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Lang SM, Reddy RA, Renz M. Neovaginal Human Papilloma Virus-Related Squamous Cell Carcinoma in a Transgender Woman. JAMA Netw Open 2024; 7:e242537. [PMID: 38488797 PMCID: PMC10943404 DOI: 10.1001/jamanetworkopen.2024.2537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/11/2024] [Indexed: 03/18/2024] Open
Abstract
This case series discusses a human papilloma virus (HPV)–related neovaginal squamous cell carcinoma in a transgender woman and the need for formal gynecologic screening recommendations.
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Affiliation(s)
- Susan M. Lang
- Gynecologic Oncology Division, Stanford University, Palo Alto, California
| | - Ravali A. Reddy
- Gynecologic Oncology Division, Stanford University, Palo Alto, California
| | - Malte Renz
- Gynecologic Oncology Division, Stanford University, Palo Alto, California
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2
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Affiliation(s)
- Almog Badash
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Dara Grennan
- Division of Infectious Diseases, Department of Medicine, J.H. Stroger Hospital of Cook County, Chicago, IL, USA
| | - Joerg Albrecht
- Division of Dermatology, Department of Medicine, J.H. Stroger Hospital of Cook County, Chicago, Illinois, USA; Department of Otolaryngology, Division of Dermatology, Rush Medical College, Chicago, Illinois, USA.
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3
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Smart AC, Liu KX, Domogauer JD, Rodriguez-Russo C, Jones B, Dickstein DR, Mancias JD, Shiloh RY, Wintner A, Zietman AL, Marshall DC, Dyer MA, Russo AL. Gender-Affirming Surgery and Cancer: Considerations for Radiation Oncologists for Pelvic Radiation in Transfeminine Patients. Int J Radiat Oncol Biol Phys 2023; 117:301-311. [PMID: 37230432 PMCID: PMC10527783 DOI: 10.1016/j.ijrobp.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
Access to gender-affirming surgery is increasing for many transgender and nonbinary people in the United States, and radiation oncologists must be equipped to care for patients who have undergone such surgery in the region of their planned radiation treatment field. There are no guidelines for radiation treatment planning after gender-affirming surgery, and most oncologists do not receive training in the unique needs of transgender people with cancer. We review common gender-affirming genitopelvic surgeries for transfeminine people, including vaginoplasty, labiaplasty, and orchiectomy, and summarize the existing literature on the treatment of cancers of the neovagina, anus, rectum, prostate, and bladder in these patients. We also describe our systematic treatment approach and rationale for pelvic radiation treatment planning.
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Affiliation(s)
- Alicia C Smart
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Kevin X Liu
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jason D Domogauer
- Department of Radiation Oncology, New York University Langone Health, New York University, New York, New York
| | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brianna Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joseph D Mancias
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Ron Y Shiloh
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Anton Wintner
- Department of Urology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - M Aiven Dyer
- Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - Andrea L Russo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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Mansur A, Kempf AM, Bitterman DS, Patel CG, Dyer MA, Haas-Kogan DA, Liu KX, Smart AC. Clinical outcomes of radiation therapy for transgender and gender-expansive people with cancer. Front Oncol 2023; 13:1135400. [PMID: 37746299 PMCID: PMC10517178 DOI: 10.3389/fonc.2023.1135400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Approximately 1.6 million people in the US identify as transgender, many of whom undergo gender-affirming medical or surgical therapies. While transgender individuals are diagnosed with cancer at similar rates as those who are cisgender, the impacts of radiation therapy on outcomes of gender-affirming care in transgender, nonbinary, and gender-expansive people with cancer are understudied. We report on the experiences and outcomes of transgender and gender-expansive patients receiving radiation therapy for cancer treatment. Methods This study is a multi-institutional retrospective review of patients evaluated from 2005-2019 identified as transgender or gender-expansive in the medical record and treated with radiation therapy. Results We identified 23 patients who received radiation to 32 sites, including 12 (38%) to the brain, head, or neck, 8 (25%) to the thorax, and 7 (22%) to the pelvis. Seventeen patients (74%) received gender-affirming hormone therapy and 13 patients (57%) underwent gender-affirming surgery. Four patients had pelvic radiation before or after gender-affirming pelvic surgery, including two trans women who had pelvic radiation after vaginoplasty. Four patients had radiation to the chest or thorax and gender-affirming chest or breast surgery, including two trans men with breast cancer. Two pediatric patients developed hypopituitarism and hypogonadism secondary to radiation therapy and, as adults, changed their hormone replacement therapy to affirm their transgender identities. Discussion Transgender people with cancer undergo radiation therapy for a wide range of cancers. Understanding their prior gender-affirming medical or surgical treatments and future gender affirmation goals may identify important considerations for their oncologic care.
