Gender affirming penile inversion vaginoplasty: patient-reported outcomes of the first year

Patient-reported outcomes following gender affirming vaginoplasty remain understudied. The aim of this study was to evaluate patient-reported outcomes during the first postoperative year following penile inversion vaginoplasty.

This retrospective cohort study included n = 76 consecutive patients undergoing penile inversion vaginoplasty (March 2021-January 2024) who completed questionnaires pre-op, and at 1, 3-, 6-, 9-, and 12-months post-op (n = 59, 78%). Patient-reported satisfaction with functional and anatomic outcomes including improvements in gender dysphoria were compared with logistic regression, cumulative link mixed models, and Mann-Whitney U tests.

Vaginoplasty reliably improved patient reports of matching gender identity (P < .0001), comfort in clothes (P < .0001), and reduced feelings of embarrassment (P < .0001) and distress when looking at or touching the genitals (each P < .0001). Fifty percent of respondents reached the #4 dilator by 6 months. At 1 year, the reported average vaginal depth was 12.7 cm (min 8.9 cm, max 14.0 cm), and 60% of patients had no issues with dilation. Slight or moderate difficulty was reported by 54% of respondents during the first 3 months, while 20% progressed to severe difficulty or complete cessation, beginning at 6 months and peaking at 9 months post-op. Three patients reported inability to dilate (6-12 months), all with preceding difficulties. Respondents were more likely to endorse ability to engage in their preferred sexual activity after vaginoplasty (P < .0001). Return of genital sensation was gradual, with 100% of patients having at least partial sensation at 6 months and 61% describing full sensation by 1 year (P < .001). Of those who had attempted to achieve orgasm, all were able at 9 months (P < .001). Respondents reported greater satisfaction with urinary function post-operatively (P < .001), despite 25% having diverted stream. All but 1 participant, who had a complicated post-op course, agreed with the statement "I am now happier after my surgery than before my surgery" at 1-year. Mental health concern prevalence remained stable over the course of 1 year (time effect P = .64).

During the first year after penile inversion vaginoplasty, we found high patient satisfaction for functional outcomes and alleviation of gender dysphoria. Results may assist in pre-operative counseling surrounding goals and expectations, increasing patient involvement, preparedness, and thereby outcomes and satisfaction.