The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People

Abstract

Transgender and gender diverse individuals may seek gender-affirming medical care, such as hormone therapy or surgery, to produce primary and/or secondary sex characteristics that are more congruent with their gender. Gender-affirming medical care for transmasculine individuals can include testosterone therapy, which suppresses circulating estrogen and can lead to changes in the vaginal epithelium that are reminiscent of the post-menopausal period in cisgender females. Among transfeminine individuals, gender-affirming medical care can include vaginoplasty, which is the surgical creation of a vulva and neovaginal canal, commonly using penile and scrotal skin. The effect of gender-affirming medical care on the vagina of transmasculine individuals and on the neovagina of transfeminine individuals is poorly characterized. This review summarizes what is known of the epithelium and local microbiota of the testosterone-exposed vagina and the neovagina. We focus on potential pathogens and determinants of gynecological health and identify key knowledge gaps for future research.

Complex Rectoneovaginal Fistula Repair After Vaginoplasty

“…Pelvic sepsis is a less common occurrence in RnVFs compared with RVFs, but the structure and physiology of the neovagina pose different challenges. Both native vaginas and neovaginas after PIV are made of stratified squamous epithelium; however, their composition is different both in terms of cell composition and microbiome 7,8 . In addition, scrotal hair removal during vaginoplasty may be incomplete, resulting in persistent hair and associated debris accumulating at the apex of the neovagina; in our experience, RnVF closure is not achievable if this tissue is excised.…”

The microbiome as a biomarker of anal precancerous lesions in people with HIV

“…Also, data on patients with immunosuppressive conditions other than HIV and women are lacking. Sexual behavior and gender-affirming hormone therapy may also determine microbiological and metabolic differences, as previously decribed in the vaginal microenvironment [29]. Lastly, methodological reproducibility in different settings, including differences in sample collection technique, is also a concern.…”

“…The connection between the microbiome and HPV has recently become a focal point of scientific research. Numerous studies have attempted to decipher the impact of the microbiome on HPV infection, persistence, and progression to cervical dysplasia and cancer in women (Table 1) [6,7,10,16,[18][19][20][21][22][25][26][27][28][29][30][31][32].…”

Female reproductive tract-organ axes

“…A positive association was also found between intravaginal estrogen administration and the presence of Lactobacillus in transgender men ( 195 ). However, several key gaps in this field remain in the literature, such as the systemic effect of local estrogen therapy in transgender men ( 198 ). Furthermore, the role of the FRT-organ axes in transgender people is completely unknown.…”