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Affiliation(s)
- Arian Mansur
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Abigail M. Kempf
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Danielle S. Bitterman
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Chirayu G. Patel
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
| | - M Aiven Dyer
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Radiation Oncology, Boston Children’s Hospital, Boston, MA, United States
| | - Kevin X. Liu
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiation Oncology, Boston Children’s Hospital, Boston, MA, United States
| | - Alicia C. Smart
- Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiation Oncology, Boston Children’s Hospital, Boston, MA, United States
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5
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Bybee SG, Wilson CM. Why Good Cancer Care Means Gender-Affirming Care for Transgender Individuals With Gendered Cancers: Implications for Research, Policy, and Practice. J Clin Oncol 2023; 41:3591-3594. [PMID: 37224435 PMCID: PMC10325736 DOI: 10.1200/jco.22.01857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Sara G. Bybee
- University of Utah College of Nursing, Salt Lake City, UT
| | - Christina M. Wilson
- University of Alabama at Birmingham School of Nursing and Heersink School of Medicine, Division of Gynecologic Oncology, Birmingham, AL
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Alter K, Baruch D, Ambinder D, Vaserman G, Lin N, Saji A, Bassily D, White C, Rahman M, Tang X, Ritter E, Choudhury M, Bendl R, Phillips J. Pelvic Exenteration and Abdomino-Perineal Resection in a Transgender Female with Squamous Cell Carcinoma of Unknown Origin. Urology 2023:S0090-4295(23)00188-7. [PMID: 36868412 DOI: 10.1016/j.urology.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Affiliation(s)
- Kevin Alter
- Department of Urology, Westchester Medical Center, Valhalla, NY.
| | - David Baruch
- Department of Urology, New York Medical College, Valhalla, NY
| | - David Ambinder
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | | | - Nicole Lin
- Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - Akhil Saji
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Daniel Bassily
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Charles White
- Department of Urology, Westchester Medical Center, Valhalla, NY
| | - Mozibur Rahman
- Department of Pathology, Westchester Medical Center, Valhalla, NY
| | - Xiaoyu Tang
- Department of Pathology, Westchester Medical Center, Valhalla, NY
| | - Edmond Ritter
- Department of Plastic Surgery, Westchester Medical Center, Valhalla, NY
| | | | - Ryan Bendl
- Department of Surgery, Westchester Medical Center, Valhalla, NY
| | - John Phillips
- Department of Urology, Westchester Medical Center, Valhalla, NY
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7
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Domínguez-Riscart J, Ariza-Jimenez AB, Baez-Castillo C, Mateo-Gavira I. Factors associated with knowledge and vaccination intention for human papillomavirus on trans girls by their main caregiver: A cross-sectional study. Front Immunol 2023; 14:1097449. [PMID: 37063882 PMCID: PMC10098167 DOI: 10.3389/fimmu.2023.1097449] [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: 11/13/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Trans women are highly affected by the human papillomavirus (HPV) and are at risk of suffering from HPV-related diseases such as oropharyngeal, anal, penile, or neovaginal neoplasia. HPV vaccination seems to be a good strategy to reduce HPV-related diseases, mainly during the early age before the first sexual intercourse, but only cisgender girls are covered by the National Health Services, while some high-risk groups such as trans girls are not included. Achieving a high vaccination rate is important in the adolescent population, but there are many factors that could affect it, such as lack of knowledge about HPV or fear of side effects by patients and main caregivers. The aim of our study is to analyze the knowledge of trans girls' main caregivers about HPV-related diseases in the general population and, in particular, in trans women, as well as factors associated with HPV vaccination intention. Methods A cross-sectional study was performed with the collaboration of main caregivers of adolescent trans girls, between 9 and 16 years old, assisted in two reference centers' multidisciplinary Gender Diversity Units. Information was requested through a self-completed questionnaire: HPV-related diseases Knowledge Transwomen questionnaire (HPV-TQ) was elaborated based on a 19-item self-administered questionnaire and score was standardized from 0 to 19 points. Percentage of correct answers was calculated and defined by the group of high scores that showed over 70% correct answers. Results A total of 65 main caregivers were included. Almost all main caregivers were mothers with a Caucasian ethnicity. The HPV-TQ average score was 11 (3.7) with an average correct answer of 58.1% (19.6). Only 17/65 (26.1%) of main caregivers were highly knowledgeable in HPV. Of 65 trans girls, 14 were already vaccinated (29.8% of trans girls over 12 years old); 78.5% were not vaccinated and only 21.5% had intentions to be vaccinated. The group with a high score in HPV-TQ had a longer follow-up at the transgender unit, a higher maternal vaccination rate, and a positive family history of HPV-related disease, especially in mothers. Conclusion Adolescent trans girls attended to in our units had a low rate and a low intention of vaccination against HPV. Education on and promotion and prevention of transgender HPV-related diseases should probably be implemented to achieve a higher knowledge and vaccination coverage in adolescent trans girls.
