Chronic phantom pain as a rare phenomenon after gender-affirming surgery: a systematic comparison study

The occurrence of phantom pain after surgical removal of male reproductive organs is a potential outcome. Indications for surgery may predict the probability of phantom pain after the procedure. These may vary between individuals undergoing tumor orchiectomy and those undergoing gender-affirming surgery. This study investigates the incidence of phantom pain after gender-affirming surgery. A retrospective questionnaire-based study was conducted with 55 transgender women who had undergone gender-affirming surgery, and the results were compared with those of 54 men who had undergone tumor orchiectomy, serving as a control group. The frequency, severity, risk factors, and characteristics of phantom pain in the testes and penis, painless phantom sensations in the genital area, and chronic postsurgical pain incidence were assessed. Phantom pain and painless phantom sensations in the testes were more frequent after tumor orchiectomy than after gender-affirming surgery. Transgender women did not experience persistent phantom pain after gender-affirming surgery. Chronic postsurgical pain incidence did not differ between the 2 groups. Preexisting genital pain affected the risk of chronic postsurgical pain in the tumor orchiectomy group but not the risk of phantom pain. In this study, we assessed whether transgender women experienced phantom pain after undergoing gender-affirming surgery. It appears that transgender women are less prone to phantom pain after gender-affirming surgery than are men after inguinal tumor orchiectomy. This may be attributed to alterations in the central representation of the unaccepted sex organs in the somatosensory cortex.