Comparison of Permanent Hair Removal Procedures before Gender-Affirming Vaginoplasty: Why We Should Consider Laser Hair Removal as a First-Line Treatment for Patients Who Meet Criteria

Abstract

Introduction Permanent genital hair removal is required before gender-affirming vaginoplasty to prevent hair-related complications. No previous studies have directly compared the relative efficacy, costs, and patient experiences with laser hair removal (LHR) vs electrolysis treatments. Food and Drug Administration (FDA) oversight of medical devices is poorly understood and commonly misrepresented, adversely affecting patient care. Aim This study compares treatment outcomes of electrolysis and LHR for genital hair removal and investigates FDA regulation of electrolysis and LHR devices. Methods Penile-inversion vaginoplasty and shallow-depth vaginoplasty patients completed surveys about their preoperative hair removal, including procedure type, number/frequency of sessions, cost, and discomfort. Publicly available FDA-review documents and databases were reviewed. Main Outcomes Measure Compared to electrolysis, LHR was associated with greater efficiency, decreased cost, decreased pain, and improved patient satisfaction. Results Of 52 total (44 full-depth and 8 shallow-depth) vaginoplasty patients, 22 of 52 underwent electrolysis only, 15 of 52 underwent laser only, and 15 of 52 used both techniques. Compared to patients that underwent LHR only, patients that underwent only electrolysis required a significantly greater number of treatment sessions (mean 24.3 electrolysis vs 8.1 LHR sessions, P < .01) and more frequent sessions (every 2.4 weeks for electrolysis vs 5.3 weeks for LHR, P < .01) to complete treatment (defined as absence of re-growth over 2 months). Electrolysis sessions were significantly longer than LHR sessions (152 minutes vs 26 minutes, P < .01). Total treatment costs for electrolysis ($5,161) were significantly greater than for laser ($981, P < .01). Electrolysis was associated with greater pain and significantly increased need for pretreatment analgesia, which further contributed to higher net costs for treatment with electrolysis vs laser. Many LHR and electrolysis devices have been FDA-cleared for safety, but the FDA does not assess or compare clinical efficacy or efficiency. Clinical Implications For patients with dark-pigmented hair, providers should consider LHR as the first-line treatment option for preoperative hair removal before gender-affirming vaginoplasty. Strength and Limitations This is the first study to compare electrolysis and LHR for genital hair removal. The discussion addresses FDA review/oversight of devices, which is commonly misrepresented. Limitations include the survey format for data collection. Conclusion When compared with electrolysis, LHR showed greater treatment efficiency (shorter and fewer treatment sessions to complete treatment), less pain, greater tolerability, and lower total cost. Our data suggests that, for patients with dark genital hair, providers should consider recommending laser as the first-line treatment for permanent genital hair removal before vaginoplasty.

Evaluating the psychosocial impact of gender‐affirming dermatology treatments: A systematic review

“…Most studies in this review (9/13) focused on transfeminine individuals, 13,[15][16][17][18][21][22][23]25 while only two (2/13) focused on transmasculine individuals. 19,24 Two studies (2/13) included both transfeminine and transmasculine individuals in their study population.…”

“…23 Two studies, Berger et al and Yuan et al, investigated the psychosocial outcomes of various methods of preoperative genital hair removal before gender-affirming vaginoplasty. 13,16 Berger et al compared patients who received LHR (n = 11), electrolysis (n = 7) or at-home kits (n = 5), to controls who had not received preoperative genital hair removal (n = 5). They found that postoperative hair growth and recognition of strands of hair on the vaginal dilator upon removal were associated with significantly lower odds of overall satisfaction (odds ratio [OR] 0.07, p = 0.03; OR 0.19, p = 0.02, respectively) and satisfaction with sexual function (OR 0.10, p = 0.002; OR, 0.02, p = 0.01, respectively).…”

Update on lasers in pediatric dermatology: how primary care providers can help patients and families navigate appropriate treatment options and timelines

“…For patients undergoing vaginoplasty either with or without creation of a vaginal canal, preoperative hair removal is required to minimize complications after surgery, including intravaginal irritation, infection, and keratin granulomas [60]. Laser hair removal (LHR) has been demonstrated to require fewer treatments than electrolysis to achieve completion of treatment, which is defined as the absence of regrowth over a period of 2 months [61]. LHR is the most cost-effective therapy for removal of genital hair in patients with pigmented hair.…”

Dermatological considerations for transgender and gender diverse patients: An Australian perspective

“…67 Laser hair removal may be preferred over electrolysis due to greater efficiency, less pain, better tolerability and decreased cost. 68,69 Intravaginal condyloma, squamous cell carcinoma (SCC) and lichen sclerosis have been reported in neovaginas. 39 As with all surgical procedures, scarring is inevitable, and patients may seek a dermatology review.…”

“…It is recommended to wait for 3 months following the final hair removal treatment to confirm no hair regrowth before proceeding with surgery 67 . Laser hair removal may be preferred over electrolysis due to greater efficiency, less pain, better tolerability and decreased cost 68,69 . Intravaginal condyloma, squamous cell carcinoma (SCC) and lichen sclerosis have been reported in neovaginas 39 …”