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Pando C, Gerlach LR, Challa SA, Pan AY, Francis J. Operative Complications, Vaginal Bleeding, and Practice Considerations for Patients on Testosterone Undergoing Gender-Affirming Hysterectomy. J Minim Invasive Gynecol 2024; 31:836-842. [PMID: 38823625 DOI: 10.1016/j.jmig.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/21/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
STUDY OBJECTIVE To evaluate operative complications and healthcare utilization in transgender patients on testosterone undergoing minimally invasive gender-affirming hysterectomy compared to control patients. DESIGN We performed a retrospective cohort study. Operative reports were used to gather information on intraoperative complications. We collected information on postoperative complications, electronic medical record (EMR) messages, phone calls, emergency department utilization, and clinic visits through a 90-day postoperative period. Healthcare utilization reasons were categorized as vaginal bleeding, pain, vaginal discharge, dysuria, urinary retention, bowel concern, incision concern, or other. SETTING Tertiary care academic medical center. PATIENTS Patients aged 18 to 55 who underwent a benign minimally invasive hysterectomy with or without oophorectomy performed between January 2014 and December 2022. The testosterone-using cohort consisted of patients who had a gender identity of male, transgender male, genderqueer, or nonbinary with documented testosterone use prior to surgery (n = 88). The control cohort consisted of patients who identified as female, genderqueer, or nonbinary with no documented testosterone use (n = 242). INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Patients using testosterone were younger, had a lower body mass index, lower American Society of Anesthesiologists class, and were more likely to be nulliparous. The median time patients used testosterone was 2.5 years (1.5-5.0). Patients on testosterone are at increased risk of intraoperative perineal lacerations requiring repair (RR 3.3, CI 95% [1.03-10.5]). A higher number of patients on testosterone reported vaginal bleeding via EMR message or phone call (RR 1.74 CI 95% [1.1-2.7]) compared to controls. No difference in reasons for emergency department visits was noted. The use of postoperative vaginal estrogen started at the postoperative visit was more frequent in the testosterone-using patients (7 [8.0%] vs 4 [1.7%], p = .01). CONCLUSION This study demonstrates that testosterone use preoperatively may increase risk of intraoperative vaginal laceration requiring repair. Testosterone use also correlates with increased reports of vaginal bleeding through EMR message, phone call, and clinic visit. These results contribute new evidence to include in preoperative counseling and support existing evidence surrounding the safety of gender-affirming hysterectomy.
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Affiliation(s)
- Christine Pando
- Department of Obstetrics and Gynecology, Medical College of Wisconsin (Drs. Pando and Francis), Milwaukee, Wisconsin.
| | - Leah R Gerlach
- Medical College of Wisconsin Medical School (Dr. Gerlach), Milwaukee, Wisconsin
| | - Sai Alekha Challa
- Department of Pediatrics, Medical College of Wisconsin, Children's Corporate Center (Drs. Challa and Pan), Milwaukee, Wisconsin
| | - Amy Y Pan
- Department of Pediatrics, Medical College of Wisconsin, Children's Corporate Center (Drs. Challa and Pan), Milwaukee, Wisconsin
| | - Jessica Francis
- Department of Obstetrics and Gynecology, Medical College of Wisconsin (Drs. Pando and Francis), Milwaukee, Wisconsin
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Dominoni M, Gritti A, Pano MR, Sandullo L, Papa R, Torella M, Gardella B. Which Is the Best Surgical Approach for Female-to-Male Sexual Reassignment? A Systematic Review of Hysterectomy and Salpingo-Oophorectomy Options from the Gynecological Perspective. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1095. [PMID: 39064524 PMCID: PMC11278962 DOI: 10.3390/medicina60071095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: Transgender people are defined as individuals whose gender identity does not entirely match their sex assigned at birth. Gender surgery typically represents the conclusive and irreversible step in the therapeutic process, especially for the impact on the reproductive sphere. The increased awareness of gender dysphoria and the expanding array of medical and surgical options, including minimally invasive techniques, contribute to the gradual increase in the social impact of transgender surgery. There are several surgical techniques for "gender assignment", such as vaginal, laparotomic, laparoscopic, and robotic, and the novel approach of vaginal natural orifice transluminal endoscopic surgery to perform a hysterectomy and bilateral salpingo-oophorectomy (BSO). The purpose of this review is to assess the various surgical approaches (hysterectomy and salpingo-oophorectomy) for gender reassignment in order to determine the best option in clinical practice for the female-to-male population in terms of surgical outcomes such as operative time, surgical complication, hospital discharge, postoperative pain, and bleeding. Materials and Methods: This systematic review includes studies from 2007 to 2024. Special consideration was given to articles documenting the characteristics and management of female-to-male reassignment surgery. Finally, eight papers were included in this review. Results: The literature analysis considered surgical techniques ranging from traditional surgery to innovative methods like vaginal natural orifice transluminal endoscopic surgery and robotic-assisted laparoscopic hysterectomy. Vaginal natural orifice transluminal endoscopic surgery and the robotic approach offer potential benefits such as reduced postoperative pain and shorter hospital stays. While vaginal natural orifice transluminal endoscopic surgery may encounter challenges due to narrow access and smaller vaginal dimensions, robotic single-site hysterectomy may face instrument conflict. Conclusions: The conventional laparoscopic approach remains widely used, demonstrating safety and efficacy. Overall, this review underscores the evolving landscape of surgical techniques for gender affirmation and emphasizes the necessity for personalized approaches to meet the specific needs of transgender patients.
