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Pelvic Floor Dysfunction in the Transgender Patient: A Scoping Review
Livia Maria de Souza Santos Hatanaka1, Glaucia Miranda Varella Pereira1, Lucia Alves da Silva Lara2
1Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, Rua Alexander Fleming, 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil.
Introduction And Hypothesis:
There are scant pooled data on transgender individuals regarding pelvic floor dysfunction, with or without gender-affirming surgery (GAS).
Methods:
A scoping review following PRISMA-ScR guidelines was carried out using PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Lilacs in June 2024. The following pelvic floor disorders were investigated: urinary and anorectal dysfunctions, pelvic organ prolapse (POP), sexual dysfunction and pelvic floor disorders after GAS.
Results:
Of 1284 studies, 35 remained for full-text analysis and data extraction. Urinary dysfunction was seen within 10 studies and prevalence of urinary incontinence (UI) varied from 15.4 to 53%, with age, BMI, and depression identified as factors in these studies. Anorectal dysfunction was found in four studies and constipation was the most frequent complaint, varying from 22 to 45%. Constipation was the main anorectal complaint (22%-45.6%). POP rate after neovaginoplasty ranged between 4% and 7.5%. Regarding sexual dysfunction, the Female Sexual Function Index, was the most commonly used questionnaire. Sexual desire appears to be affected by gender-affirming hormone therapy, whereas lubrication and pain were altered in trans women (TW) patients. Sexual dysfunction rates in trans men (TM) were high (54%-87.8%). Regarding complications, most common findings were vaginal stenosis in TW and urethral strictures and fistulas in TM.
Conclusion:
There is a high prevalence of pelvic floor dysfunction among the transgender population. Future cohort studies with better defined instruments and standardized pelvic examinations are recommended.
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