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Affiliation(s)
- Jesus Domínguez-Riscart
- Pediatric Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
- *Correspondence: Jesus Domínguez-Riscart,
| | - Ana-Belen Ariza-Jimenez
- Pediatric Department, Hospital Universitario Reina Sofia, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Celia Baez-Castillo
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
| | - Isabel Mateo-Gavira
- Biomedical Research and Innovation Institute of Cádiz (INiBICA), Cádiz, Spain
- Endocrinology and Nutrition Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
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8
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Awe AM, Burkbauer L, Pascarella L. Surgical Implications of LGBTQ+ Health Disparities: A Review. Am Surg 2022; 88:2786-2795. [PMID: 35466711 DOI: 10.1177/00031348221096577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) patients face challenging health care disparities. However, due to restrictions in reporting and collection of sexual orientation and gender identity (SOGI) demographic data, comprehensive studies of surgical disparities in the LGBTQ+ population are limited. This review aims to summarize the existing literature describing surgical disparities in LGBTQ+ patients and to identify areas of surgical care in which further studies are warranted. This review addresses the literature in infectious diseases, substance use disorders, bariatrics, cardiovascular medicine, oncology, and laryngology as relevant to surgical practice. Understanding the current landscape of knowledge in LGBTQ+ surgical disparities and the areas where gaps in research exist will help the surgeon to create a framework of practice to provide more equitable care to LGBTQ+ patients.
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Affiliation(s)
- Adam M Awe
- Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
| | - Laura Burkbauer
- Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
| | - Luigi Pascarella
- Division of Vascular Surgery, Department of Surgery, 2332University of North Carolina, Chapel Hill, NC, USA
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9
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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.
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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
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Sterling J, Garcia MM. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Transl Androl Urol 2021; 9:2771-2785. [PMID: 33457249 PMCID: PMC7807311 DOI: 10.21037/tau-20-954] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Over the last 50 years cancer mortality has decreased, the biggest contributor to this decrease has been the widespread adoption of cancer screening protocols. These guidelines are based on large population studies, which often do not capture the non-gender conforming portion of the population. The aim of this review is to cover current guidelines and practice patterns of cancer screening in transgender patients, and, where evidence-based data is lacking, to draw from cis-gender screening guidelines to suggest best-practice screening approaches for transgender patients. We performed a systematic search of PubMed, Google Scholar and Medline, using all iterations of the follow search terms: transgender, gender non-conforming, gender non-binary, cancer screening, breast cancer, ovarian cancer, uterine cancer, cervical cancer, prostate cancer, colorectal cancer, anal cancer, and all acceptable abbreviations. Given the limited amount of existing literature inclusion was broad. After eliminating duplicates and abstract, all queries yielded 85 unique publications. There are currently very few transgender specific cancer screening recommendations. All the guidelines discussed in this manuscript were designed for cis-gender patients and applied to the transgender community based on small case series. Currently, there is not sufficient to evidence to determine the long-term effects of gender-affirming hormone therapy on an individual’s cancer risk. Established guidelines for cisgender individuals and can reasonably followed for transgender patients based on what organs remain in situ. In the future comprehensive cancer screening and prevention initiatives centered on relevant anatomy and high-risk behaviors specific for transgender men and women are needed.
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Affiliation(s)
- Joshua Sterling
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Maurice M Garcia
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, Los Angeles, CA, USA.,Department of Urology, University of California San Francisco, San Francisco, CA, USA.,Department of Anatomy, University of California San Francisco, San Francisco, CA, USA
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11
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Wang G, Ferguson D, Ionescu DN, Hoang L, Barrett S, van Niekerk D, Rose JN, Kollmannsberger C. HPV-Related Neovaginal Squamous Cell Carcinoma Presenting as Lung Metastasis after Male-to-Female Gender Confirmation Surgery. Case Rep Oncol 2020; 13:17-22. [PMID: 32110215 PMCID: PMC7036568 DOI: 10.1159/000504936] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022] Open
Abstract
There have been 4 reported cases of squamous cell carcinoma (SCC) of the neovagina in transgender women. In this report, we present another case of neovaginal SCC in a transgender woman, which was HPV-related, with lung metastasis as the initial presentation, and which was also complicated by her previous history of metastatic renal cell carcinoma. This unique case highlights the diagnostic challenges in these unusual scenarios. Through this report, we hope to address the benefits of multidisciplinary tumor board rounds, provision of detailed clinical information, and familiarization of the transgender anatomy within the pelvis in this group of patients. We also propose that transgender women undergo a continuous annual follow-up after postoperative follow-up is completed.
