Pelvic Floor Dysfunction in the Transgender Patient: A Scoping Review

Area of Science:

• Urology
• Gastroenterology
• Sexual Health
• Transgender Health

Background:

• Limited pooled data exists on pelvic floor dysfunction in transgender individuals, with or without gender-affirming surgery (GAS).
• Pelvic floor disorders encompass urinary, anorectal, and sexual dysfunctions, and complications post-GAS.

Purpose of the Study:

• To conduct a scoping review of existing literature on pelvic floor dysfunction in transgender populations.
• To identify the prevalence and types of pelvic floor disorders in transgender individuals.

Main Methods:

• A comprehensive scoping review was performed following PRISMA-ScR guidelines.
• Searched major databases (PubMed, EMBASE, Scopus, Web of Science, Cochrane, Lilacs) in June 2024.
• Investigated urinary/anorectal dysfunction, pelvic organ prolapse (POP), sexual dysfunction, and post-GAS complications.

Main Results:

• Urinary incontinence prevalence ranged from 15.4% to 53%, influenced by age, BMI, and depression.
• Constipation was the most frequent anorectal complaint (22%-45.6%).
• Pelvic organ prolapse after neovaginoplasty was 4%-7.5%. Sexual dysfunction rates were high in trans men (54%-87.8%), with desire affected by hormone therapy and lubrication/pain issues in trans women. Common complications included vaginal stenosis (trans women) and urethral strictures/fistulas (trans men).

Conclusions:

• Pelvic floor dysfunction is highly prevalent in the transgender population.
• Standardized instruments and pelvic examinations are recommended for future research.
• Further cohort studies are necessary to better define and manage these conditions.