The Greatest Challenges after Gender-Affirming Vaginoplasty: A Qualitative Analysis

Gender-affirming vaginoplasty can involve profound postoperative challenges related to the typical healing process and potential complications. We present a qualitative analysis of the greatest challenges that individuals experience after vaginoplasty with respect to physical, social, and emotional changes.

Data were collected through a community-informed, cross-sectional survey of individuals who have undergone vaginoplasty. Respondents were recruited via social media platforms between June and November 2020. Respondents were asked to complete an open-ended question on the greatest challenges they faced in the postoperative period. Responses were thematically analyzed using an inductive approach with double coding for reliability.

In total, 171 respondents had undergone vaginoplasty; among these, 111 respondents (65%) responded to the "greatest challenges" question. There were no significant differences in demographics between those who did or did not respond to this prompt. Seven major themes were identified, followed by subthemes to further categorize responses. The major themes found among the greatest challenges responses were postoperative complications (n = 39 respondents, 35%), dilation (35, 35%), effect on activities of daily living (26, 23%), mental health challenges (15, 14%), lack of support (14, 13%), sexual function (14, 13%), and health care access (13, 12%).

These greatest challenges after vaginoplasty may be used to inform patients, clinicians, and health care systems about unmet pre- and postoperative needs. Increasing both psychosocial support and patient education on postoperative recovery can help to improve outcomes by anticipating the short- and long-term challenges vaginoplasty patients may face.