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Affiliation(s)
- Gang Wang
- Department of Pathology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - David Ferguson
- Department of Radiology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Diana N Ionescu
- Department of Pathology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Lien Hoang
- Department of Pathology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Barrett
- Department of Radiology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Dirk van Niekerk
- Department of Pathology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - James Neil Rose
- Department of Radiation Oncology, BC Cancer Abbotsford Centre, Abbotsford, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - Christian Kollmannsberger
- Department of Medical Oncology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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Fernández-Ruiz M, Pantoja-Garrido M, Frías-Sánchez Z, Rodríguez-Jiménez I, Aguilar-Martín MDV. Epidermoid carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome. Case report and literature review. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2019; 70:266-276. [PMID: 32142241 DOI: 10.18597/rcog.3328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 01/06/2020] [Indexed: 01/09/2023]
Abstract
Objective To present the case of a squamous carcinoma in the neovagina of a patient with Mayer-Rokitansky-Küster-Hauser syndrome and review of the literature related to treatment and prognosis of vaginal neoplasms or HPV infection in transgender women or with MRKH syndrome. Materials and methods A 56-year-old woman consulted to the Hospital Universitario of Sevilla (Spain). During the clinical examination, a exophytic tumor at the bottom of the vagina was found and the biopsy reported squamous carcinoma and positive nucleic acid amplification test for human papilloma (HPV) type 16. A literature search of case reports, case series and observational studies published from 2000 to October 2019 in English and Spanish was performed in Medline via PubMed, with the follow- ing terms: "congenital abnormalities"; "Mullerian aplasia"; "neovagina"; "Vaginal neoplasms"; "Squamous carcinoma"; "HPV infection" was performed. Results 14 studies were finally included; seven corresponded to squamous cell carcinoma, three to adenocarcinoma and four reported HPV infection only. All of the squamous cell carcinomas were at advanced stages due to local or lymphatic compro- mise and received radiotherapy with concomitant chemotherapy or radical surgery. The prognosis was bad in three of the cases. Patients with adenocarcinoma also presented with advanced lesions due to local extensión and received surgical treatment and two cases received concomitant chemotherapy. Only one patient was followed-up for five years or more. HPV infection is common in women who underwent neovagina reconstruction. Conclusions Patients with neovagina are susceptible to develope squamous carcinomas or adenocarcinomas depending if skin or intestinal tissue grafts are used. According to local compromise at the time of diagnosis, radical or combined treatments are required. Which screening strategies for HPV, squamous cell carcinomas and adenocarcinoma is to be investigated.
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Affiliation(s)
- Marta Fernández-Ruiz
- Servicio de Ginecología del Hospital general Santa María del Puerto (Cádiz), España
| | - Manuel Pantoja-Garrido
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen Macarena de Sevilla (España)
| | - Zoraida Frías-Sánchez
- Unidad de Gestión Clínica de Ginecología del Hospital Universitario Virgen del Rocío de Sevilla (España)
| | - Inmaculada Rodríguez-Jiménez
- Unidad de Gestión Clínica de Obstetricia y Ginecología del Hospital Universitario Virgen Macarena de Sevilla (España)
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13
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Sullivan P, Trinidad J, Hamann D. Issues in transgender dermatology: A systematic review of the literature. J Am Acad Dermatol 2019; 81:438-447. [DOI: 10.1016/j.jaad.2019.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
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14
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Dhingra N, Bonati LM, Wang EB, Chou M, Jagdeo J. Medical and aesthetic procedural dermatology recommendations for transgender patients undergoing transition. J Am Acad Dermatol 2019; 80:1712-1721. [DOI: 10.1016/j.jaad.2018.05.1259] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/22/2018] [Accepted: 05/28/2018] [Indexed: 11/28/2022]
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Abstract
Gender-affirming hormonal treatment (HT) in transgender people is considered safe in general, but the question regarding (long-term) risk on sex hormone-related cancer remains. Because the risk on certain types of cancer differs between men and women, and some of these differences are attributed to exposure to sex hormones, the cancer risk may be altered in transgender people receiving HT. Although reliable epidemiologic data are sparse, the available data will be discussed in this article. Furthermore, recommendations for cancer screening and prevention will be discussed as well as whether to withdraw HT at time of a cancer diagnosis.
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Affiliation(s)
- Christel J M de Blok
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Koen M A Dreijerink
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands; Center of Expertise on Gender Dysphoria, Amsterdam UMC, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands.
