Metoidioplasty FAQs

Pre-op age requirements?

Pre-op insurance requirements?

Insurance companies generally follow WPATH guidelines. WPATH guidelines currently require 2 letters from providers, one can be your primary care or hormone specialist and the other from a mental health specialist.
However, many insurance companies follow the previous WPATH recommendations of 3 letters: 1 from your hormone specialist and 2 from mental health providers (1 provider needs to be a PhD or MD). Please check with your insurance carrier for their specific requirements.

How long do I have to be in the area?

We require patients stay in our area for 4 weeks. A pre-op visit can be up to 1 week prior to surgery and then 3 weekly routine post-operative visits are required. Everyone needs to be seen in person pre-operatively. This cannot be done over the phone. A physical exam is needed.

Does my place of recovery have any distance requirements?

All surgical patients must stay in the Bay Area for a total of 3 weeks post-surgery.
We require that you stay in San Francisco County and within 30 traffic minutes from our office for the first 2 weeks post-surgery.
For your final week in the Bay Area, you may stay within 30 driving miles from our office location and are not required to stay in San Francisco County.
Why is this required? The first 2 weeks is the time when some emergencies can happen. If 911 is called, they will take you to the closest emergency room which may not be equipped to see our post-operative patients and where we may not have facility privileges to treat patients.

Support Person:

Your support person is required to be in the area from the day you are discharged from the medical facility until after your 3-week post operative visit.
There can be a team of support people, but there must be someone continuously available and no gaps in coverage.
Your support person does not have to have a medical background.
Your support person will be responsible for making sure you get from the medical facility to your place of recovery, that you are fed, taking your meds, emptying your foley/urine bag the first week, ensuring you are getting to your appointments, and calling us if there is an emergency.

Do I have to have the uterus removed first?

If you are having a vaginectomy (removal of the vagina), then the uterus has to be removed first. If you are keeping the vagina, the uterus does not have to be removed.

What happens at the first post-op visit?

We check on your incision sites, swelling, pain level. We instruct you to start test driving peeing through your new lengthened urethra (urethroplasty) if you had elected to have that part of the procedure.

What happens at the 2nd and 3rd post-op visits?

We again check on incisions, swelling, pain levels. If there is some separation of incisions, we will instruct you to use dilute hydrogen peroxide (1 tablespoon in 1 cup of water) in a squirt or spray bottle 3 times per day and pat dry. This helps with healing and helps inhibit bacterial growth.

When I pee, urine dribbles out at the base of my scrotum.

This is a fistula, an opening usually in the seam between the original urethra opening and the new urethra. A lot of times, this will heal with time. If not, a procedure can be done to help close this opening.

When can I have a fistula repair?

We have to wait 3 months for this area to heal before it's ready for another procedure. During this time, fistulas can heal themselves as well.

Can I have testicle implants at the same time as the metoidioplasty and scrotoplasty?

No, we have to wait 6 months for this area to heal prior to placing any implants.

Why is it important to have an active relationship with a mental health provider?

Preoperative World Professional Association for Transgender Health requires assessment prior to an irreversible surgery like those involving sterilization procedures.
Post-Operatively: No matter what the surgery, there is a post-operative blues condition that occurs for everyone. The bigger the surgery, the bigger the blues. On average it occurs 2-3 months after a big surgery. This will manifest in inability to concentrate, fatigue and depression. It is important to have a mental health provider visit scheduled about 2 months after surgery or for when these symptoms start to manifest as occurrence can be variable. The episode lasts approximately 2-4 weeks but is different for everyone. It is important to have a provider that knows you in order to be able to guide you through this experience.
It is also helpful to let your support system know ahead of time about the above symptoms, in order to signal you to make your appointment with your mental health provider.