Postoperative Vaginoplasty Outcomes for Transgender and Nonbinary Patients in a U.S. County Safety-Net Health System

The study characterizes postoperative outcomes and associated demographic and medical factors among transgender and nonbinary (TNB) patients who received vaginoplasty in a newly established nonfellowship surgical program that trained existing surgeons in a safety-net hospital in Colorado.

Retrospective chart review of electronic medical records was performed for patients who underwent full- or minimal-depth vaginoplasty from May 2018 to April 2021 and were ≥1 year postsurgery. Demographic and medical characteristics, major and minor surgical complications, postoperative visits, pelvic floor physical therapy outcomes, narcotic usage, and length of time since surgery were collected. Descriptive and bivariate statistical analyses were performed.

A total of 153 patients underwent surgery: 140 had full-depth penile-inversion vaginoplasty and 13 had minimal-depth vaginoplasty. Three were lost to follow-up and excluded. Median follow-up time was 3.6 months (interquartile range [IQR] 2.8, 12.8). Patient demographics included median age of 31.5 years (27.0, 42.0), and predominantly White non-Hispanic (90%), single (61.3%), residing in the metro area (65.3%). About half of patients had Medicaid or Medicare (48.7%) and 44.7% received primary care within the study site system. Major and minor complication rates were 28% (n = 42) and 66.7% (n = 100), respectively. The most common major complications were hemorrhage with blood transfusion (n = 10, 6.7%) and infection requiring antibiotics (n = 19, 12.7%). No venous thromboembolism or fistula occurred. No demographic or medical characteristics were associated with surgical complications.

Vaginoplasty complication rates for TNB patients in a newly established county safety-net hospital program were largely within published ranges, which supports the safety and feasibility of providing these surgeries in similar settings.