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Sigma-lead Male-to-Female Gender Affirmation Surgery: Blending Cosmesis with Functionality. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2169. [PMID: 31321174 PMCID: PMC6554166 DOI: 10.1097/gox.0000000000002169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/08/2019] [Indexed: 11/15/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Current male-to-female (MtF) sex-reassignment-surgery techniques have not been fully successful to achieve the ideal objectives. The ordeal of multiple procedures, associated complications, and suboptimal results leads to high rate of dissatisfaction. We have tried to overcome functional inadequacy and address the esthetic issues for outer genitalia and vagina with our innovative “true shape sigma-lead SRS: Kaushik’s technique,” which has now become the technique of choice for MtF genital SRS for our patients. Methods: Between April 2007 and April 2017, authors performed 386 sigma-lead SRS in MtF transsexuals. Results were analyzed based on complications, resurgeries, and esthetic/functional outcomes. Corrective SRS using rectosigmoid constituted 145 cases and is not a part of this study. Results: Maximum follow-up was 7 years (average 34 months). Seventy-eight (20.2%) patients had complications, majority being minor (97.4%). Forty-four (11.4%) required resurgeries, 10 (2.6%) were corrective for introital stricture and mucosal prolapse, whereas 34 (8.8%) opted for optional minor esthetic enhancement. The overall satisfaction rate for cosmetic and functional outcomes was 4.7 out of 5. In addition to review of the literature, innovations in the technique have been explained. Conclusions: Kaushik’s sigma-lead MtF SRS technique is a step short to become the gold standard of genital SRS because it has proven to be safe and reliable. It allows faster healing, minimal dilation, and nearly natural cosmetic results in the form of clitoris/clitoral hood, labia minora, labia majora along with self-lubricating, fully deep, and sensate neovagina with orgasmic capabilities. This is perhaps the largest reported series of rectosigmoid use in transsexuals carried out for primary vaginoplasty.
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17
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Yeung H, Luk KM, Chen SC, Ginsberg BA, Katz KA. Dermatologic care for lesbian, gay, bisexual, and transgender persons: Epidemiology, screening, and disease prevention. J Am Acad Dermatol 2019; 80:591-602. [PMID: 30744875 PMCID: PMC6375301 DOI: 10.1016/j.jaad.2018.02.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM. Women who have sex with women experience disparities in STDs, including chlamydia and HPV. Transgender patients have unique, and often unmet, dermatologic needs during gender transition (also called gender affirmation), related to hormonal therapy and gender-affirming surgery. Familiarity with LGBT health issues and disease-prevention guidelines can enable dermatologists to provide medically appropriate and culturally competent care to LGBT persons.
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Affiliation(s)
- Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| | - Kevin M Luk
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Suephy C Chen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Division of Dermatology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Brian A Ginsberg
- Department of Dermatology, Mount Sinai Hospital, New York, New York
| | - Kenneth A Katz
- Department of Dermatology, Kaiser Permanente, San Francisco, California
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18
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Squamous Carcinoma of the Neovagina after Male-to-Female Reconstruction Surgery: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2019; 2019:4820396. [PMID: 30775041 PMCID: PMC6354136 DOI: 10.1155/2019/4820396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the neovagina after genital reconstruction surgery is a rare occurrence with only very few cases published up to the present. We report a case of a 43-year-old transgender woman who developed neovaginal SCC 23 years after vaginoplasty. The patient tested positive for high-risk human papillomavirus (HPV). At the time of diagnosis, radiological investigations revealed already existing lymph node and osseous metastases. The treatment consisted of various cycles of chemotherapy and radiation therapy. Unfortunately, the formation of additional metastases, including cerebral, pulmonary, and hepatic metastases, could not be prevented. After comparing the literature on the topic, we conclude that neovaginal carcinoma often appears years and decades after genital reconstruction surgery. We therefore recommend the continuation of regular clinical follow-up for transgender women after postoperative follow-up is completed. With this approach, potential lesions may be detected at an earlier stage and a better outcome may be achieved. Follow-up should include neovaginal examination and cytological smear testing. At a later age, we recommend additional regular prostate-specific antigen (PSA) testing and digital rectal examination (DRE). Moreover, transgender women are advised to take part in mammography screening starting at the age of 50, especially when additional risk factors are present.
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19
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O'Hanlan KA, Gordon JC, Sullivan MW. Biological origins of sexual orientation and gender identity: Impact on health. Gynecol Oncol 2018; 149:33-42. [PMID: 29605047 DOI: 10.1016/j.ygyno.2017.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023]
Abstract
Gynecologic Oncologists are sometimes consulted to care for patients who present with diverse gender identities or sexual orientations. Clinicians can create more helpful relationships with their patients if they understand the etiologies of these diverse expressions of sexual humanity. Multidisciplinary evidence reveals that a sexually dimorphic spectrum of somatic and neurologic anatomy, traits and abilities, including sexual orientation and gender identity, are conferred together during the first half of pregnancy due to genetics, epigenetics and the diversity of timing and function of sex chromosomes, sex-determining protein secretion, gonadal hormone secretion, receptor levels, adrenal function, maternally ingested dietary hormones, fetal health, and many other factors. Multiple layers of evidence confirm that sexual orientation and gender identity are as biological, innate and immutable as the other traits conferred during that critical time in gestation. Negative social responses to diverse orientations or gender identities have caused marginalization of these individuals with resultant alienation from medical care, reduced self-care and reduced access to medical care. The increased risks for many diseases, including gynecologic cancers are reviewed. Gynecologic Oncologists can potentially create more effective healthcare relationships with their patients if they have this information.
