Patient-Reported Esthetic and Functional Outcomes of Primary Total Laparoscopic Intestinal Vaginoplasty in Transgender Women with Penoscrotal Hypoplasia

Abstract

Introduction Puberty-suppressing hormonal treatment may result in penoscrotal hypoplasia in transgender women, making standard penile inversion vaginoplasty not feasible. For these patients, intestinal vaginoplasty is a surgical alternative, but knowledge on patient-reported postoperative outcomes and quality of life is lacking. Aims To assess patient-reported functional and esthetic outcomes, quality of life, satisfaction, and sexual well-being after primary total laparoscopic intestinal vaginoplasty in transgender women. Methods A survey study was performed on transgender women who underwent primary total laparoscopic intestinal vaginoplasty with at least 1 year of clinical follow-up. Thirty-one transgender women completed the questionnaires (median age at time of surgery = 19.1 years, range = 18.3–45.0) after a median clinical follow-up of 2.2 years (range = 0.8–7.5). Consenting women were asked to complete a combined questionnaire of the Subjective Happiness Scale, the Satisfaction With Life Scale, Cantril's Ladder of Life Scale, the Female Sexual Function Index, the Female Genital Self-Imaging Scale, the Amsterdam Hyperactive Pelvic Floor Scale—Women, and a questionnaire addressing postoperative satisfaction. Main Outcome Measures Patient-reported functional and esthetic outcomes and postoperative quality of life. Results Patients graded their life satisfaction a median of 8.0 (range = 4.0–10.0) on Cantril's Ladder of Life Scale. Patients scored a mean total score of 27.7 ± 5.8 on the Satisfaction With Life Scale, which indicated high satisfaction with life, and a mean total score of 5.6 ± 1.4 on the Subjective Happiness Scale. Functionality was graded a median score of 8.0 of 10 (range = 1.0–10.0) and esthetics a score of 8.0 out of 10 (range = 3.0–10.0). The mean Female Sexual Function Index total score of sexually active transgender women was 26.0 ± 6.8. Conclusion This group of relatively young transgender women reported satisfactory functional and esthetic results of the neovagina and a good quality of life, despite low Female Sexual Function Index scores.

Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-up Study

“…Most studies point out the substantial risks of these surgeries (Horbach et al, 2015), whereas data collection via surveys obtained similarly high self-reported complication rates (Lawrence, 2006). The high number of satisfied respondents found in the present study is comparable to earlier studies (Bouman et al, 2016;Buncamper et al, 2015;De Cuypere et al, 2005;Horbach et al, 2015;Lawrence, 2003;Lawrence, 2006;Nelson, Whallett, & McGregor, 2009;Rehman et al, 1999;Smith et al, 2005;Weigert et al, 2013) and emphasizes the effectiveness of gender-affirming procedures. Yet, most treatment evaluation studies have collected data in a clinical setting, whereas the present study reports on a cohort that was surveyed in their home environment with limited dependence on clinicians (although the participants were invited through the clinics).…”

“…In general, the literature gives high percentages of satisfaction with GAS procedures: breast augmentation 87% to 100% (De Cuypere et al, 2005;Smith, van Goozen, Kuiper, & Cohen-Kettenis, 2005;Weigert, Frison, Sessiecq, Al Mutairi, & Casoli, 2013), vaginoplasty 83% to 100% (De Cuypere et al, 2005;Horbach et al, 2015;Lawrence, 2003;Rehman, Lazer, Benet, Schaefer, & Melman, 1999;Smith et al, 2005), subcutaneous mastectomy 92% to 100% (De Cuypere et al, 2005;Nelson, Whallett, & McGregor, 2009;Smith et al, 2005), and phalloplasty 100% (De Cuypere et al, 2005). Clinical evaluation studies show positive appraisal of both genital functionality and aesthetics after surgery, whereas sexual outcomes were found to be less positive (Bouman et al, 2016;Buncamper et al, 2015). In a cohort of 232 operated trans women, Lawrence (2003) examined the effect of three categories of characteristics on (dis)satisfaction with genital GAS, namely personal characteristics (e.g., age), therapy characteristics (e.g., psychotherapy provided), and psychosocial characteristics.…”

Medically assisted gender affirmation: when children and parents disagree

“…Recent insurance database analysis and patient-reported outcome studies identified patients as young as 14 years old undergoing a gender-affirming mastectomy 18 19. Some research works suggest there are psychosocial benefits to individuals receiving gender mastectomy in their teens 18 20–22. For both surgical and hormonal gender-affirming care, there are psychosocial and physical benefits for transgender minors.…”

Sexual Experiences in Transgender People: The Role of Desire for Gender-Confirming Interventions, Psychological Well-Being, and Body Satisfaction

“…Age, relationship status (0 = no partner, 1 = partner), and gender identity (0 = binary [male or female], 1 = nonbinary [both male and female or neither male nor female]) were included as control variables. Previous studies have shown the importance of relationship status for sexual satisfaction, sexual activity, and sexual functioning (Bouman et al, 2016;Weyers et al, 2009).…”