Considering surgery

What happens during uterus and ovary removal?

Uterus removal (hysterectomy A gender-affirming lower surgery to remove all or part of the uterus and sometimes the ovaries and/or fallopian tubes. ) removes the uterus (usually including the cervix) and the fallopian tubes. Ovary removal (oophorectomy A gender-affirming lower surgery to remove the ovaries. ) removes one or both of the gonads (ovaries). You can have the uterus and fallopian tubes removed and keep one or both ovaries, or you can have all the organs removed.

People choose to have the surgery in order to reduce dysphoria, prevent monthly bleeding Menstrual bleeding or period. , eliminate the need for regular Pap tests (or HPV self-screening Process of checking for signs of a health issue or medical condition before symptoms appear. ) and allow you to lower your dose of testosterone. (A lower testosterone dose may reduce unwanted side effects and risks.) This surgery may also be a required step prior to some genital reconstruction surgeries. In B.C., this surgery is done by an obstetrician and gynecologist (OBGYN).

Visit Understanding the Procedure for detailed information on the procedure, your options and the potential risks.

Making a decision about surgery

A wide range of people choose to have gender-affirming surgery, including people who are transgender, Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) or non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. . While having surgery does not make anyone more or less trans, it can help some people feel more comfortable in their body.

Questions to ask yourself

As you consider whether surgery is right for you, it may be helpful to start by asking yourself the following questions:

• Do you plan to stop taking hormone therapy in the future?
• Is the ability to become pregnant important to you?
• If you are choosing to have ovaries removed, do you want to have one or both ovaries removed?
• Do you have any health issues that may restrict your options?
• Can you afford the additional costs associated with surgery (such as travel, aftercare costs, time off work, etc.)?

Setting realistic expectations

Like with any other surgical intervention, there are risks associated with uterus and ovary removal. Many people are very happy with the outcomes of their surgery, but some also experience complications or results that don’t meet their expectations. Being prepared for the outcomes of this surgery and the possibility of disappointment are part of ensuring you have realistic expectations. 

Outcomes of uterus and ovary removal

• Permanently ends monthly bleeding
• Eliminates the need for regular Pap tests (or HPV self-screening)
• Results in permanent inability to become pregnant
• Requires lifelong hormone therapy (if ovaries removed)
• May allow a person to lower their dose of testosterone, reducing unwanted side effects and risks
• Allows for vaginectomy A surgical procedure that involves the removal of vaginal tissue and the closure of the genital opening (vaginal canal). which may be done with genital reconstruction

We recommend familiarizing yourself with the complications associated with uterus and ovary removal.

When to have surgery 

Timing is also an important consideration for surgery. You may be heading off to school, starting a new job or have other important life events. Commitments like these make it difficult to accommodate the down time needed to recover from surgery. Picking the right time for surgery is as important to your recovery as any other pre or postop activity your primary care provider A person’s main health care provider in non-emergency situations such as check-ups and referrals. Family doctors, general practitioners (GPs) and nurse practitioners (NPs) are all primary care providers. recommends. 

This guide is meant to help you decide

There are many physical, social and financial considerations that may impact your decision to have surgery. This guide was prepared to help you understand the costs, the procedure, the risks and the recovery associated with uterus and ovary removal. 

Surgical costs — who pays for these?

Public funding

The B.C. Medical Services Plan (MSP The Medical Services Plan (MSP) is a B.C. government health plan that pays for physician services and referred services that are considered medically necessary, such as specialists (surgeon, psychiatrist, etc.), diagnostic x-rays, or laboratory services, for all BC residents. Some residents qualify for premium assistance for physiotherapy, chiropractic, naturopathy, massage therapy and acupuncture. ) will pay for the cost of uterus and ovary removal.

Other surgery-related costs

While MSP pays for most of the costs associated with uterus and ovary removal, there are other costs you should consider, including:

• Time off from work — You will need time off for both your surgery and recovery period. Recovery times are unique to each person, but it usually takes 4–6 weeks for most people to return to work. If your work is physically demanding, you may need more time.  
• Medical supplies & other post-surgery items — These include wound care supplies and medications. You can find a full list of recommended post-surgery items here.
• Travel and accommodation — If you don’t live near your surgical centre, you will need to cover the costs of travel. You may want to arrive a day ahead of your surgery and may need to stay for several days after. Ensure that you budget for accommodations, meals and parking.
• Costs for your support person — If someone is coming with you to help with your care before and after surgery, you may need to account for their travel and accommodation costs as well.

Financial support available

There may be some financial help available depending on your employer and your income bracket. 

• Paid leave — Speak with your employer or Human Resources department about any short-term disability, sick leave or vacation time you can use during your time off. 
• Extended benefits — If you have extended benefits, check your program to see what is covered.
• Disability assistance — If you are on provincial disability assistance, you can contact the Ministry of Social Development and Poverty Reduction to discuss funding for travel, support garments and other medically necessary Treatments, procedures or services that health care professionals determine are essential for diagnosing or treating a medical condition based on established medical guidelines and individual patient needs. supplies. Your primary care provider can write you a letter of support to access these funds.
• EI Sickness Benefits — EI Sickness Benefits can be an option for individuals who are working and meet the eligibility criteria. 
  First Nations Health Authority (FNHA) Benefits Program — Individuals who are Indigenous, have status and live in B.C. are able to access FNHA benefits. These benefits can provide coverage for gender-affirming resources and postoperative supplies, like compression garments.
• Fundraising — Consider organizing online or in-person fundraisers.

There are also several programs that can help you cover transportation costs, including:

• Hope Air — A Canadian charity that arranges free flights for low-income Canadians who must fly to get health care.
• Travel Assistance Program (TAP) — If travel costs are a barrier for you, you may qualify for this program. You can apply for the program through your primary care provider. Visit the TAP website to learn about the application process.
• First Nations Health Authority (FNHA) Medical Transportation Benefit — FNHA benefits can also cover the costs of travel, accommodation and meals when you need to travel for medically necessary care.