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Affiliation(s)
- Katherine A O'Hanlan
- Laparoscopic Institute for Gynecology and Oncology (LIGO), 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States.
| | - Jennifer C Gordon
- University of Tennessee Health Sciences Center, Memphis, TN, United States.
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20
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Joint R, Chen ZE, Cameron S. Breast and reproductive cancers in the transgender population: a systematic review. BJOG 2018; 125:1505-1512. [DOI: 10.1111/1471-0528.15258] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 01/02/2023]
Affiliation(s)
- R Joint
- The University of Edinburgh; Edinburgh UK
| | - ZE Chen
- Chalmers Sexual Health Clinic; Edinburgh UK
| | - S Cameron
- Chalmers Sexual Health Clinic; Edinburgh UK
- Obstetrics and Gynaecology; University of Edinburgh; Royal Infirmary of Edinburgh; Edinburgh UK
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21
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Seyed-Forootan K, Karimi H, Seyed-Forootan NS. Autologous Fibroblast-Seeded Amnion for Reconstruction of Neo-vagina in Male-to-Female Reassignment Surgery. Aesthetic Plast Surg 2018; 42:491-497. [PMID: 29383415 DOI: 10.1007/s00266-018-1088-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Plastic surgeons have used several methods for the construction of neo-vaginas, including the utilization of penile skin, free skin grafts, small bowel or recto-sigmoid grafts, an amnion graft, and cultured cells. PURPOSE The aim of this study is to compare the results of amnion grafts with amnion seeded with autograft fibroblasts. MATERIALS AND METHODS Over 8 years, we compared the results of 24 male-to-female transsexual patients retrospectively based on their complications and levels of satisfaction. Sixteen patients in group A received amnion grafts with fibroblasts, and the patients in group B received only amnion grafts without any additional cellular lining. The depths, sizes, secretions, and sensations of the vaginas were evaluated. The patients were monitored for any complications, including over-secretion, stenosis, stricture, fistula formation, infection, and bleeding. RESULTS The mean age of group A was 28 ± 4 years and group B was 32 ± 3 years. Patients were followed up from 30 months to 8 years, (mean 36 ± 4) after surgery. The depth of the vaginas for group A was 14-16 and 13-16 cm for group B. There was no stenosis in neither group. The diameter of the vaginal opening was 34-38 mm in group A and 33-38 cm in group B. We only had two cases of stricture in the neo-vagina in group B, but no stricture was recorded for group A. All of the patients had good and acceptable sensation in the neo-vagina. Seventy-five percent of patients had sexual experience and of those, 93.7% in group A and 87.5% in group B expressed satisfaction. CONCLUSION The creation of a neo-vaginal canal and its lining with allograft amnion and seeded autologous fibroblasts is an effective method for imitating a normal vagina. The size of neo-vagina, secretion, sensation, and orgasm was good and proper. More than 93.7% of patients had satisfaction with sexual intercourse. Amnion seeded with fibroblasts extracted from the patient's own cells will result in a vagina with the proper size and moisture that can eliminate the need for long-term dilatation. The constructed vagina has a two-layer structure and is much more resistant to trauma and laceration. No cases of stenosis or stricture were recorded. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Kamal Seyed-Forootan
- Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Karimi
- Plastic and Reconstructive Surgery, Iran University of Medical Sciences, Tehran, Iran.
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22
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Bollo J, Balla A, Rodriguez Luppi C, Martinez C, Quaresima S, Targarona EM. HPV-related squamous cell carcinoma in a neovagina after male-to-female gender confirmation surgery. Int J STD AIDS 2017; 29:306-308. [DOI: 10.1177/0956462417728856] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vaginoplasty by penile and scrotal skin inversion is a well-established technique for male-to-female gender confirmation surgery. In this setting, chronic inflammation and lacerations associated with history of human papillomavirus (HPV) infection may induce a high risk of malignant degeneration in the long term. A 78-year-old transgender woman was admitted with genital discomfort and neovaginal discharge. The patient’s history revealed male-to-female gender confirmation surgery with construction of a neovagina by penile and scrotal skin inversion at 33 years of age. Physical examination of the genitalia revealed presence of fecal material, suggestive of recto-neovaginal fistula. A biopsy specimen was positive for well-differentiated HPV-related squamous cell carcinoma. Magnetic resonance imaging (MRI) showed a bulky mass in the posterior wall of the neovagina that infiltrated the urethra, prostatic gland and the anterior rectal wall. Following a multidisciplinary evaluation, we performed a definitive sigmoid colostomy and administered chemotherapy. Long-term follow-up seems advisable in patients after vaginoplasty due to the possibility of delayed development of cancer. Following biopsy, we consider MRI as the modality of choice to identify possible infiltration of the adjacent structures. As data regarding these lesions are scarce and management is complex, a multidisciplinary approach is recommended.
