Complications of the neovagina in male‐to‐female transgender surgery: A systematic review and meta‐analysis with discussion of management

Abstract

Gender-affirmation surgery is often the final gender-confirming medical intervention sought by those patients suffering from gender dysphoria. In the male-to-female (MtF) transgendered patient, the creation of esthetic and functional external female genitalia with a functional vaginal channel is of the utmost importance. The aim of this review and meta-analysis is to evaluate the epidemiology, presentation, management, and outcomes of neovaginal complications in the MtF transgender reassignment surgery patients. PUBMED was searched in accordance with PRISMA guidelines for relevant articles (n = 125). Ineligible articles were excluded and articles meeting all inclusion criteria went on to review and analysis (n = 13). Ultimately, studies reported on 1,684 patients with an overall complication rate of 32.5% and a reoperation rate of 21.7% for non-esthetic reasons. The most common complication was stenosis of the neo-meatus (14.4%). Wound infection was associated with an increased risk of all tissue-healing complications. Use of sacrospinous ligament fixation (SSL) was associated with a significantly decreased risk of prolapse of the neovagina. Gender-affirmation surgery is important in the treatment of gender dysphoric patients, but there is a high complication rate in the reported literature. Variability in technique and complication reporting standards makes it difficult to assess the accurately the current state of MtF gender reassignment surgery. Further research and implementation of standards is necessary to improve patient outcomes. Clin. Anat. 31:191-199, 2018. © 2017 Wiley Periodicals, Inc.

The neovaginal microbiome of transgender women post-gender reassignment surgery

“…Mass spectrometry analysis identified a total of 541 unique bacterial proteins from 38 genera belonging to 7 different phyla: Actinobacteria, Bacteroidetes, Firmicutes, Fusobacteria, Proteobacteria, Synergistetes, and Tenericutes. We identified on average 8 species per neovaginal sample (range 2-17), 6 species per rectal sample (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], and 5 species per cis vaginal sample (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. On average, the most prevalent taxa by protein abundance in the neovaginal samples were Porphyromonas (30.2%), Peptostreptococcus (9.2%), Prevotella (9.0%), and Mobiluncus (8.0%), with a large proportion undistinguishable (16.9%) (median bacterial spectral count = 63, range = 14.5-177.9).…”

“…Many transgender women (TW), defined here as people assigned as male at birth who identify as female, undergo medical interventions such as feminizing hormone therapy and gender reassignment surgery (GRS) for gender affirmation purposes [2]. GRS generally includes neovaginoplasty, during which a neovagina is created through penile inversion, scrotal grafts, sigmoid colon grafts, and/or a combination thereof [3].…”

The evolution of transgender surgery

“…These include the resection of the corpus spongiosum, an extended pocket dissection and a commitment to vaginal dilation to maintain the dimensions of the neovagina (Selvaggi et al ). This penile inversion technique encompasses five major steps, including: penile disassembly, construction of the neovaginal cavity, the creation of the labia majora, reconstruction of a female urethral meatus and clitoris, and a bilateral orchiectomy (Amend et al ; Dreher et al ).…”

Reconstruction of a completely obstructed rectosigmoid vaginal introitus in a transgender woman

“…Patients with vaginal agenesis, gender identity disorder, and gynecologic neoplasms or trauma require vaginal reconstructions to restore their sexual function and aesthetic "shape" [1][2][3]. Various methods have been developed for successful reconstruction, such as the use of split-thickness and full-thickness skin grafts, buccal mucosal grafts, penile skin inversion flaps, and penoscrotal inversion flaps and rectosigmoid vaginoplasty [1][2][3]. Of these techniques, rectosigmoid vaginoplasty is a frequently used surgical method in male-tofemale sex reassignment surgery [4].…”