ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”

Özer, Müjde; Toulabi, Sahaand Poor; Fisher, Alessandra D.; T’Sjoen, Guy; Buncamper, Marlon E.; Monstrey, Stan; Bizic, M.; Djordjević, Miroslav L.; Falcone, Marco; Christopher, Nim; Simón, Daniel; Capitán, Luis Pérez; Motmans, Joz

doi:10.1016/j.esxm.2021.100471

Cited by 14 publications

(13 citation statements)

References 218 publications

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“…Additionally, most focus exclusively on sexual functioning (Kennis et al., 2022 ), and thus neglecting sexual satisfaction and broader operationalizations of sexual pleasure beyond functioning. The effects of current TGD-related medical treatments on sexuality are heterogeneous (Özer et al., 2022 ; T'Sjoen et al., 2020), and there has been little research on the sexuality of TGD adolescents (Bungener et al., 2017; Maheux et al., 2021 ; Ristori et al., 2021 ; Stübler & Becker-Hebly, 2019 ; Warwick et al., 2022 ). While sex-positive approaches to counseling and treatment for sexual difficulties experienced by TGD individuals have been proposed (Fielding, 2021 ; Jacobson et al., 2019 ; Richards, 2021 ), to date there is insufficient research on the effectiveness of such interventions.…”

Section: Chapter 17 Sexual Healthmentioning

confidence: 99%

“…Transition-related care can affect sexual function, pleasure, and satisfaction, both in positive and negative ways (Holmberg et al., 2018; Kerckhof et al., 2019 ; Thurston & Allan, 2018 ; Tirapegui et al., 2020 ). On the positive side, gender-affirming care can help TGD people improve their sexual functioning and increase their sexual pleasure and satisfaction (Kloer et al., 2021 ; Özer et al., 2022 ; T'Sjoen et al., 2020). On the negative side, however, data indicate problematic sexual health outcomes due to hormonal and surgical treatments (Holmberg et al., 2018; Kerckhof et al., 2019 , Stephenson et al., 2017 ; Weyers et al., 2009 ).…”

Section: Chapter 17 Sexual Healthmentioning

confidence: 99%

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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

1,193

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 17 Sexual Healthmentioning

confidence: 99%

Section: Chapter 17 Sexual Healthmentioning

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

1,193

492

View full text Add to dashboard Cite

show abstract

“…[34][35][36][37] However, inadequate vaginal dimensions, delayed wound healing, and pain are frequent causes of sexual dysfunction, which may lead to postoperative regret. 36,38 Postoperative stenosis, whether it be introital, stromal, urethral, or vaginal in etiology, is reported to occur between 10% and 18% of cases. Although the vaginal stenosis rate (16.5%) in our population approximated this average, the average was skewed by the elevated proportion of stenosis in obesity class I (26.0%) and class II/III (38.9%).…”

Section: Discussionmentioning

confidence: 99%

“…Maintaining patency of the vaginal introitus is essential in optimizing postoperative sexual well-being and has been associated with improved satisfaction related to body image, relationship stability, and overall quality of life 34–37 . However, inadequate vaginal dimensions, delayed wound healing, and pain are frequent causes of sexual dysfunction, which may lead to postoperative regret 36,38 . Postoperative stenosis, whether it be introital, stromal, urethral, or vaginal in etiology, is reported to occur between 10% and 18% of cases.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Obesity on Vaginoplasty Outcomes

Berger,

Lava,

Spoer

et al. 2024

Ann Plast Surg

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Background Some surgeons use body mass index criteria within the patient selection processes before vaginoplasty, thereby limiting access to select obese patients. We sought to better characterize the effect of obesity on postoperative outcomes across multiple vaginoplasty techniques. Methods A single-center retrospective review of all transfeminine patients undergoing primary vaginoplasty procedures from December 2018 to July 2022 was conducted. Patients were stratified into cohorts according to the World Health Organization Obesity Class criteria. Data regarding demographics, comorbidities, operative details, postoperative complications, and all-cause revision were collected. Results A total of 237 patients met the inclusion criteria. Average follow-up duration was 9.1 ± 4.7 months. Multivariate regression revealed that patients with class I and class II/III obesity were associated with higher odds of developing vaginal stenosis (class I: odds ratio [OR], 7.1 [P = 0.003]; class II/III: OR, 3.4 [P = 0.018]) and all-cause revision (class I: OR, 3.7 [P = 0.021]; class II/III: OR, 4.8 [P = 0.027]). Undergoing either robotic peritoneal or robotic intestinal vaginoplasty was associated with lower odds of delayed wound healing (peritoneal: OR, 0.2 [P < 0.001]; intestinal: OR, 0.2 [P = 0.011]). Lastly, adherence to dilation regimen was negatively associated with development of vaginal stenosis (OR, 0.04; P < 0.001). Conclusions Patients with obesity may be at a higher risk of developing vaginal stenosis after vaginoplasty, which may ultimately necessitate operative revision. Although patients with obesity may remain surgical candidates, proper preoperative counseling and adherence to postoperative vaginal dilation regimens are critical to optimizing outcomes.

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“…But there are no data on sexual wellbeing following orchiectomy-only, vocal feminization surgery, facial feminization surgery or the removal of the female sexual organs. So, there is a need for more studies focusing exclusively on the effects of GAS on sexual wellbeing ( 43 , 44 ). Current understanding of the effect of chronic disease on LGBT+ sexuality is limited and mostly focused on the male sexual response.…”

mentioning

confidence: 99%

Do we urologists know enough about gender minorities with prostate cancer?

Javaroni

2024

Int. braz j urol.

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ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”

Cited by 14 publications

References 218 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

The Effect of Obesity on Vaginoplasty Outcomes

Do we urologists know enough about gender minorities with prostate cancer?

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