Rainbow oil painting from https://unsplash.com/@steve_j

Gender Affirming Pelvic Surgery

Gender affirming pelvic surgery can be an important step in aligning your body with your gender identity. It may also alleviate gender dysphoria and improve quality of life, sexual wellbeing, and mental health.

As a gynaecologist with experience in this space, I offer a range of surgical options in a respectful, inclusive, and evidence-based environment. Every person’s goals and journey are different, and I work collaboratively with you and your whānau or support team to develop a tailored approach.

Surgical options I offer

I offer several types of gender affirming pelvic surgery, which can be performed individually or in combination depending on your needs:

Laparoscopic Hysterectomy

Removal of the uterus (and usually cervix), often combined with salpingectomy. Can be performed with or without ovary removal.

Bilateral Salpingo-oophorectomy

Removal of both ovaries and fallopian tubes, leading to surgical menopause. Often done for those on long-term testosterone.

Approach and environment

  • Affirming care: Your identity will be respected, affirmed, and never questioned. You can bring a support person to any appointment.
  • Low-discomfort exams: Pelvic examination is always optional and often not required.
  • Trauma-informed: I take a gentle, explanatory approach. You’ll be in control throughout.

If you have had negative experiences with healthcare in the past, you’re not alone — and that shouldn’t be a barrier to care. I aim to provide a safer, more affirming experience.

What to expect

  • Pre-op assessment includes discussing your goals, hormone use, previous surgeries, and mental health support.
  • In most cases, I will perform surgery laparoscopically (keyhole), offering a faster recovery.
  • You’ll receive a personalised plan for managing hormones, contraception (if needed), and any fertility considerations.

Recovery

Recovery depends on the type of surgery, but generally includes:

  • Discharge same day or next morning for laparoscopic hysterectomy or oophorectomy
  • Rest and light duties for 1–2 weeks
  • Full recovery in 4–6 weeks
  • Spotting or cramping may occur for a few days
  • Surgical menopause symptoms if both ovaries are removed (discussed in detail pre-op)

Read more in my Surgical Recovery Toolkit.

Fertility and preservation

Hysterectomy and/or oophorectomy are irreversible and will end your ability to carry a pregnancy or produce eggs unless eggs or embryos are banked beforehand.

If fertility preservation is important to you, I can refer you to a fertility specialist before surgery.

Mental health support and letters

For these procedures, a support letter from a mental health professional experienced in gender affirming care is required.

I’m familiar with current NZ guidelines and work with your existing GP, psychologist, or psychiatrist where needed. If you don’t have a provider, I can help connect you with someone.

Dr Sam Holford

Welcome exactly as you are

Gender affirming pelvic surgery is highly individual. Whether you’re seeking hysterectomy, oophorectomy, or planning for further affirming procedures, I provide safe, respectful, and collaborative care to support your identity.

Book an appointment

FAQs

Do I need a support letter from a therapist for this surgery?
Yes, in line with the Standards of Care for the Health of Transgender and Gender Diverse People, a letter of support from a qualified mental health professional is required for genital reconstructive surgery. This ensures that you have dedicated support and have fully explored the implications of this permanent step.
What is the recovery time for a gender-affirming hysterectomy?
For a laparoscopic (keyhole) hysterectomy, most people can go home the same day or the next morning. You should plan for about 1-2 weeks of rest and light duties, with a return to all normal activities, including strenuous exercise, at around 6 weeks. Read more in my Surgical Recovery Toolkit.
Will I need to continue testosterone after my ovaries are removed?
Yes. Once the ovaries are removed, they no longer produce hormones, so you will need to continue on testosterone as hormone replacement therapy to maintain your physical and mental health. We will coordinate with your GP or endocrinologist to ensure your hormone management is seamless.
Does having a hysterectomy affect future lower surgery options like phalloplasty or metoidioplasty?
A hysterectomy is often a required step before undergoing phalloplasty or metoidioplasty. Performing it laparoscopically is the standard approach and does not negatively impact your future surgical options. We can discuss the specifics of your surgical journey and timing.
What about fertility preservation?
Removing the uterus and/or ovaries is irreversible and will end your ability to carry a pregnancy or produce eggs. If preserving your fertility is important, we can refer you to a fertility specialist to discuss options like egg or embryo banking before you proceed with surgery.

Trusted resources

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.