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Affiliation(s)
- Mattia Dominoni
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.R.P.); (B.G.)
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Gritti
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.R.P.); (B.G.)
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Martina Rita Pano
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.R.P.); (B.G.)
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Lucia Sandullo
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy; (L.S.); (R.P.); (M.T.)
| | - Rossella Papa
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy; (L.S.); (R.P.); (M.T.)
| | - Marco Torella
- Obstetrics and Gynecology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy; (L.S.); (R.P.); (M.T.)
| | - Barbara Gardella
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (A.G.); (M.R.P.); (B.G.)
- Department of Obstetrics and Gynecology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
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Wascher J, Hazra A, Fisher AR. Sexual Health for Transgender and Gender Diverse Individuals: Routine Examination, Sexually-Transmitted Infection Screening, and Prevention. Obstet Gynecol Clin North Am 2024; 51:405-424. [PMID: 38777492 DOI: 10.1016/j.ogc.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Gynecologists play a critical role in the office evaluation of transgender and gender diverse individuals. This includes the provision of essential healthcare services including the treatment and prevention of human immunodeficiency virus and sexually-transmitted infections and screening for human papillomavirus infection-related diseases and cancers. Caring for patients who identify as transgender or gender diverse (TGD) and who have undergone gender-affirming surgical treatments is challenging due in part to clinical gaps in knowledge resulting from insufficient training and educational resources. A patient-centered approach to the care of TGD individuals requires knowledge of the general principles of affirming, holistic care with attention to the risk factors, and anatomic considerations unique to this population. This review aims to provide basic knowledge needed for the successful gynecologic evaluation of a gender diverse patient.
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Affiliation(s)
- Jocelyn Wascher
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Aniruddha Hazra
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Pritzker School of Medicine, 924 E 57th Street #104, Chicago, IL 60637, USA
| | - Andrew R Fisher
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA; Pritzker School of Medicine, 924 E 57th Street #104, Chicago, IL 60637, USA.
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Donmez EE, Elci E, Elci G. Total vNOTES hysterectomy versus conventional total laparoscopic hysterectomy in virgin transgender men. MINIM INVASIV THER 2024; 33:163-170. [PMID: 38353421 DOI: 10.1080/13645706.2024.2309960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/08/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND AND AIM Comparison of the applicability, safety, and surgical outcomes of total vaginal NOTES hysterectomy (TVNH) using natural orifice transluminal endoscopic surgery, which is considered a natural orifice surgery for hysterectomy with bilateral salpingo-oophorectomy (HBSO) in virgin transgender men, with conventional total laparoscopic hysterectomy (TLH). MATERIAL AND METHODS A retrospective cohort study was conducted between 2019 and 2021. The results of transgender male individuals who underwent HBSO operations using TVNH (n = 21) were compared with those who underwent operations using TLH (n = 62). RESULTS TVNH was performed in 21 individuals, while TLH was performed in 62 individuals. Patients in the TVNH approach group had a longer operation duration than those in the TLH group (p = .001). Patients in the TVNH group experienced less pain at two hours (5 ± 1.56), six hours (4 ± 1.57), 12 h (2 ± 0.91), and 24 h (1 ± 0.62) postoperatively (p = .001). The postoperative hospitalization duration was shorter in the TVNH group (1.6 ± 1.01) than in the TLH group (2.9 ± 0.5) (p = .001). CONCLUSIONS For the HBSO operation of female-to-male transgender individuals, TVNH, which is completely endoscopically performed, can be preferred and safely conducted as an alternative surgical method to conventional laparoscopy.
