The neovaginal microbiome of transgender women post-gender reassignment surgery

Abstract

Background: Gender reassignment surgery is a procedure some transgender women (TW) undergo for genderaffirming purposes. This often includes the construction of a neovagina using existing penile and scrotal tissue and/ or a sigmoid colon graft. There are limited data regarding the composition and function of the neovaginal microbiome representing a major gap in knowledge in neovaginal health. Results: Metaproteomics was performed on secretions collected from the neovaginas (n = 5) and rectums (n = 7) of TW surgically reassigned via penile inversion/scrotal graft with (n = 1) or without (n = 4) a sigmoid colon graft extension and compared with secretions from cis vaginas (n = 32). We identified 541 unique bacterial proteins from 38 taxa. The most abundant taxa in the neovaginas were Porphyromonas (30.2%), Peptostreptococcus (9.2%), Prevotella (9.0%), Mobiluncus (8.0%), and Jonquetella (7.2%), while cis vaginas were primarily Lactobacillus and Gardnerella. Rectal samples were mainly composed of Prevotella and Roseburia. Neovaginas (median Shannon's H index = 1.33) had higher alpha diversity compared to cis vaginas (Shannon's H = 0.35) (p = 7.2E−3, Mann-Whitney U test) and were more similar to the non-Lactobacillus dominant/polymicrobial cis vaginas based on beta diversity (perMANOVA, p = 0.001, r 2 = 0.342). In comparison to cis vaginas, toll-like receptor response, amino acid, and shortchain fatty acid metabolic pathways were increased (p < 0.01), while keratinization and cornification proteins were decreased (p < 0.001) in the neovaginal proteome. Conclusions: Penile skin-lined neovaginas have diverse, polymicrobial communities that show similarities in composition to uncircumcised penises and host responses to cis vaginas with bacterial vaginosis (BV) including increased immune activation pathways and decreased epithelial barrier function. Developing a better understanding of microbiome-associated inflammation in the neovaginal environment will be important for improving our knowledge of neovaginal health.

Perforation of sigmoid neovagina in a patient with Mayer-Rokitansky-Küster-Hauser syndrome

“…Birse et al studied neovaginal microbiome of transgender females post gender reassignment surgery and found Porphyromonas , Peptostreptococcus , Prevotella , Mobiluncus , and Jonquetella to be the prominent organisms, while cis vaginas primarily had Lactobacillus and Gardnerella [ 8 ]. Abdominopelvic actinomycosis is a rare disease.…”

Anatomical and sexual health considerations among transfeminine individuals who have undergone vaginoplasty: A review

“…Another study investigated the composition and function of the neovaginal microbiome in TGW who had undergone either penile inversion or rectosigmoid reconstruction. 32 TGW with penile skin-lined neovaginas had diverse, polymicrobial communities that were similar to those of uncircumcised penises with regard to bacterial composition. Host responses seen in the neovaginas in this study were similar to those of cisgender women with BV, particularly increased immune activation pathways and decreased integrity of the epithelial barrier.…”

“…Microbiology of the penile flap will most likely resemble that of the natal penile microbiome, but notably it is an extracorporeal tissue that becomes intracorporeal. 32

Figure 1.Anatomy of vaginal and vulvar components. PS: penile skin; NVBG: neurovascular bundle and glans; CSU: corpus spongiosum and urethra.

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Tackling underrepresentation to aid understanding of Parkinson’s disease: Progress and further opportunities

“…Many trans women undergo vaginoplasty surgery; the resulting organ -often called a neovagina -becomes populated with a microbial community. So far, how the neovaginal microbiome is implicated in health conditions is not only unknown, but even its basic composition is largely unclear, with only three studies having tried to address the question of how diverse the neovaginal microbiome is (Weyers et al, 2009;Rizzo et al, 2018;Birse et al, 2020). While each study represents an important effort, all studies to date have significant limitations, in particular with respect to the variety of surgical techniques used to create a neovagina -e.g.…”