1
|
Vaithiya V, Subbaraj S. Evaluation of the Efficacy of Magnetic Resonance Imaging for Feminizing Gender Affirmation Genital Surgery: A Novel Approach. Cureus 2024; 16:e60823. [PMID: 38910612 PMCID: PMC11191378 DOI: 10.7759/cureus.60823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/25/2024] Open
Abstract
Background Gender dysphoria is treated with gender affirmation surgery (GAS) for assigned male at birth (AMAB) individuals. This study aimed to evaluate the postoperative anatomical changes in AMAB individuals who underwent GAS using magnetic resonance imaging (MRI) and to compare it with cis-females, thereby assessing the efficacy of the surgical technique in achieving pelvic anatomy similar to cis-females. Methodology This was a prospective observational study done in a tertiary care hospital. AMAB individuals who underwent gender affirmation genital surgery using single-stage solely penile skin inversion vaginoplasty were included after informed consent and approval by the Institutional Human Ethics Committee. Patients with complications such as deep space surgical site infection (SSI) and neo-vaginal prolapse were excluded. All the study participants were advised a vaginal self-dilatation regimen, reviewed three months after the surgery, and subjected to an MRI of the pelvis with a vaginal tutor. Parameters such as neo-vaginal depth, alpha (α) angle, rectovaginal thickness, and remnant of corpora cavernosa were measured and compared with cis-female parameters measured from images in the archives from the Department of Radiology. Result A total of 21 patients were included in the study, with a mean age of 27±4.7. Between the study group and cis-females, no significant difference was seen in vaginal depth, and cis-females had significantly higher values in other parameters. There was a significant difference between the subgroups, i.e., defaulters and non-defaulters in soft tissue parameters such as vaginal depth (p=0.001), α angle (p=0.002), and rectovaginal thickness (p=0.002) with the non-defaulter patients having higher values. Conclusion Single-stage penile skin inversion vaginoplasty is capable of producing anatomical parameters, importantly neo-vaginal depth, which is fairly comparable with cis-female, as evident in the non-defaulter subgroup patients. Proper compliance with the vaginal dilatation regimen plays a significant role in the maintenance of soft tissue pelvic anatomical parameters.
Collapse
Affiliation(s)
- Vinoth Vaithiya
- General Surgery, All India Institute of Medical Sciences, Madurai, Madurai, IND
| | - Saravanakumar Subbaraj
- General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to be University), Puducherry, IND
| |
Collapse
|
2
|
Bruce LK, Morris MP, Swanson M, Kuzon WM, Morrison SD. Post Penile Inversion Vaginoplasty Clinical Examination: Considerations and Techniques. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4338. [PMID: 35620498 PMCID: PMC9126509 DOI: 10.1097/gox.0000000000004338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/23/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Lauren K. Bruce
- From the University of Michigan School of Medicine, Ann Arbor, Mich
| | - Martin P. Morris
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pa
| | - Marco Swanson
- Section of Plastic Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - William M. Kuzon
- Section of Plastic Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Shane D. Morrison
- Section of Plastic Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Mich
- Division of Plastic Surgery, Department of Surgery, Seattle Children’s Hospital, Seattle, Wash
| |
Collapse
|
3
|
Kakadekar A, Greene DN, Schmidt RL, Khalifa MA, Andrews AR. Nonhormone-Related Histologic Findings in Postsurgical Pathology Specimens From Transgender Persons. Am J Clin Pathol 2022; 157:337-344. [PMID: 34596219 DOI: 10.1093/ajcp/aqab143] [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: 03/23/2021] [Accepted: 07/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The objective of this review is to characterize the literature addressing postprocedural complications in persons undergoing gender-affirming surgeries. METHODS A literature search using the OVID MEDLINE and PubMed databases was performed to identify all studies describing histologic findings in surgical pathology specimens from transgender persons from 1946 to April 2021. The studies describing postsurgical complications were categorized based on anatomic site, type of complication, study design, publication region, and date. RESULTS Thirty-nine studies describing postsurgical complications in transgender women were identified. The most common sites of postprocedural pathology included the breasts and neovagina, with additional studies including buttocks and thighs, cutaneous sites, and the pulmonary system. Most of the literature comprised case reports, followed by case series and comparative studies. The search did not identify any studies of complications secondary to masculinizing surgeries. CONCLUSIONS This body of literature is small but growing. Most studies are case reports. There are significant gaps in the literature. The literature in this area is not yet mature enough to support a meta-analysis.