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Affiliation(s)
- Emin Erhan Donmez
- Department of Gynecology Oncology, Koc University Faculty of Medicine, Istanbul, Turkey
| | - Erkan Elci
- Department of Obstetrics and Gynecology, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Gulhan Elci
- Department of Obstetrics and Gynecology, University of Healty Sciences Sancaktepe Training and Research Hospital, Istanbul, Turkey
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O'Connor RM, Scott ME, Rimel BJ. Vaginal Cuff Dehiscence in Transgender Patients After Minimally Invasive Hysterectomy. J Minim Invasive Gynecol 2024; 31:138-146. [PMID: 37925016 PMCID: PMC11129707 DOI: 10.1016/j.jmig.2023.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 11/06/2023]
Abstract
STUDY OBJECTIVE To compare rates of vaginal cuff dehiscence (VCD) in transgender patients with cisgender patients after minimally invasive hysterectomy (MIH). DESIGN We performed a single-surgeon, retrospective cohort analysis comparing the rates of VCD in patients undergoing MIH for gender affirmation with other indications (benign, malignant, prophylactic) with our study surgeon between January, 2015, and December, 2021. SETTING Major, urban, academic tertiary care hospital in the United States. PATIENTS 166 patients met inclusion criteria with 49 of those patients undergoing MIH (29.5%) for gender affirmation. Of the remaining 117 patients, 92 (78.6%) underwent MIH for cancer, 15 (12.8%) for prophylaxis, and 10 (8.5%) for benign indications. INTERVENTIONS Not applicable. MEASUREMENTS We assessed included patients for baseline demographics, presence of risk factors for VCD, details of index hysterectomy, and details of cuff dehiscence events. MAIN RESULTS Transgender patients tended to be younger at the time of surgery, but demographics were otherwise similar between both groups. Most transgender patients (n = 36, 73.5%) had both ovaries removed at the time of hysterectomy, 100% were on testosterone therapy pre- and postoperatively, and none used supplementary estrogen. Three of the 49 transgender patients (6.1%) experienced postoperative dehiscence of the vaginal cuff compared with 2 of the 117 cisgender patients (1.7%). This failed to reach statistical significance; however, our descriptive analysis showed that all cases of dehiscence in the cisgender group had identifiable precipitating factors (i.e., trauma). By comparison, all cases of dehiscence in the transgender group were spontaneous with few identifiable risk factors. CONCLUSION Transgender patients undergoing MIH may be at increased risk of VCD, although the rarity of this surgical complication precluded determination of statistical significance in our data set. We propose testosterone exposure as a possible risk factor for VCD, although we cannot exclude other factors, such as young age, as drivers of VCD in this population. Future studies of biospecimens are needed to evaluate for cellular differences in these patients.
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Affiliation(s)
- Reed M O'Connor
- Department of Obstetrics and Gynecology (Dr. O'Connor), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Marla E Scott
- Division of Gynecologic Oncology (Drs. Scott and Rimel)
| | - B J Rimel
- Division of Gynecologic Oncology (Drs. Scott and Rimel).
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Siringo NV, Boczar D, Berman ZP, Chaya BF, Kimberly L, Rodriguez Colon R, Trilles J, Brydges H, Rodriguez ED. Gender-affirming hysterectomy in the United States: A comparative outcomes analysis and potential implications for uterine transplantation. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:222-228. [PMID: 37923702 DOI: 10.1363/psrh.12246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE Hysterectomy is a gynecological procedure sometimes performed as part of the gender-affirming process for transgender and gender-expansive patients assigned female at birth. Our goal was to compare surgical outcomes between patients undergoing gender-affirming hysterectomy and patients undergoing hysterectomy for benign menstrual disorders. We then explored the implications of gender-affirming hysterectomy for uterine transplantation. METHODS We performed a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2009 through 2018. We identified patients undergoing hysterectomy in the United States based on Current Procedural Terminology code. We used the International Classification of Diseases 9 or 10 codes to identify patients with benign menstrual disorders (non-gender-affirming group) and gender dysphoria (gender-affirming group). We compared patient characteristics and surgical complications. RESULTS Of the 40,742 patients that met inclusion criteria, 526 (1.3%) patients were individuals with gender dysphoria. Compared to patients who underwent hysterectomy for benign menstrual disorders, gender-affirming patients were younger, were healthier, had a lower prevalence of diabetes, and were more likely to undergo surgery in the outpatient setting, with shorter time to discharge. Complication rates were similar between groups. Logistic regression controlling for the American Society of Anesthesiology classification determined the difference of return to the operating room was not statistically significant (OR 1.082; 95% CI, 0.56-2.10; p = 0.816). CONCLUSION Gender-affirming hysterectomy has a safety profile similar to hysterectomy performed for benign menstrual disorders. Researchers should further explore the possibility of uterus donation among these patients as they may be suitable candidates.
