Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery

Abstract

Background: Penile inversion vaginoplasty is the most common gender-affirming procedure for transfeminine patients. Patients undergoing this procedure may require revision labiaplasty and clitoroplasty. This study describes complications and outcomes from the largest reported cohort in the United States to undergo penile inversion vaginoplasty with subsequent revision labiaplasty and/or clitoroplasty. Methods: A retrospective chart review was performed of a single surgeon’s experience with penile inversion vaginoplasty with or without revision labiaplasty and/or clitoroplasty between July of 2014 and June of 2016 in a cohort of gender-diverse patients assigned male at birth. Patient demographic data, complications, and quality of life data were collected. Univariate and multivariate comparisons were completed. Results: A total of 117 patients underwent penile inversion vaginoplasty. Of these, 28 patients (23.9 percent) underwent revision labiaplasty and/or clitoroplasty, with nine patients (7.7 percent) undergoing both procedures. Patients who underwent penile inversion vaginoplasty necessitating revision were significantly more likely to have granulation tissue (p = 0.006), intravaginal scarring (p < 0.001), and complete vaginal stenosis (p = 0.008). The majority of patients who underwent revision labiaplasty and/or clitoroplasty reported satisfaction with their final surgical outcome (82.4 percent) and resolution of their genital-related dysphoria (76.5 percent). Conclusions: Patients who developed minor postoperative complications following penile inversion vaginoplasty were more likely to require revision surgery to address functional and aesthetic concerns. Patients responded with high levels of satisfaction following revision procedures, with the majority of patients reporting resolution of genital-related dysphoria. Transfeminine patients who undergo penile inversion vaginoplasty should be counseled on the possibility of revisions during their postoperative course. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Sexual health after vaginoplasty: A systematic review

“…[31][32][33][34][35][36][39][40][41][46][47][48][49][52][53][54][55][56] Studies reported between 46.9% and 100% of patients able to be aroused postoperatively (median 85.7%). [31][32][33]35,51,64,65,67,68 Kerckhof et al (2019) found that a significantly lower percentage of patients (15.9%) had difficulties with sexual arousal postoperatively when compared with preoperative patients while controlling for hormone treatment. 42 Only one study qualified sexual arousal and reported that 75% of patients were satisfied with their arousal postoperatively.…”

“…Most studies demonstrated that a high fraction of patients became more sexually active and satisfied with sexual activity following vaginoplasty when compared to pre-operativ ely. 45,64,65,68,102,107,121,124,153,156,159 In aggregate, 37-93.9% (median 75%) of 650 patients reported improvements post-operatively in satisfaction or happiness with their sex lives. 45,64,65,68,107,116,121,124,153,156 Bruck (2013) showed that prior to vaginoplasty less than 1 out of 10 women reported being satisfied with sexual activity, while postoperatively 3 out of 4 women were satisfied with their sexual activity.…”

“…45,64,65,68,102,107,121,124,153,156,159 In aggregate, 37-93.9% (median 75%) of 650 patients reported improvements post-operatively in satisfaction or happiness with their sex lives. 45,64,65,68,107,116,121,124,153,156 Bruck (2013) showed that prior to vaginoplasty less than 1 out of 10 women reported being satisfied with sexual activity, while postoperatively 3 out of 4 women were satisfied with their sexual activity. 107 Collyer & Heal reported that there was no correlation between lack of sexual function and patients experiencing regret for undergoing surgery.…”

Vaginoplasty tips and tricks

“…Dissatisfaction, even to the point of surgical regret, appears to be increased by the presence of surgical complications (2). Therefore, it is crucial to address potential future self-limited and non-self-limited complications, and communicate effectively how those complications will be ameliorated should they occur (15). Requests for revision, usually to improve features of the cosmetic appearance can include reconstruction of the clitoral hood, formation of a more defined labia minora, or reduction of labia majora size/bulk (5).…”

Requirement of mental health referral letters for staged and revision genital gender‐affirming surgeries: An unsanctioned barrier to care

“…Viruses, including Zika virus, Ebola virus, cytomegalovirus and human immunodeficiency virus (HIV), have been isolated from semen and can be sexually transmitted. 6,11,12 Furthermore, some viruses (eg HIV, Zika virus, herpes simplex virus (HSV) and human papillomavirus) can adhere to or be internalized by spermatozoa, 7,13 which may pose a risk for embryonic infection and cause adverse reproductive outcomes.…”