Patients who underwent gender-affirming surgery report satisfaction, reduced distress

Patient satisfaction is high during the first year following penile inversion vaginoplasty for functional outcomes and alleviation of gender dysphoria, a study has shown.

Vaginoplasty resulted in improvements in patient reports of matching gender identity (p<0.0001), comfort in clothes (p<0.0001), and reduced feelings of embarrassment (p<0.0001) and distress when looking at or touching the genitals (p<0.0001 for each). Of the respondents, half (50 percent) 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). Three of five patients (60 percent) reported no issues with dilation.

During the first 3 months, nearly half of the respondents (54 percent) reported slight or moderate difficulty, while one in five (20 percent) progressed to severe difficulty or complete cessation, beginning at 6 months and peaking at 9 months after surgery. Three patients also reported inability to dilate (6‒12 months), all with preceding difficulties.

Notably, respondents tended to endorse ability to engage in their preferred sexual activity after vaginoplasty (p<0.0001). Genital sensation returned gradually, with 100 percent of patients having at least partial sensation at 6 months, and 61 percent reporting full sensation by 1 year (p<0.001). Of those who had attempted to achieve orgasm, all succeeded at 9 months (p<0.001).

Postoperatively, respondents reported greater satisfaction with urinary function (p<0.001), despite 25 percent having diverted stream. All patients, except for one, who had a complicated postoperative course agreed with the statement “I am now happier after my surgery than before my surgery at 1 year. Moreover, mental health concern prevalence was stable over the year (p=0.64 time effect).

“Results may assist in preoperative counselling surrounding goals and expectations, increasing patient involvement, preparedness, and thereby outcomes and satisfaction,” the authors said.

Seventy-six patients undergoing penile inversion vaginoplasty were included in this retrospective cohort study. Participants completed questionnaire prior to surgery and at 1, 3, 6, 9, and 12 months after vaginoplasty (n=59, 78 percent).

The authors compared patient-reported satisfaction with functional and anatomic outcomes, including improvements in gender dysphoria, using logistic regression, cumulative link mixed models, and Mann‒Whitney U tests.