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Affiliation(s)
- Nicolette V Siringo
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Daniel Boczar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Laura Kimberly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
- Division of Medical Ethics, Department of Population Health, New York University Langone Health, New York, New York, USA
| | - Ricardo Rodriguez Colon
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Jorge Trilles
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Hilliard Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
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Ozceltik G, Hortu I, Itil IM, Yeniel AO. Vaginal approach versus laparoscopy for hysterectomy in transgender men. J Gynecol Obstet Hum Reprod 2021; 51:102286. [PMID: 34910989 DOI: 10.1016/j.jogoh.2021.102286] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/14/2021] [Accepted: 12/06/2021] [Indexed: 02/05/2023]
Abstract
STUDY OBJECTIVE To describe a vaginal approach combining vaginal hysterectomy (VH) with transvaginal natural orifice transluminal endoscopic surgery (vNOTES) bilateral salpingo-oophorectomy (BSO) for hysterectomy in transgender men and to evaluate the feasibility, safety, and surgical outcomes of this approach in comparison with laparoscopy. MATERIAL AND METHODS Retrospective cohort study comparing outcomes of the vaginal approach (n = 45) and laparoscopy (n = 45) in transgender men undergoing hysterectomy between May 2017 and June 2020. RESULTS There was one intraoperative complication (bladder injury) in the laparoscopy group, which was the reason for the only conversion from the initial surgical approach. All vaginal procedures were completed without any intraoperative complications or conversions. Patients in the vaginal approach group had shorter operative times compared to the laparoscopy group (median 60 [range, 30-130] vs median 85 [range, 63-179] minutes; P < 0.001). One patient in the vaginal approach group experienced late-onset intraabdominal bleeding and underwent reoperation on postoperative day 4 after failed expectant management. There were no reoperations in the laparoscopy group. Patients in the vaginal approach group experienced less pain at postoperative 12 h and 24 h (P values < 0.001 and < 0.001, respectively). Postoperative hospital stay was shorter in the vaginal approach group than in the laparoscopy group (median 2 [range, 1-7] vs. median 2 [range, 2-6] days; P < 0.001). There were no readmissions within 30 days after surgery in either group. CONCLUSION The vaginal approach combining VH with vNOTES BSO is a feasible and safe alternative to laparoscopy for hysterectomy in transgender men.
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Affiliation(s)
- Gokay Ozceltik
- From the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir 35100, Turkey.
| | - Ismet Hortu
- From the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir 35100, Turkey
| | - Ismail Mete Itil
- From the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir 35100, Turkey
| | - Ahmet Ozgur Yeniel
- From the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir 35100, Turkey
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El-Arabi AM, Barrera EP, McLaren HE, Gray M, Grimstad FW. Masculinizing Gender Affirming Surgery. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2021.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ahmad M. El-Arabi
- Department of Urology, University of Kansas Health System, Kansas City, Kansas, USA
| | - Ellis P. Barrera
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Hillary E. McLaren
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Meredith Gray
- Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Frances W. Grimstad
- Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, Massachusetts, USA
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Ferrando CA, Chapman G, Pollard R. Preoperative Pain Symptoms and the Incidence of Endometriosis in Transgender Men Undergoing Hysterectomy for Gender Affirmation. J Minim Invasive Gynecol 2021; 28:1579-1584. [PMID: 33497725 DOI: 10.1016/j.jmig.2021.01.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVE To describe the incidence of pelvic pain in transgender men undergoing hysterectomy for gender affirmation and to describe the incidence of endometriosis found at the time of surgery. DESIGN Retrospective chart review of transgender men presenting for gender-affirming hysterectomy between 2010 and 2019. Patients were identified by Current Procedural Terminology codes and documented male gender in the medical record, which was queried for perioperative data. SETTING All patients underwent minimally invasive hysterectomy under general anesthesia by 2 surgeons at 2 institutions. PATIENTS Patients were individuals assigned female at birth identifying as male who met the criteria for gender-affirming hysterectomy. INTERVENTIONS Hysterectomy performed using preferred techniques by the surgeons in this study. MEASUREMENTS AND MAIN RESULTS Sixty-seven (N = 67) patients underwent hysterectomy: 98.5% (66) total laparoscopic with salpingo-oophorectomy and 1.5% (1) total laparoscopic with ovarian preservation. Mean age and body mass index were 29(±8) years and 28.6(±6.7) kg/m2, respectively. Of the patients, 89.5% (60) were on testosterone for a median of 36 (12-300) months: 59.7% (40) were amenorrheic, 43.2% (29) had dysmenorrhea, 17.9% (12) reported heavy menses, and 14.9% had irregular menses. Furthermore, 50.7% (34) complained of pelvic pain (35.3% constant, 64.7% cyclic). Intraoperative endometriosis was diagnosed in 26.9% (18) of the patients: in 32.3% of the patients who reported pelvic pain and in 21.9% of the patients without pain. There were no differences between patients with endometriosis compared with those without endometriosis except for those with endometriosis were more likely to report irregular bleeding (27.8% vs 8.3%, p = .04) and were also more likely to complain of heavy menses (66.7% vs 35.4%, p = .03). CONCLUSION Of the transgender men who presented for hysterectomy, 50% reported pelvic pain, but only 1 in 3 with pain had findings of endometriosis. Patients found to have endometriosis were more likely to report irregular bleeding and/or heavy menses.
