Details and Requirements

Penile Inversion Vaginoplasty Gender Affirmation Surgery

The following is a detailed collection of pre-surgery requirements or things Dr. Gallagher may ask of you before we can schedule and complete your surgery. These are done to be sure that you are 100% healthy and ready to undergo surgery when the time comes.

Hair Removal

Hair removal IS NOT required by Dr. Gallagher for Penile Inversion Vaginoplasty. This is a new update as of March 2018. If you are currently undergoing hair removal you are welcome to continue to complete it, but we no longer require it to be done if you choose not to. Hair removal has never been required for zero-depth, orchiectomy and scrotoplasty and will continue not to be.

You can review our blog post here for more information on why we have decided not to require pre-operative hair removal. Dr. Gallagher will also give more information at the time of a consultation.

If you choose to complete hair removal, below are the recommendations for doing so.

Choices for hair removal are Laser and Electrolysis. Electrolysis may be more effective for some patients as some lasers are not able to remove light blonde, white, silver or grey hair so please default to your hair removal specialist. In oder to attain full clearance at least 6 sessions are needed at least 6 weeks apart for most patients.

We have attached an illustration here that shows the areas that should have the hair removed if you desire. We suggest that you give this graft to your hair removal specialist.

Most insurance plans do not consider the hair removal as medically necessary even if they do provide benefits for your surgery. Because of this, most patients will have to pay out of pocket for these sessions. In that case, we do recommend you use the website/App Groupon at . With this option you can often find local providers that offer cheaper package deals on hair removal. We would suggest that you reach out to them prior to purchase to be sure they offer hair removal in the genital area.

(Body Mass Index)

For safety reasons we require our patients undergoing Penile Inversion Vaginoplasty surgery to have a Body Mass Index of no higher than 30. This is because of the risks of possibly life threatening complications increase when a patient is overweight. These complications include infections, blood clots and injury to the bladder and bowel. We understand that this can be very frustrating as bottom surgery is often the last step in gender confirmation, however your safety is of the utmost concern and this is a strict requirement.

The BMI is defined as the body mass divided by the square of the body height and is universally expressed in units of kg/m2 , resulting from mass in kilograms and height in meters. To find out your BMI, we recommend you perform an internet search for “BMI calculator”.

The numbers you are given there will be close or the same as what we issue you in the office. You can further help you calculate how much weight you will need to lose to be ready for surgery from there.

The weightloss will need to be maintained at least until the time of surgery.

We may elect not to see you for a consultation until your BMI is closer or in range with you being ready for surgery. The amount of weight you will need to lose will help us determine when best to see you in the office.

Along the same lines, if we have consulted with you and you gain more than 5lbs by the time of surgery, we will need to be aware of that as well.

Please ask us if you have further questions regarding the BMI requirement.

**There is not a BMI requirement for the zero-depth vaginoplasty procedure.

How long do I have to stay in the hospital?

Your inpatient stay is determined primarily by how far away you live from our office. There are also certain health circumstance that would be cause for a longer stay.

  1. I live in the Indianapolis area
    1. If you are having penile inversion vaginoplasty or zero-depth and you live in the Indianapolis area, you will be planned for a 3 day inpatient hospital stay.
  2. I live outside of Indianapolis
    1. If you do not live in the Indianapolis area your surgical stay and arrangements will look different. We will ask that you stay in the area for 7 days, part of that time as inpatient and possibly outpatient for a portion of that time. If you will need to fly out of Indiana we will likely put you on a blood thinner to fly back at 7 days. You will either need to plan to return to us for post-op follow up appointments or make arrangements to follow up with another surgeon close to home, or we can speak with your primary care physician so they will be comfortable examining you.
    2. We will require that you follow up with us in 1 month to ensure proper healing.

General Pre-Operative Information

The following information is meant for your general information at this time. When the time edges closer to your surgery date, we will issue you further detailed instructions. Items may be individualized, as patient needs vary.


You will withhold all hormones, blockers and cross-sex, 2 weeks before your scheduled surgery date. Certain circumstances may require Dr. Gallagher to stop your HRT for a longer period of time.

In most cases, you will be allowed to restart your HRT 1 week post-surgery. You will also need to adjust the amounts of your hormones after surgery as your body will no longer require the same levels. Dr. Gallagher can advise on the adjustment and you should follow up with your HRT provider soon after surgery to be sure the adjustments are at their recommended levels.

