Post gender-affirming vulvovaginoplasty survey of transgender adults

Characterizing patient-reported outcomes is essential to informing perioperative counseling in gender-affirming genital surgery. This study used patient-reported outcomes to characterize gender congruence, genital self-image, and sexual function after gender-affirming vulvovaginoplasty. Transgender patients assigned male at birth at a single academic center were invited to complete a post-surgery survey. Of 157 patients who had undergone surgery between September 2016 and March 2022, 41 (26.1%) completed the consent and survey. Gender congruence was assessed with items relating the experience of gender to quality-of-life. Genital self-image and sexual function were measured with adaptations of the Female Genital Self-Image Scale and Female Sexual Function Index. R software (Version 2023.03.0 + 386) was used for statistical analyses. Of 41 participants who underwent vulvoplasty (N = 9) or vulvovaginoplasty (N = 32), mean age was 45.8 years (standard deviation = 14.0) and median post-surgery time was 167.5 days (interquartile range = 273.5). Of those who had engaged in sexual activity in the past four weeks (N = 22), 40.9% (N = 9) were satisfied with their ability to reach orgasm. Additionally, 83.3% felt positively about their genitals and 95.8% were happier after surgery than before. Of those who had not recently engaged in sexual activity (N = 17), 82.4% felt positively about their genitals and 94.1% were happier after surgery. Patients in this study reported high rates of positive genital self-image and overall happiness regardless of whether they had engaged in sexual activity or were satisfied with their sexual function. These findings suggest that the psychosocial benefits of improved gender congruence can impact well-being even when sexual function is still evolving. Studies utilizing community-specific outcomes measures can more precisely evaluate whether these psychosocial gains persist independently of functional outcome. Not applicable