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Affiliation(s)
- Cecile A Ferrando
- Center for Urogynecology & Pelvic Reconstructive Surgery, Subspecialty Care for Women's Health, Center for LGBT+ Care, Cleveland Clinic (Drs. Ferrando and Chapman).
| | - Graham Chapman
- Center for Urogynecology & Pelvic Reconstructive Surgery, Subspecialty Care for Women's Health, Center for LGBT+ Care, Cleveland Clinic (Drs. Ferrando and Chapman)
| | - Robert Pollard
- Division of Minimally Invasive Gynecologic Surgery, MetroHealth System (Dr. Pollard), Cleveland, Ohio
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10
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Gardella B, Dominoni M, Bogliolo S, Spinillo A. Surgical outcome for robotic-assisted single-site hysterectomy (RSSH) in female-to male reassignment compared to its use in benign gynecological disease: a single center experience. J Robot Surg 2020; 15:579-584. [PMID: 32880794 DOI: 10.1007/s11701-020-01143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
This study was oriented to assess surgical outcomes, feasibility, and safety of Robotic-assisted Single-Site Hysterectomy and bilateral salpingo-oophorectomy (RSSH/BSO) performed for sexual reassignment compared to indications for the benign gynecologic disease. The present trial is a retrospective analysis of a prospectively collected database. After the exclusion of 3 patients with endometrial cancer on histological specimens, 112 subjects were considered for final analysis: 60 transgender men (TM) and 52 cisgender women (CW). There is a statistical difference in surgical time (total operative time p = 0.0152, docking p = 0.0011, console time p = 0.0001, and anesthesia time p = 0.0061) between TM and CW. Other than in TM, a significant difference in uterine volume (p = 0.0001), Body Mass Index (p = 0.0169), and previous comorbidity (p = 0.0001) was reported. There are no differences in conversion rate, the decrease in hemoglobin and blood loss, hospital stay, intra- and postoperative complications between the two groups. RSSH for sex reassignment appears to be a safe, viable, and cost-effective option with a significant decrease in surgical time compared to other indications for benign disease. In addition, the benefit of this scar-less surgical procedure appears to be more evident in TM's due to the absence of traditional surgical stigmata.
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Affiliation(s)
- Barbara Gardella
- Department of Obstetrics and Gynecology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
| | - Stefano Bogliolo
- Department of Obstetrics and Gynecology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy.,Division of Gynecologic Oncology, European Institute of Oncology, Milan, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynecology, University of Pavia, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100, Pavia, Italy
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Abstract
Sex-change procedures, better described as gender-change procedures, involve preparing patients psychologically and surgically for gender transition to treat their gender dysphoria. Physical treatment might include hysterectomy for female to male transition, and post-castration fashioning of an artificial vagina for male to female transition. Conservative opposition to accommodating and recognizing such procedures remains in some countries, and where treated, transgender individuals might face social hostility and oppression. However, human rights laws increasingly provide for transgender non-discrimination and government re-issue of official documents such as birth certificates and social insurance cards in the changed gender. A UK legal decision required a transgendered male who retained his ovaries and uterus to be registered as mother on the birth certificate of the child he bore. Most challenging are decisions on adolescents' requests for gender transition, especially over parents' objections. Laws increasingly recognize that legal minors with sufficiently evolved intellectual and emotional capacity can make decisions for themselves.
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Affiliation(s)
- Bernard M Dickens
- Faculty of Law, Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
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