Feminizing Genital Gender-Confirmation Surgery

Hadj-Moussa, Miriam; Ohl, Dana A.; Kuzon, William M.

doi:10.1016/j.sxmr.2017.11.005

Cited by 68 publications

(41 citation statements)

References 34 publications

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“…Single-center and single-surgeon studies have questioned the use of arbitrary cutoffs and the effects of BMI on postoperative complication rates following GAS via retrospective analysis and have found no clear correlation. 14,21 We were unable to find any multicenter studies confirming these findings in the scientific literature.…”

Section: Introductionmentioning

confidence: 72%

“…Data from multiple single-center series demonstrate that this procedure is safe and effective, but also that the reported overall surgical complication rate ranges from <30 to >70%. 14–21 Because each of these studies reflects a single-center, unique patient population, and varying criteria for surgical candidacy, we questioned whether the 2-fold variance in reported complication rates after PIV could be related to differing degrees of obesity in each center’s patient population. Single-center and single-surgeon studies have questioned the use of arbitrary cutoffs and the effects of BMI on postoperative complication rates following GAS via retrospective analysis and have found no clear correlation.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty

Ives

Fein

Finch

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Gender affirmation surgery (GAS) has a positive impact on the health of transgender patients; however, some centers employ body mass index (BMI) as a strict selection criterion for surgical candidacy. Several single-center studies have found no clear correlation between BMI and complication rates. We conducted a retrospective multicenter study at 2 university-based centers to test the null hypothesis: obesity is not a significant determinant of the risk of acute surgical complications in patients undergoing penile inversion vaginoplasty (PIV). Methods: This is a retrospective chart review of all adult patients at the University of Michigan and the University of Miami undergoing gender-affirming PIV with minimum follow-up time of 3 months between 1999 and 2017. A logistic regression model of analysis is used to examine the predictive factors for surgical complications and delayed revision urethroplasty in our patient sample. Results: One hundred and one patients met inclusion criteria for this study. The mean BMI at the time of procedure was 26.9kg/m 2 (range 17.8–48.2). Seventeen patients (16.8%) had major complications and 36 patients (35.6%) had minor complications. On logistic regression analysis, none of the recorded covariates were significant predictors of delayed revision urethroplasty or major, minor, or any complications. Conclusions: We found that obese patients can safely undergo GAS and that BMI alone should not preclude appropriately selected patients from undergoing GAS. We acknowledge that selection based on overall health and other medical comorbidities is certainly warranted for gender-affirming PIV and all other surgical procedures.

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Section: Introductionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty

Ives

Fein

Finch

et al. 2019

Plastic and Reconstructive Surgery - Global Open

Self Cite

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“…Providers should have knowledge about the type of tissue used to construct the neovagina, which can affect future STI and HIV preventive care and screening recommendations. The majority of vaginoplasty surgeries conducted in the United States use penile and scrotal tissue to create the neovagina ( 351 ). Other surgical techniques use intestinal tissue (e.g., sigmoid colon graft) or split-skin grafts ( 352 ).…”

Section: Sti Detection Among Special Populationsmentioning

confidence: 99%

Sexually Transmitted Infections Treatment Guidelines, 2021

Workowski¹,

Bachmann²,

Chan³

et al. 2021

MMWR Recomm. Rep.

1,726

2,621

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These guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11-14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs. BOX 1. The Five P's approach for health care providers obtaining sexual histories: partners, practices, protection from sexually transmitted infections, past history of sexually transmitted infections, and pregnancy intention Additional information about external condoms is available at https://www.cdc.gov/condomeffectiveness. Internal CondomsCondoms for internal vaginal use, also known as female condoms, are available worldwide (e.g., the FC2 Female Condom, Reddy condom, Cupid female condom, and Woman's condom) (31,32). Use of internal condoms can provide protection from acquisition and transmission of STIs, although data are limited. Internal condoms are more costly compared with external condoms; however, they offer the advantage of being controlled by the receptive partner as an STI and HIV prevention method, and the newer versions might be acceptable to all persons. Although the internal condom also has been used during receptive anal intercourse, efficacy associated with this practice remains unknown (33). Additional information about the internal condom is available at http://www.ashasexualhealth. org/pdfs/Male_and_Female_Condoms.pdf. Cervical DiaphragmsIn observational studies, diaphragm use has been demonstrated to protect against cervical gonorrhea, chlamydia, and trichomoniasis (34). However, a trial examining the effect of a diaphragm plus lubricant on HIV acquisition among women in Africa reported no additional protective effect when compared with the use of male condoms alone. Likewise, no difference by study arm in the rate of acquisition of chlamydia, gonorrhea, or herpes occurred (35,36). Diaphragms should not be relied on as the sole source of protection against HIV and other STIs.

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“…In the literature, the reported incidence of introital stenosis range from 6.7 to 14.5 percent (4,5,8,9,(11)(12)(13). According to Hadj-Moussa et al (18) a regimen of postoperative prophylactic dilation is crucial to minimize the development of this outcome. At our institution, our protocol for vaginal dilation started seven days after surgery and was performed three to four times a day during the first 3 months and was continued until the individual had regular sexual intercourse.…”

Section: Postoperative Resultsmentioning

confidence: 99%

Male-to-Female Gender-Affirming Surgery: 20-Year Review of Technique and Surgical Results

et al. 2021

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Purpose: Gender dysphoria (GD) is an incompatibility between biological sex and personal gender identity; individuals harbor an unalterable conviction that they were born in the wrong body, which causes personal suffering. In this context, surgery is imperative to achieve a successful gender transition and plays a key role in alleviating the associated psychological discomfort. In the current study, a retrospective cohort, we report the 20-years outcomes of the gender-affirming surgery performed at a single Brazilian university center, examining demographic data, intra and postoperative complications. During this period, 214 patients underwent penile inversion vaginoplasty.Results: Results demonstrate that the average age at the time of surgery was 32.2 years (range, 18–61 years); the average of operative time was 3.3 h (range 2–5 h); the average duration of hormone therapy before surgery was 12 years (range 1–39). The most commons minor postoperative complications were granulation tissue (20.5 percent) and introital stricture of the neovagina (15.4 percent) and the major complications included urethral meatus stenosis (20.5 percent) and hematoma/excessive bleeding (8.9 percent). A total of 36 patients (16.8 percent) underwent some form of reoperation. One hundred eighty-one (85 percent) patients in our series were able to have regular sexual intercourse, and no individual regretted having undergone GAS.Conclusions: Findings confirm that it is a safety procedure, with a low incidence of serious complications. Otherwise, in our series, there were a high level of functionality of the neovagina, as well as subjective personal satisfaction.

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Feminizing Genital Gender-Confirmation Surgery

Cited by 68 publications

References 34 publications

Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty

Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty

Sexually Transmitted Infections Treatment Guidelines, 2021

Male-to-Female Gender-Affirming Surgery: 20-Year Review of Technique and Surgical Results

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