Vaginoplasty in San Francisco

Medically reviewed by Lin-Lin Liu, PA on July 31, 2026.

Vaginoplasty for gender-affirmation can be a transformative surgery for trans women and transfeminine non-binary patients who experience gender dysphoria related to their reproductive organs. Vaginoplasty takes grafts from the patient’s natal genital tissue and sometimes other parts of the body to construct a vulva, a fully sensate clitoris and a functional vaginal canal. To maintain vaginal depth and width, a lifetime commitment to dilation is required.

San Francisco is one of the cities with some of the best-trained and most practiced vaginoplasty surgeons in the world, including Dr. Zara Ley (she/her/they), a trans woman, board-certified surgeon and former patient herself. At the Gender Confirmation Center, Dr. Ley leads an expert team with years of experience guiding patients through vaginoplasty, vulvoplasty, labiaplasty, orchiectomy and related procedures.

Dr. Ley offers free surgical consultations––commitment free––to patients who have questions about whether this procedure is right for them. You can request a consultation with her here.

What Is MTF Vaginoplasty?

Vaginoplasty, sometimes called male to female (MTF) sex reassignment surgery (SRS), reconstructs a patient’s genital tissue to give them a vaginal canal, vulva, shortened urethra and fully sensate clitoris.

Vaginoplasty Techniques: Penile Inversion, Peritoneal, and Colon Vaginoplasty

Vaginoplasty surgeries can line the vaginal canal with penile skin or other tissue, such as the mucus membrane of the colon or the peritoneal tissue of the abdominal wall. These techniques include:

  • Penile inversion vaginoplasty: Lines the vaginal canal with skin grafts from the penis, scrotum and, in some cases, the hips.
  • Robotic-assisted peritoneal flap vaginoplasty: Lines the vaginal canal with the membrane of the inner lining of the abdominal wall, using the assistance of a robot.
  • Peritoneal pull-through vaginoplasty: Lines the vaginal canal with the membrane of the inner lining of the abdomen.

Please note that Dr. Ley only offers the penile-inversion technique at this time, as it has the most long-term evidence to back its effectiveness. 

Related Procedures

Other feminizing bottom surgery procedures include:

  • Orchiectomy: the surgical removal of the testicles
  • Labiaplasty and clitoroplasty: the surgical (re)construction of the labia minora and clitoral hood
  • Vulvoplasty: the creation of a vulva, fully-sensate clitoris and shortened urethra without a vaginal canal.

Not sure which is right for you? Our surgeons offer free consultations to help you decide — no commitment required.

Why Choose Gender Confirmation Center in San Francisco

Dr. Ley is sought out world-wide for her expertise in feminine bottom surgery. Besides having an intimate understanding of the patient experience as a former patient herself, she is recognized as a leader in her field, having trained several surgeons on the vaginoplasty technique.

Dr. Ley’s vaginoplasty patients are generally very satisfied with her results because of how she has perfected her surgical technique over the years.Dr. Ley offers an innovative two-stage approach to the traditional, penile-inversion vaginoplasty. The first stage of a traditional vaginoplasty creates the vaginal canal, clitoris and labia majora. About 5 months later, if the vagina and vulva have healed properly, a clitoral hood and labia minora are constructed.

By splitting up this operation into two stages, the vulva has a better chance of healing properly. This has given Dr. Ley’s patients more consistent results, leaving them more satisfied with the outcome of their surgery and less likely to request a revision procedure later on.

Dr. Ley practices out of San Francisco, California, one of the cities that has a great concentration of resources for LGBTQ+ healthcare and gender-affirming surgery. Dr. Ley’s care team has a patient-first approach, meaning that they are committed to listening to patients at every step of the surgical process: putting their goals and needs front-and-center when designing the surgical plan all the way to recovery.

What to Expect: Preparing for Bottom Surgery

Patients will likely need to take the following steps to get a surgery date scheduled for vaginoplasty:

  • Letter of support: To undergo bottom surgery with Dr. Ley, she requires that patients present a letter of support from a gender care health professional––such as an endocrinologist or licensed mental health professional––continuously for at least 9 months. If you wish to have your health insurance help you with the costs of vaginoplasty, be sure to look into their coverage requirements for the procedure.
  • Medical clearance: For safety reasons, patients will need to disclose their full medical history. This includes pre-existing medical conditions, medications and supplements you are taking, as well as lifestyle habits such as smoking and exercise. From there, we will likely work with your primary health provider and/or solicit that you undergo certain medical exams to inform our design of your personalized surgical plan.
  • Orchiectomy: Patients can undergo an orchiectomy prior to or during their vaginoplasty procedure with Dr. Ley. Since an orchiectomy will leave patients irreversibly infertile, we strongly encourage you to look into your fertility preservation options beforehand.
  • Hair removal: Patients may need to undergo laser hair removal and/or electrolysis of their scrotum and parts of their penile shaft prior to surgery, depending on their surgical plan. Your care team will clarify this for you in your free consultation. The medical illustration below demonstrates the areas where the patient may need to undergo permanent hair removal prior to surgery:

MTF Vaginoplasty

Vaginoplasty in San Francisco: Travel and Insurance Approval

Many of Dr. Ley’s patients come into San Francisco from out of town to undergo surgery with her. To help with travel, we have compiled a free guide for patients on how to cut costs for out-of-town medical travel, how to find trans-friendly resources, and more!

