Variant genital gender-affirming surgery: a systematic review

Area of Science:

• Medical Science
• Surgical Innovation
• Gender-Affirming Care

Background:

• Variant genital gender-affirming surgery (GGAS) encompasses diverse procedures tailored to individual patient needs and preferences.
• Patients opt for variant GGAS to mitigate risks associated with standard procedures or due to a lack of dysphoria regarding certain genital structures.

Approach:

• A systematic review of 23 case series (17 masculinizing, 6 feminizing) was conducted following PRISMA guidelines.
• Literature search encompassed PubMed, Embase, Web of Science, and Cochrane databases up to December 2023.
• Risk of bias was assessed for all included studies.

Key Points:

• Masculinizing surgeries: Urethral complications were linked to extended urethras and vaginal preservation; primary perineal urethrostomy can mitigate risks.
• Feminizing surgeries: Avoiding vaginal canal creation during vulvoplasty can prevent visceral damage and the need for lifelong dilation.
• All reviewed studies exhibited a high risk of bias, indicating a need for higher-quality research.

Conclusions:

• Variant GGAS is crucial for respecting the autonomy and preferences of transgender and gender-diverse individuals.
• Informed consent is paramount, requiring thorough discussion of risks and benefits for each surgical step.
• Further high-quality research is needed to better understand the outcomes and optimize techniques in variant GGAS.