Metoidioplasty FAQs

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 will I have to stay in San Francisco?

  • About 4 weeks. You will have a preoperative visit the a few business day prior to surgery, and then 3 weekly visit after surgery.


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 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 testes implants at the same time as the metoidioplasty & 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. 

  • Also helpful to let your support system know ahead of time the above symptoms, in order to signal you to make your appointment with your mental health provider.