are overweight (BMI over 30) run a greater risk of thrombosis, wound infection and delayed wound healing after surgery.
To calculate your BMI yourself, please see the website of the Netherlands Nutrition Centre: Voedingscentrum.
Good urinary function
In order to undergo genital surgery, it is important that you are able to urinate properly. The urologist can assess your urinary function with the use of a medical flow meter. If your urinary function is found to be inadequate, this should first be improved, under supervision of the urologist.
Removal of the vagina (colpectomy) in preparation for the urethral extension
If you are having a metoidioplasty or phalloplasty with urethral extension, the vagina should be removed before the urethral extension operation. This reduces the risk of urethral problems. More information on the colpectomy can be found here.
Hormone use
Most healthcare facilities require that you must have used testosterone for at least 1 year before undergoing genital surgery. This ensures that the female hormones 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. In some instances, it requires that you temporarily stop taking other types of medications, such as blood thinners, or a change to the dose; your physician or anaesthetist will give you the appropriate instructions.
Additional preconditions phalloplasty
In order to be eligible for phalloplasty, you will need to comply with a number of additional preconditions, in addition to the General Terms and Conditions of Genital Surgery as described above. These additional preconditions involve an assessment of whether the donor skin from other areas of your body (arm, leg or flank) would be suitable for the phalloplasty:
- Your donor skin should not be too thick and must be well perfused.
- Your donor skin must be depilated
Thickness and perfusion of the donor skin
The donor skin is your own skin that is used for creating the penis. It can be taken from your forearm, upper leg or flank. This skin should not be too thick. When you pick up and lift the piece of skin, the fold should not be thicker than 2 cm. The plastic surgeon will assess this during the consultation in the outpatient clinic. You can try to reduce the layer of subcutaneous fat through endurance training (in the case of your upper leg, this means cycling or running). During this consultation, the plastic surgeon will also assess the degree of perfusion of the donor skin. In addition, the presence of any scarring of the skin is assessed to decide whether this could be a problem for the creation of the penis.
Depilation of the donor skin
If skin from the forearm is used as donor skin for the urethra, it needs to be depilated. This is important to prevent hair from growing on the inside of the urethra. During the consultation at the outpatient clinic, the plastic surgeon will determine whether this needs to be done in your case.
At least 6 months before surgery, you should start the depilation process, as this will take several treatments. Permanent hair removal methods include laser, intense pulsed light and electrology, performed by a skin therapist or beautician.
The area to be depilated depends on the chosen operation method:
- Phalloplasty fully created from skin taken from the forearm (shaft and urethra): an area of around 4 by 17 cm on the ulnar side (little finger side) must be depilation (see Figure 2).
- Only creating the urethra from the forearm: this requires depilation of an area of around 4 by 17 cm on the radial side (thumb side) (see Figure 3).
Health insurance
At the time of writing (March 2022), health insurance in the Netherlands covers hysterectomy, colpectomy, metoidioplasty and phalloplasty. For donor skin depilation, the insurance only covers that of the skin used for making the urethra. Therefore, you will have to pay yourself for the costs of depilating the skin from which the shaft of the penis is made.
This text was edited on 7-10-2022
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Hysterectomy (removal of the uterus)
Hysterectomy is a gynecological surgery in which the uterus is removed. Read all about the treatment option on this page!