 

For some patients that are coming into San Francisco for vaginoplasty, getting insurance to cover their procedure might involve some extra steps. For example, if Dr. Ley is not an in-network provider for your insurance plan, you will need to ask your primary care provider for a referral to her to initiate the insurance pre-approval process. We strongly encourage you to check your insurance plan’s clinical guidelines for covering vaginoplasty, and to ask your carrier about covering surgery out-of-state if you do not reside in California. For more information, click here, or request a free consultation to get in touch with our insurance concierge team.

Recovery and Post-Op Vaginoplasty Care

Recovery from vaginoplasty generally takes 6-8 weeks, however it often takes up to 6 months for inflammation to fully resolve. The following are general recovery guidelines for vaginoplasty. For more detailed instructions, click here.

  • Patients can expect to stay in the hospital for at least 3 nights after surgery.
  • Patients can expect to have a urinary catheter for about 8 days post-op. Bruising and swelling will be expected around your genital area and will subside in a few weeks.
  • Patients will be given a dilation protocol that needs to be followed to maintain vaginal depth and width. The frequency of dilation subsides after the first year of recovery, but it is a lifetime commitment to maintain results.
  • We ask patients to wait 3 months until after surgery before having penetrative sex.
  • Patients should avoid heavy lifting and strenuous physical activity for the first 6 weeks after surgery.

How Much Is Vaginoplasty? Cost and Insurance Coverage

Vaginoplasty can cost $23,000 – $24,500, before or without health insurance coverage. Please note that this range is merely an estimate and does not include facility fees, hospital fees, anesthesiology fees, or pathology fees. Click here for more information.

Vaginoplasty Results and Patient Outcomes

Several peer-reviewed studies have demonstrated that qualified candidates who undergo vaginoplasty with experienced, board-certified providers have extremely high rates of general satisfaction, satisfaction with sexual function and overall improved quality of life.

Patient Testimonials: San Francisco Vaginoplasty

The following testimonials are from two of Dr. Ley’s vaginoplasty patients:

“I had a breast augmentation and vaginoplasty with Dr. Ley in 2024, and both were very positive experiences. Gender Confirmation Center was very helpful with getting insurance squared away and scheduling everything, but Dr. Ley and her clinic staff really made the difference. I had all of my questions answered to my satisfaction, and I always felt my concerns were heard and addressed. Everything was handled very smoothly, even the surgical complications I experienced.

The best thing about the surgical team is that it‘s led by a transgender woman! I could really feel the understanding and empathy she had for me and my experience as opposed to other surgeons I consulted with. I also found the rest of her staff, especially her nurses and PA‘s, to be incredibly helpful and responsive. I never had to wait long to hear back about urgent questions and concerns.”

“I’ve gotten facial feminization, body contouring and, most recently, vaginoplasty from Dr. Ley. The results have been truly life-changing. I’m healing up wonderfully from my recent bottom surgery and it’s looking beautiful. Dr. Ley is a very skilled surgeon with a great eye for aesthetics and has a very warm, kind and affirming bedside manner. Thank you Dr. Ley!”

Schedule Your Vaginoplasty Consultation in San Francisco

The first step in any patient’s surgical journey is to request a consultation. At the Gender Confirmation Center, we offer all of our consultations free of cost to patients to reduce some of the barriers to access to care.

Once you are in our system, our care team will reach out to you to help you acquire any necessary supporting documents to get your surgery date scheduled.

Please note that for bottom surgery, Dr. Ley generally requires that patients come into her San Francisco office for a consultation.

Serve as a conversion-oriented section encouraging prospective patients to take the next step with Gender Confirmation Center.

FAQs

How much does vaginoplasty cost in San Francisco in 2026?

Without insurance, vaginoplasty can cost $23,000 – $24,500, aside from other costs such as hospital, facility and anesthesia fees.

What is the difference between penile inversion and colon vaginoplasty?

A penile-inversion vaginoplasty uses skin grafts from the penis and scrotum to line the vaginal canal, whereas a colon vaginoplasty uses the mucus membrane of a graft from the colon to line the vaginal canal. While some colon vaginoplasty patients are able to have self-lubricating vaginas, these results are inconsistent. The penile-inversion technique has more long-term evidence to back its success and durability, whereas the colon pull-through technique is relatively newer.

How long does it take for vaginoplasty to fully heal?

Patients usually see swelling fully subside around 3-6 months post-op, although it can take longer in some cases. Even after this period, patients will still need to dilate to maintain surgical results.

Does insurance cover MTF bottom surgery in California?

Due to state law, all insurance providers in California are required to cover some medically necessary gender-affirming healthcare services; this generally includes vaginoplasty. Be sure to consult with your insurance provider for coverage details and requirements.

What does the dilation schedule look like after vaginoplasty?

The following schedule for dilation is most commonly utilized:

  • Post-op appointment to 1 month after surgery: Dilation 4 times a day
  • Months 2-6: Dilation twice a day
  • Months 7-12: Dilation once a day
  • Year 2 and on: This is an ongoing dynamic and fluid stage. The need for dilation may be anywhere between once a week to once a month.