MTF: Genital
Surgery

Requirements - Prior to Surgery

Social History - As per the Standards of Care developed by WPATH (World Professional Association for Transgender Health), please indicate when hormone therapy was initiated and how long you have been living in your non-biological gender role. Include recent employment history (confidentially, of course), relationship status, etc. We would also like a single photograph of you to place in your file (partially to help us to recognize you upon your arrival!) Please use the application, available here in PDF Format or RTF Format.

Medical History - Please indicate any major medical problems and any previous surgery as well as any current medications. Use the Medical History form, available here in PDF Format or RTF Format.

Genital Hair Removal - This area seems to generate more disagreement amongst surgeons than any other area. Hair grows in cycles of 13 weeks so generally cannot be cleared at the time of surgery although we do clear follicles from the scrotal area and perform extensive intra-operative electrolysis at the time of surgery. If you wish to have a truly hair-free vagina, pre-operative hair removal is highly recommended. Laser is less expensive overall and generally effective for this purpose, but best with darker hair, where the pigment absorbs the laser energy best. Electrolysis is the traditional method if laser is not available to you. The recommended locations are:

1. The Scrotal Sac (most important). Follicles will be scraped and zapped during surgery, but hair growth cycles prevent us from getting all of the dormant hair.
2. The central 2/3 of the scrotum is most important. Leave some along the sides for scar cover-up. You may wish to taper the bottom portion down to a point 1" above the anus.
3. The Penile Shaft (important)

In my opinion, it is the penile shaft and the scrotal areas that are most important as these are uniformly utilized to create the female vagina. Remember to plan ahead, you will need multiple laser treatments over a 5-6 month period to ensure effective and permanent hair removal. Please stop hair removal treatments at least two weeks prior to your SRS to permit the area to heal and recover....

Also remember that no matter how well the surgery goes, there will be two scars running along each large labia. These are nicely covered by hair - so the hair on the outer scrotum and higher than the shaft should be left intact for maximum coverage.

We've come up with a sketch of the recommended areas to remove hair from.

Looking for someone to do the genital hair removal? We've complied a list here.

Psychiatric Evaluations - Per the WPATH Standards of Care, two (2) Psychiatric evaluations must be provided, usually by a psychologist or psychiatrist and someone working in the field of clinical sexology, in recommendation for surgery. We're slowly building a list of mental health professionals who work with the transgender population, here. In general, despite her misgivings about the Standards of Care, Dr. Bowers is required by the hospital and insurers to require two letters of approval. Our rigid adherence to a standard of care allows Dr. Bowers and Mt. San Rafael Hospital to retain insurance for this important, but still rare, practice of medicine. Please be sure your letters of recommendation are received by Dr. Bowers no less than 30 days prior to your surgery date. (If you currently have a letter of recommendation from your primary therapist and are having trouble finding a therapist to provide a second letter, there is now someone in Trinidad who may be able to help. Dr. Steffani Argyle has worked with the transgender community for many years, and has offered her services to our patients. You can contact her directly for further information regarding fees and requirements by email at mahinalani@yahoo.com or by phone at (719) 859-1522.)

Suitability for Surgery - Please note that the final determination indicating acceptance for surgery is made by Dr.Bowers, usually no later than the day prior to surgery. Consultation prior to setting a surgery date is offered if you are in the area at a cost of $150. Acceptance criteria include: (a) Weight less than 210 pounds (unless height/weight proportional) (If you are over 210 pounds (regardless of proportion or level of fitness) you *must* let Dr. Bowers know in advance; she will contact you to determine if surgery should be postponed. Surgery simply takes longer in heavier patients and puts you at greater risk for complications, If you arrive greater than this weight, you risk postponement, or a $500 surcharge to cover the longer length of surgery.) (b) Non-smoker (unless specifically exempted by Dr. Bowers). For smokers, tissue healing is truly poorer and the risk of surgical complications greater.

If you are over 45, please provide us with a copy of an EKG performed within 6 months of your scheduled surgery. If you are unable to provide a copy, you will need to have an EKG performed at MSRH - an additional reading fee (about $45) will be billed separately.

HIV Status - Please send an HIV result from an accredited laboratory performed no sooner than 12 weeks prior to surgery. HIV- Status, however, is not a pre-requisite for acceptance for surgery. (contact Dr. Bowers specifically regarding her criteria). If you have not sent us an HIV test, you may perform and HIV rapid test in Dr. Bowers office, for a cash payment of $62 (payable to Planned Parenthood). HIV testing is currently required only for MTF vaginoplasty, unless risk factors apply. We leave this up to you.

Skin Grafting - The need for non-scrotal skin grafting to create the neovagina is necessary in no more than 5% of cases. However, this determination does need to be made at the time of the clinical evaluation and is an additional $1000. Skin from the scrotal sacs is preferred as the graft-donor site and allows us to almost always have enough skin to achieve suitable vaginal length. Grafted skin from the lower abdomen, buttocks, or Repliform® subject to additional fee.

If you do consider yourself to be on the unusually small size, or have specific requirements or expectations for post-surgical depth please include that information in your medical history and consider a consultation with Dr. Bowers.

You will need to arrive in Trinidad the day prior to surgery (or sooner) with a pre-operative consultation performed at that time. This will need to be arranged with Dr. Bowers' office (in special cases, this can be done upon admission to the hospital). There is no charge for this visit. Exceptions to being seen the day prior to surgery may be made in rare circumstances, with prior approval from Dr. Bowers. Consultations prior to scheduling are not necessary, but may be arranged (subject to a $175 fee).

Want to schedule surgery? Please use this Application Form in PDF Format or RTF Format when sending in a deposit for SRS.

Have a date set? Please submit your Medical History using this form, in PDF Format or RTF Format at least one month prior to your surgery.

Already started your countdown? We've put together a GRS Checklist for you to make sure you've got everything, in PDF Format or RTF Format.

Next: Travel and Accommodations

©2006 Marci L. Bowers, MD
328 Bonaventure Street, Suite #2 • Trinidad, CO 81082
Phone: (719) 846-6300 • FAX: (719) 846-9500
Email: info@marcibowers.com

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