We know that pausing your hormones can cause anxiety, so it is important to understand that this is done for your health and safety. Clotting (blood clots) after major surgery is a very serious concern and can be deadly. The risk is heightened when you are having surgery in the pelvic region, for this reason, all hormones must be stopped 2 weeks before your scheduled surgery date. Dr. Gallagher will not take any chances when it comes to your health and safety so following orders with this step is of the utmost importance.

Bowel Prep

When we see you for your pre-operative appointment (appointment to assess surgery readiness – this is usually not the same as your initial consultation) we will prescribe you 4 different bowel cleanse products. The bowel cleanse is a very important step to ensure that during your surgery your bowel and stomach are empty of all contents that could hinder your surgery. We will issue you detailed steps of this process at the pre-operative appointment.

Upon waking up on the day before surgery you will want to eat a hearty breakfast with protein. This will be your only solid food for the rest of the day and in the day(s) following surgery. Please have this breakfast before 9:00 am as your cleanse will be underway.

Please plan to take this day to prep off of work and free of scheduling commitments. The bowel prep will require you to be near a restroom and be able to rest and hydrate in-between visits. Drink extra water during your cleanse as well. It is normal to feel tired and with less energy through the day so allowing yourself to rest is key.

General Information

  • For vaginoplasty’s you will not be able to drive for several weeks, so you will want to take that into consideration when deciding on a surgery date. You will need help with transportation to and from your follow up appointments and any other life events.
  • We recommend that you buy several packages of maxi pads, some for day use and some for night as you will have some light bleeding and possible discharge.
  • Some patients will need to see a pelvic physical therapist after surgery to help with pelvic floor relaxation techniques and help with diliation. We have some here in the Indianapolis area that we work with, if you are coming from out of town, we will work to try and find someone in your area to work with you.

Post-Operative Information

This portion is meant to give you general information about your post-op healing time. Once your surgery has been scheduled, you will be issued greater detail on the items of importance.

Time off work

Dr. Gallagher will ask that with a penile vaginoplasty that you be able to take 6 – 8 weeks off work to allow for adequate healing before you are back to your regular schedule. For the first week after leaving the hospital we will ask that you have someone home with you to help with anything you may need.

  • Things to consider with your time off is having enough savings to be able to take the required time off work and still manage your bills and other financial responsibilities comfortably.
  • If you are able to take FMLA at your job we will fill out all necessary documents for you and file them back to your employer. Please do this well in advance of your surgery date to allow enough time for us to process these for you. We prefer that these be emailed or faxed to us to complete. Waiting until the last minute to file for time off may cause your surgery to be delayed or not being paid while you are off work.

Things to plan for

  • Meal prepping, meal delivery services and friends willing to help you with meals after surgery will make things much smoother. Maintaing a healhty diet after surgery is strongly recommended.
  • You will not be able to lift, push, pull more than 5-10 lbs for about 6 weeks after surgery.
  • Whomever will be staying with you to help during surgery should be someone dependable who will be able to stay with you during the entire time you need help. If you do not have someone that can stay with you please let us know so we can work to get you the appropriate support.

Diliation…the big commitment

Your new vagina is created in a space that was not previously there and lined with your own tissue. Your body is very good at healing itself and will always try to close down this space if the new vagina isn’t taken care of properly.

Before undergoing vaginoplasty it is extremely important that you are prepared to take care of it! In the first few days this can be scary and inconvenient but will quickly become second nature.

  • Dilation in the first few weeks must be done several times a day- eventually this routine will be decreased to about 3 times a week. If a patient is having penetrative intercourse this counts.
  • Once the packing is out of the new vagina you are usually ready to dilate. You will be provided with your new dilator set of 4 and as needed, a 5th, smaller dilator.
  • Dr Gallagher will teach you how to dilate in the office. This is not uncomfortable and most patients just experience pressure. Using lubricant is very important and should be on your part of your post-op kit.
  • During the recovery phase at home a patient will find an area she can relax in and gently place the dilator with the help of a mirror and lubricant
  • This soon will become second nature. Depending on your healing you can graduate up the size of the dilators but don’t worry every patient heals at a different rate. You will be given a chart with a typical dilation schedule but depending on your recovery Dr. Gallagher may vary this somewhat.
  • Douching: Because your vagina is lined with skin douching becomes an important part of taking care of it. We recommend you purchase a douche kit. Douching can just be incorporated into your shower routine using regular soap and water.
  • Dr. Gallagher will issue you a schedule that is individualized on a case-by-case basis to help keep you on track.