Collapse
Affiliation(s)
- Archan Kakadekar
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA,USA
| | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City, UT,USA
| | - Mahmoud A Khalifa
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Alicia R Andrews
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
4
|
Kloer C, Parker A, Blasdel G, Kaplan S, Zhao L, Bluebond-Langner R. Sexual health after vaginoplasty: A systematic review. Andrology 2021; 9:1744-1764. [PMID: 33882193 DOI: 10.1111/andr.13022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Vaginoplasty is a gender-affirming procedure for transgender and gender diverse (TGD) patients who experience gender incongruence. This procedure reduces mental health concerns and enhances patients' quality of life. A systematic review investigating the sexual health outcomes of vaginoplasty has not been performed. OBJECTIVES To investigate sexual health after gender-affirming vaginoplasty for TGD patients. DATA SOURCES MEDLINE/PubMed, Embase, Scopus, and PsycINFO databases were searched, unrestricted by dates or study design. METHODS We included primary literature that incorporated TGD patients, reported sexual health outcomes after vaginoplasty intervention and were available in English. Outcomes included at least one of these sexual health parameters: sexual desire, arousal, sensation, activity, secretions, satisfaction, pleasure, orgasm, interferences, or aids. RESULTS Our search yielded 140 studies with 12 different vaginoplasty surgical techniques and 6,953 patients. The majority of these studies were cross-section or retrospective cohort observational studies (66%). 17.4%-100% (median 79.7%) of patients (n = 2,384) were able to orgasm postoperatively regardless of revision or primary vaginoplasty techniques. Female Sexual Function Index was the most used standardized questionnaire (17 studies, ranging from 16.9 to 28.6). 64%-98% (median 81%) of patients were satisfied with their general sexual satisfaction. The most common interference of sexual activity was dyspareunia. CONCLUSIONS The heterogenous methods of measuring sexual outcomes reflect the difficulty in comparing single-center surgical outcomes, encouraging the need for a standardized and validated metric for reporting sexual health after vaginoplasty for TGD patients. The most common sexual health parameter reported is sexual activity while therapeutic aids and pleasure were the least reported parameters. Future studies are needed to improve and expand methods of measuring sexual health, including prospective studies, validated questionnaires, and inclusive metrics. Systematic review registration number: PROSPERO 01/01/2021: CRD42021224014.
Collapse
Affiliation(s)
- Carmen Kloer
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA.,Duke University School of Medicine, Duke Health Systems, Durham, NC, USA
| | - Augustus Parker
- NYU Grossman School of Medicine, New York University Langone Health, New York, NY, USA
| | - Gaines Blasdel
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Samantha Kaplan
- Duke University School of Medicine, Duke Health Systems, Durham, NC, USA
| | - Lee Zhao
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Rachel Bluebond-Langner
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, NY, USA
| |
Collapse
|
5
|
Boas SR, Ascha M, Morrison SD, Massie JP, Nolan IT, Shen JK, Vyas KS, Satterwhite T. Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery. Plast Reconstr Surg 2019; 144:1451-1461. [PMID: 31764668 DOI: 10.1097/prs.0000000000006282] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Penile inversion vaginoplasty is the most common gender-affirming procedure for transfeminine patients. Patients undergoing this procedure may require revision labiaplasty and clitoroplasty. This study describes complications and outcomes from the largest reported cohort in the United States to undergo penile inversion vaginoplasty with subsequent revision labiaplasty and/or clitoroplasty. METHODS A retrospective chart review was performed of a single surgeon's experience with penile inversion vaginoplasty with or without revision labiaplasty and/or clitoroplasty between July of 2014 and June of 2016 in a cohort of gender-diverse patients assigned male at birth. Patient demographic data, complications, and quality of life data were collected. Univariate and multivariate comparisons were completed. RESULTS A total of 117 patients underwent penile inversion vaginoplasty. Of these, 28 patients (23.9 percent) underwent revision labiaplasty and/or clitoroplasty, with nine patients (7.7 percent) undergoing both procedures. Patients who underwent penile inversion vaginoplasty necessitating revision were significantly more likely to have granulation tissue (p = 0.006), intravaginal scarring (p < 0.001), and complete vaginal stenosis (p = 0.008). The majority of patients who underwent revision labiaplasty and/or clitoroplasty reported satisfaction with their final surgical outcome (82.4 percent) and resolution of their genital-related dysphoria (76.5 percent). CONCLUSIONS Patients who developed minor postoperative complications following penile inversion vaginoplasty were more likely to require revision surgery to address functional and aesthetic concerns. Patients responded with high levels of satisfaction following revision procedures, with the majority of patients reporting resolution of genital-related dysphoria. Transfeminine patients who undergo penile inversion vaginoplasty should be counseled on the possibility of revisions during their postoperative course. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Collapse
