Gender affirming penile inversion vaginoplasty: patient-reported outcomes of the first year.
Patient-reported outcomes following gender affirming vaginoplasty remain understudied. The aim of this study was to evaluate patient-reported outcomes during the first postoperative year following penile inversion vaginoplasty.
This retrospective cohort study included n = 76 consecutive patients undergoing penile inversion vaginoplasty (March 2021-January 2024) who completed questionnaires pre-op, and at 1, 3-, 6-, 9-, and 12-months post-op (n = 59, 78%). Patient-reported satisfaction with functional and anatomic outcomes including improvements in gender dysphoria were compared with logistic regression, cumulative link mixed models, and Mann-Whitney U tests.
Vaginoplasty reliably improved patient reports of matching gender identity (P < .0001), comfort in clothes (P < .0001), and reduced feelings of embarrassment (P < .0001) and distress when looking at or touching the genitals (each P < .0001). Fifty percent of respondents reached the #4 dilator by 6 months. At 1 year, the reported average vaginal depth was 12.7 cm (min 8.9 cm, max 14.0 cm), and 60% of patients had no issues with dilation. Slight or moderate difficulty was reported by 54% of respondents during the first 3 months, while 20% progressed to severe difficulty or complete cessation, beginning at 6 months and peaking at 9 months post-op. Three patients reported inability to dilate (6-12 months), all with preceding difficulties. Respondents were more likely to endorse ability to engage in their preferred sexual activity after vaginoplasty (P < .0001). Return of genital sensation was gradual, with 100% of patients having at least partial sensation at 6 months and 61% describing full sensation by 1 year (P < .001). Of those who had attempted to achieve orgasm, all were able at 9 months (P < .001). Respondents reported greater satisfaction with urinary function post-operatively (P < .001), despite 25% having diverted stream. All but 1 participant, who had a complicated post-op course, agreed with the statement "I am now happier after my surgery than before my surgery" at 1-year. Mental health concern prevalence remained stable over the course of 1 year (time effect P = .64).
During the first year after penile inversion vaginoplasty, we found high patient satisfaction for functional outcomes and alleviation of gender dysphoria. Results may assist in pre-operative counseling surrounding goals and expectations, increasing patient involvement, preparedness, and thereby outcomes and satisfaction.
This retrospective cohort study included n = 76 consecutive patients undergoing penile inversion vaginoplasty (March 2021-January 2024) who completed questionnaires pre-op, and at 1, 3-, 6-, 9-, and 12-months post-op (n = 59, 78%). Patient-reported satisfaction with functional and anatomic outcomes including improvements in gender dysphoria were compared with logistic regression, cumulative link mixed models, and Mann-Whitney U tests.
Vaginoplasty reliably improved patient reports of matching gender identity (P < .0001), comfort in clothes (P < .0001), and reduced feelings of embarrassment (P < .0001) and distress when looking at or touching the genitals (each P < .0001). Fifty percent of respondents reached the #4 dilator by 6 months. At 1 year, the reported average vaginal depth was 12.7 cm (min 8.9 cm, max 14.0 cm), and 60% of patients had no issues with dilation. Slight or moderate difficulty was reported by 54% of respondents during the first 3 months, while 20% progressed to severe difficulty or complete cessation, beginning at 6 months and peaking at 9 months post-op. Three patients reported inability to dilate (6-12 months), all with preceding difficulties. Respondents were more likely to endorse ability to engage in their preferred sexual activity after vaginoplasty (P < .0001). Return of genital sensation was gradual, with 100% of patients having at least partial sensation at 6 months and 61% describing full sensation by 1 year (P < .001). Of those who had attempted to achieve orgasm, all were able at 9 months (P < .001). Respondents reported greater satisfaction with urinary function post-operatively (P < .001), despite 25% having diverted stream. All but 1 participant, who had a complicated post-op course, agreed with the statement "I am now happier after my surgery than before my surgery" at 1-year. Mental health concern prevalence remained stable over the course of 1 year (time effect P = .64).
During the first year after penile inversion vaginoplasty, we found high patient satisfaction for functional outcomes and alleviation of gender dysphoria. Results may assist in pre-operative counseling surrounding goals and expectations, increasing patient involvement, preparedness, and thereby outcomes and satisfaction.
Authors
Pickel Pickel, Potter Potter, MacLeod MacLeod, Drodge Drodge, Grober Grober, Krakowsky Krakowsky, Millman Millman, Goldsher Goldsher
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