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Affiliation(s)
- Jesús Bollo
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Carrer Sant Antoni Maria Claret, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Andrea Balla
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Carrer Sant Antoni Maria Claret, Universidad Autónoma de Barcelona, Barcelona, Spain
- Department of General Surgery and Surgical Specialties “Paride Stefanini”, Sapienza, University of Rome, Rome, Italy
| | - Carlos Rodriguez Luppi
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Carrer Sant Antoni Maria Claret, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Carmen Martinez
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Carrer Sant Antoni Maria Claret, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties “Paride Stefanini”, Sapienza, University of Rome, Rome, Italy
| | - Eduard M Targarona
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Carrer Sant Antoni Maria Claret, Universidad Autónoma de Barcelona, Barcelona, Spain
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23
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Gibson AW, Radix AE, Maingi S, Patel S. Cancer care in lesbian, gay, bisexual, transgender and queer populations. Future Oncol 2017; 13:1333-1344. [DOI: 10.2217/fon-2017-0482] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Lesbian, gay, bisexual, transgender and queer (LGBTQ) populations experience health and healthcare disparities that may place them at higher risk for developing cancer. In addition, LGBTQ communities have psychosocial factors, such as fear of discrimination, that have substantial impacts on their medical care. As a result, these populations have specific needs with regard to cancer screening, treatment and support that must be addressed by cancer care providers. Although much has been done to address cancer care in the general population, more improvement is needed in the care of LGBTQ patients. We aim to present an overview of the current state of LGBTQ cancer care, opportunities for improvement and how cancer centers and providers can create a better future for the care of LGBTQ cancer patients.
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Affiliation(s)
- Alec W Gibson
- Medical Scientist Training Program & Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Asa E Radix
- Callen-Lorde Community Health Center, NY, USA
| | - Shail Maingi
- Department of Medical Oncology, St Peter's Health Partners Cancer Care, Troy, NY, USA
| | - Shilpen Patel
- Department of Radiation Oncology & Department of Global Health, University of Washington, Seattle, WA, USA
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24
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Grosse A, Grosse C, Lenggenhager D, Bode B, Camenisch U, Bode P. Cytology of the neovagina in transgender women and individuals with congenital or acquired absence of a natural vagina. Cytopathology 2017; 28:184-191. [DOI: 10.1111/cyt.12417] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2016] [Indexed: 12/21/2022]
Affiliation(s)
- A. Grosse
- Institute of Clinical Pathology; University Hospital Zurich; Zurich Switzerland
| | - C. Grosse
- Department of Pathology; Kepler University Hospital; Linz Austria
| | - D. Lenggenhager
- Institute of Clinical Pathology; University Hospital Zurich; Zurich Switzerland
| | - B. Bode
- Institute of Clinical Pathology; University Hospital Zurich; Zurich Switzerland
| | - U. Camenisch
- Institute of Clinical Pathology, Diagnostic Molecular Pathology; University Hospital Zurich; Zurich Switzerland
| | - P. Bode
- Institute of Clinical Pathology; University Hospital Zurich; Zurich Switzerland
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25
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Cornelisse VJ, Jones RA, Fairley CK, Grover SR. The medical care of the neovagina of transgender women: a review. Sex Health 2017; 14:442-450. [DOI: 10.1071/sh17044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022]
Abstract
For transgender women, genital adjustment surgery involves removal of the natal reproductive organs and creation of a neovagina, vulva and clitoris. We conducted a review of the medical literature in order to summarise the issues that can affect the health of the neovagina in the long term, and to make recommendations on how to manage these issues.
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26
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Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in Transgender People: Evidence and Methodological Considerations. Epidemiol Rev 2017; 39:93-107. [PMID: 28486701 PMCID: PMC5868281 DOI: 10.1093/epirev/mxw003] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 12/13/2022] Open
Abstract
Transgender people comprise a diverse group of individuals whose gender identity or expression differs from that originally assigned to them at birth. Some, but not all, transgender people elect to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. As cross-sex hormones administered for the purposes of gender affirmation may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern. In addition, concerns about cancer risk in transgender patients have been linked to sexually transmitted infections, increased exposure to well-known risk factors such as smoking and alcohol use, and the lack of adequate access to screening. Several publications have identified cancer as an important priority in transgender health research and called for large-scale studies. The goals of this article are to summarize the evidence on factors that may differentially affect cancer risk in transgender people, assess the relevant cancer surveillance and epidemiologic data available to date, and offer an overview of possible methodological considerations for future studies investigating cancer incidence and mortality in this population.