Affiliation(s)
- Samuel R Boas
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Mona Ascha
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Shane D Morrison
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Jonathan P Massie
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Ian T Nolan
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Jacson K Shen
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Krishna S Vyas
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| | - Thomas Satterwhite
- From Case Western Reserve University School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center; the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine; the Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University; New York University School of Medicine; the University of Sydney School of Medicine; the Department of Plastic Surgery, Mayo Clinic; Brownstein and Crane Surgical Services
| |
Collapse
|
6
|
Matoso A, Khandakar B, Yuan S, Wu T, Wang LJ, Lombardo KA, Mangray S, Mannan AASR, Yakirevich E. Spectrum of findings in orchiectomy specimens of persons undergoing gender confirmation surgery. Hum Pathol 2018; 76:91-99. [DOI: 10.1016/j.humpath.2018.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/27/2018] [Accepted: 03/07/2018] [Indexed: 11/24/2022]
|
7
|
[Inguinal hernia and spermatic cord cyst in a patient previously subjected to sex-change surgery]. Cir Esp 2011; 90:404-5. [PMID: 21496792 DOI: 10.1016/j.ciresp.2011.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 02/08/2011] [Accepted: 02/13/2011] [Indexed: 11/23/2022]
|
8
|
Sutcliffe P, Dixon S, Akehurst R, Wilkinson A, Shippam A, White S, Richards R, Caddy C. Evaluation of surgical procedures for sex reassignment: a systematic review. J Plast Reconstr Aesthet Surg 2009; 62:294-306; discussion 306-8. [DOI: 10.1016/j.bjps.2007.12.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 08/06/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
|
9
|
Krege S, Bex A, Lümmen G, Rübben H. Male-to-female transsexualism: a technique, results and long-term follow-up in 66 patients. BJU Int 2001; 88:396-402. [PMID: 11564029 DOI: 10.1046/j.1464-410x.2001.02323.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To report experience of a new surgical technique in male-to-female transsexual patients, the complications, and the functional and psychosocial long-term results. PATIENTS AND METHODS From April 1995 to July 2000, 66 male patients underwent gender-transforming surgery at our institution and were registered prospectively. The operation should result in a normal appearing introitus, a vaginoplasty allowing for sexual intercourse and a sensitive clitoris. This was achieved by preserving the neurovascular bundle. The glans was transformed into a clitoris, the phallic cylinder used as a vagina and labia were formed from the scrotal folds. RESULTS Major complications during, immediately and some time after surgery occurred in nine of the 66 patients (14%), including severe wound infections in six, a rectal lesion in three, necrosis of the glans in three and necrosis of the distal urethra in one. Minor complications, e.g. meatal stenosis in seven patients, occurred in 24 (36%) of patients. Ten patients with insufficient penile skin had the phallic cylinder augmented with a free-skin mesh graft, but in three of these patients an ileal augmentation was finally constructed because scarring occurred at the suture line between the penile skin and the augmented graft. A long-term follow-up questionnaire about the functional and psychosocial aspects was completed by 31 patients. More than 90% of the patients were satisfied with the cosmetic result and capacity for orgasm; 58% reported having sexual intercourse. CONCLUSION Male-to-female surgery can achieve excellent cosmetic and functional results. Although the operative technique is partly standardized, surgery remains challenging because of several possible complications. None of the present patients claimed to regret their decision to undergo gender-transforming surgery.
Collapse
Affiliation(s)
- S Krege
- Department of Urology, University of Essen, Medical School, Essen, Germany
| | | | | | | |
Collapse
|