Complications and Patient-reported Outcomes in Transfemale Vaginoplasty: An Updated Systematic Review and Meta-analysis

Bustos, Samyd S.; Bustos, Valeria P.; Mascaró, Andrés; Ciudad, Pedro; Forte, Antonio J.; Corral, Gabriel Del; Manrique, Oscar J.

doi:10.1097/gox.0000000000003510

Cited by 43 publications

(52 citation statements)

References 74 publications

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“…Other complications include issues such as stenosis of the neovaginal canal, rectovaginal fistulae, and inflammation (intestinal vaginoplasty) (Bustos et al., 2021 ). These require a combination of nonsurgical and surgical treatment with consultation and possible referral back to the primary surgeon with other surgical consultants (i.e., colorectal surgeon), if required.…”

Section: Chapter 13 Surgery and Postoperative Carementioning

confidence: 99%

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman

Radix

Bouman

et al. 2022

International Journal of Transgender Health

1,179

492

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Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for t...

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Section: Chapter 13 Surgery and Postoperative Carementioning

confidence: 99%

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman

Radix

Bouman

et al. 2022

International Journal of Transgender Health

1,179

492

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“…Intestinal vaginoplasty is a modality available for the creation of a neovaginal canal in patients undergoing feminizing surgery who do not have adequate tissue from penile inversion (89). These surgical techniques use intestinal segments from the small or large bowel such as the ileum, sigmoid, or right colon for the creation of a neovagina that provides favorable vaginal sexual function and alleviates gender dysphoria (89–95). Postoperative complications can include surgical site infection, small bowel obstruction, peritonitis, rectovaginal fistulas, rectal injury (96), vaginal stenosis (97), and prolapse (Table 3) (89,98–102).…”

Section: Surgical Considerations and Care Of The Neovaginamentioning

confidence: 99%

Digestive Health in Sexual and Gender Minority Populations

et al. 2022

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It has been over 50 years since the Stonewall Inn Riots in June 1969, a seminal event for the lesbian, gay, bisexual, transgender, queer, intersex, and other sexual and gender-diverse minorities (LGBTQI1, or lesbian, gay, bisexual, transgender, queer, intersex, and everyone else) rights movement. However, sexual and gender minority (SGM) individuals still face discrimination and harassment due to their sexual orientation or gender identity. As such, the National Institute on Minority Health and Health Disparities has identified SGM communities as a "health disparity population." Broadly, there are higher rates of sexually transmitted infections, substance use and abuse, mental health conditions, obesity and eating disorders, certain cancers (breast, cervical, and anorectal), and cardiovascular disease in SGM communities. Transgender patients, especially those of color, are more likely to be uninsured, experience discrimination, and be denied health care than cisgender patients. In addition, SGM individuals have twice the risk of lifetime exposure to emotional, physical, and sexual trauma compared with heterosexuals. It is expected all these factors would negatively affect digestive health as well. This review summarizes the effects of social determinants of health and discrimination on health care access, highlights important digestive diseases to consider in the SGM population, and offers solutions to improve and prioritize the health of these communities. We aim to draw attention to SGM-specific issues that affect gastrointestinal health and spur research that is desperately lacking.

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“…Zur Prävention von thrombembolischen Ereignissen, die postoperativ durch die häufige Immobilisierung der Patientinnen begünstigt werden, raten viele Operateure zu einer präoperativen (Teil-)Nekrosen der die Neovagina auskleidenden Haut können sowohl bei der Verwendung freier Transplantate als auch bei der penilen Inversion als Folge von Perfusionsstörungen auftreten. Sie sind relativ häufig, betreffen aber meist nur wenig Fläche der Haut und heilen konservativ ab [22]. Bei ausgedehnten Nekrosen hingegen kann es schon früh zu einem vollständigen Zugrundegehen der Neovagina kommen, was dann einen sekundären Neuaufbau erforderlich macht.…”

Section: Komplikationenunclassified

“…antibiotische Therapie erfolgen. Vaginale Strikturen treten direkt postoperativ entweder durch die oben beschriebenen Nekrosen der auskleidenden Haut oder auch durch postoperative Infektionen auf [4,22]. Deutlich häufiger kommt es aber mittel-und langfristig zu Engen, wenn das notwendige Bougieren durch die Patientin selbst unterbleibt.…”

Section: Komplikationenunclassified

Genitalchirurgische Maßnahmen zur Feminisierung bei Geschlechtsdysphorie

Bohr

2021

Gynäkologe

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Genital surgical procedures for feminization in gender dysphoriaThe necessity and the benefits of genital approximating surgery in gender dysphoria are established, therefore the indications after careful diagnostics are indisputable. For vaginoplasty, the method of choice is penile inversion, in which the penile skin is inserted as a pedicled flap into the prepared vaginal space. Alternatively, free skin grafts or intestinal segments can be used. Lifelong bougienage of the vagina is obligatory for all methods. The spectrum of complications after vaginoplasty is broad. Of particular note, although rare, is injury to the anterior rectal wall, from which rectovaginal fistulas can result. During the course strictures of the urinary meatus or also the neovagina occur. Corrections must often be surgically undertaken but conservative measures, e.g. intensified bougienage and topical estrogen treatment, can also be successful. Neovaginal infections are treated analogously to infections of a native vagina. A special situation is inflammation of the intestinal neovagina, which must be treated with mesalazine.

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Complications and Patient-reported Outcomes in Transfemale Vaginoplasty: An Updated Systematic Review and Meta-analysis

Abstract: Supplemental Digital Content is available in the text.

Cited by 43 publications

References 74 publications

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Digestive Health in Sexual and Gender Minority Populations

Genitalchirurgische Maßnahmen zur Feminisierung bei Geschlechtsdysphorie

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