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Affiliation(s)
- Hayley Braun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Janice Brockman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Center for Cancer Statistics, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Winship Cancer Institute, Emory University, Atlanta, Georgia
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27
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Ginsberg BA. Dermatologic care of the transgender patient. Int J Womens Dermatol 2016; 3:65-67. [PMID: 28492057 PMCID: PMC5418958 DOI: 10.1016/j.ijwd.2016.11.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 11/08/2016] [Accepted: 11/21/2016] [Indexed: 02/01/2023] Open
Abstract
Given the complexities of the transitioning process, transgender individuals may face unique dermatologic needs in addition to routine care. Exogenous hormones affect hair and sebum production, gender-confirming surgeries often require dermatologic pre- and postoperative interventions, and postoperative anatomy may show unique presentations of routine skin conditions. Aesthetic techniques that are often used for rejuvenation may have a role in facial feminization and masculinization and unfortunately are too frequently performed by nonmedical personnel with negative consequences. Ultimately, physicians should strive to make their office a more accommodating environment for transgender individuals.
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Affiliation(s)
- B A Ginsberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
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28
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Reyes Claret A, Martín Jiménez Á, Robles Gourley AA, Ibarra de la Rosa JM, Vicens Vidal M. Microinvasive squamous carcinoma of neovagina created with peritoneal flap (Davidov): Case report and literature review. J OBSTET GYNAECOL 2016; 37:131-135. [PMID: 27866418 DOI: 10.1080/01443615.2016.1234445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Carcinoma of the vagina is a rare disease, and it is even more rare when it appears in a neovagina, having its incidence and optimum treatment constantly discussed. The aim of this article was to review the cases described in the currently available literature and describe the second documented case of carcinoma in a neovagina created with peritoneal flaps, and also list the possible pathways and risk factors for its development. The case we present is a 49-year-old female who after undergoing a laparoscopic colpectomy of the upper two-thirds of the vagina, with an immediate reconstruction with peritoneal flaps by laparoscopy, at a 4 months follow up presented a focal microinvasive squamous carcinoma in the vault of the neovagina. After reviewing the literature, we conclude that excisional treatment is the preferable option to avoid the progression to an invasive carcinoma. However, this case demonstrates the importance of the necessity to do regular cito-vulvovaginoscopic examinations after the complete surgical treatment because of the chance of persistent or recurrent lesions on the transplanted tissue.
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Affiliation(s)
- Albert Reyes Claret
- a Department of Obstetrics and Gynaecology , Son Llàtzer Hospital , Palma de Mallorca , Spain
| | - Ángel Martín Jiménez
- a Department of Obstetrics and Gynaecology , Son Llàtzer Hospital , Palma de Mallorca , Spain
| | | | | | - Margalida Vicens Vidal
- a Department of Obstetrics and Gynaecology , Son Llàtzer Hospital , Palma de Mallorca , Spain
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Abstract
Creation of a neovagina is uncommon, but it may be performed for congenital absence or anomaly, after exenterative cancer surgery, or in male-to-female transsexuals. A variety of tissues may be used to create the neovagina. Lesions of the neovagina are uncommon and probably not well known to most practitioners. A review of these lesions will be helpful if such a patient presents.
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30
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Ginsberg BA, Calderon M, Seminara NM, Day D. A potential role for the dermatologist in the physical transformation of transgender people: A survey of attitudes and practices within the transgender community. J Am Acad Dermatol 2016; 74:303-8. [DOI: 10.1016/j.jaad.2015.10.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/24/2022]
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31
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Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques. J Sex Med 2015; 12:1499-512. [DOI: 10.1111/jsm.12868] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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32
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An overview of neovaginal reconstruction options in male to female transsexuals. ScientificWorldJournal 2014; 2014:638919. [PMID: 24971387 PMCID: PMC4058296 DOI: 10.1155/2014/638919] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 04/22/2014] [Indexed: 11/23/2022] Open
Abstract
Transsexualism is a complex condition in which the person experiences the inconsistency between the desired gender and their biological gender. Absence of the vagina is devastating in male to female transsexuals. Creation of the neovagina is the main surgical problem in these patients. Historically, beginnings of the neovaginal creation have their roots in the treatment of Mayer-Rokitansky syndrome and conditions such as cloacal anomalies, certain intersex disorders, vaginal malignancies, or severe vaginal trauma, but have more recently found great purpose in male to female sex reassignment surgery. Many operative procedures have been described but none is ideal. Therefore, the search for new, improved solutions continues. In neovaginoplasty reconstruction of the vulvovaginal complex is performed in its entity. The gold standard in neovaginal reconstruction in male to female sex reassignment surgery is penile skin inversion technique with or without scrotal flaps, which enables adequate sensation of the neovagina, good neovaginal depth, good erotic sensitivity of the neclitoris, and esthetically acceptable labia minora and maiora.
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