Using a novel and validated survey tool to analyze sexual functioning following vaginoplasty in transgender...

Background In the healthcare setting, transgender patients are often marginalized, face discrimination and have limited access to high-quality gender-affirming care, such as gender-affirming surgery (GAS). As a result, the available data pertaining to GAS are often based on convenience samples, and the majority of published studies in the US are cross-sectional. Transgender people may undergo GAS to align their bodies with their gender identities. There has been little emphasis on the GAS self-evaluated experience. GAS may be associated with improved quality of life in transgender people. This study aimed to analyze the functionality of transgender patients' genitals following vaginoplasty. Methods A total of 306 transgender patients responded to a validated survey for patient-reported feminizing GAS outcomes. Surveys were given to patients prior to GAS, and then 2weeks, 6months and 12months postoperatively. Pre- and post-GAS responses were compared using McNemar and Wilcoxon signed-rank tests. Self-identified race/ethnicity was available for all survey participants. All participants voluntarily took the same survey by using the same survey platform to eliminate bias. Results Five questions showed significant improvement between the 2-week and 6-month responses. These questions assessed if respondents had sensation in their clitoris (P =0.031), the frequency that clitoral stimulation was pleasurable (P =0.018), the presence of sexual activity in the past 3months (P P =0.031) and if labial irritation while walking or exercising decreased (P =0.051). Significant differences were not detected between the 6-month and 12-month responses for any of the survey questions. Conclusions The results of five different metrics regarding sexual activity and vaginal functioning showed a significant improvement for transgender people following GAS. Findings also similarly demonstrate a high success rate of sexual activity after GAS. These are significant patient-reported outcomes using tools validated for the transgender population. Respondent outcomes significantly improved between the 2-week and 6-month time period, but did not differ between the 6-month and 12-month period, suggesting the ideal time to assess the above-described patient-perceived outcomes with vaginoplasty is 6months postoperatively.