Patient reported outcome measures and quality of life assessment in genital gender confirming surgery

Abstract

Transgender and gender nonbinary (TGNB) individuals may seek genital gender confirming surgery (GCS) as part of their transition. Outcomes of genital GCS may include gender congruence, sexual functioning and satisfaction, urinary symptoms, aesthetic satisfaction, and overall quality of life, among others. Despite a wide number of studies on results of vaginoplasty, metoidioplasty, phalloplasty, and other genital GCS, data regarding patient reported outcomes are limited. To date, there is no patient reported outcome measure (PROM) validated within the TGNB population to assess subjective outcomes of GCS. In this review, we aim to describe existing tools being utilized to report outcomes following GCS, assessing the merits and limitations of each.

Metoidioplasty: Surgical Options and Outcomes in 813 Cases

“…Heterogenity within the trans group and different requirements regarding the requests for GAS pose a question of additional analysis regarding the patient wishes, expectations and limitations of available surgical approaches. Non-binary transgenders may require only partial genital reconstruction that will satisfy their needs of standing micturition, sexual function and esthetic appearance ( 6 , 7 ). After 50 years of surgical experience and numerous modifications of techniques, neophalloplasty still presents a greatest challenge in GAS ( 8 ).…”

Gender-Affirming Surgeries in Transgender and Gender Diverse Adolescent and Young Adults: A Pediatric and Adolescent Gynecology Primer

“…Sexual function after vaginoplasty is diverse, and most studies are limited by having incomplete data on how preoperative functioning and goals differ or change following surgery. 55 In general, studies show that most patients report satisfaction, including ability to achieve orgasm, following vaginoplasty, but highest-risk sexual concerns include arousal difficulties, low sexual aversion, and low sexual desire. 48 , 56 Some sexual function concerns may be remediable with appropriate sex education and counseling around responsive rather than spontaneous arousal patterns and appropriate use of sexual lubricants.…”

Initial Psychometric Evaluation of a Brief Sexual Functioning Screening Tool for Transmasculine Adults: Transmasculine Sexual Functioning Index

“…The resulting TM-SFI comprises 6 questions which take approximately 3 minutes to complete. Respondents answer questions regarding their experiences in the last 4 weeks (see Table 1: [I] TM-SFI and [2] original FSFI-6). Response options consist of 5-point Likert and frequency scales from "very low or none at all" to "very high" and "almost never or never" to "almost always or always."…”

“…Sexual functioning is most often considered an outcome in evaluating medical gender affirmation among TM individuals. 2 Research generally demonstrates increases in sexual functioning with hormonal and surgical intervention. 3 , 4 , 5 Yet, these studies often rely on TM people presenting for gender affirmation treatment and/or with a clinical diagnosis of gender dysphoria.…”