INTRODUCTION: This study identifies patterns in perioperative care, surgical methods, and associations with complications in transgender patients undergoing gender-affirming hysterectomy while taking testosterone. The primary outcome was the incidence of vaginal cuff separation. The secondary outcome was any complication requiring intervention. METHODS: This is a descriptive multi-institution retrospective cohort study. Analysis of categorical variables used chi-squared tests or Fisher's exact tests. For continuous variables, we used independent-samples t -tests or Mann–Whitney rank-sum tests for normal and skewed distributions, respectively. RESULTS: There were 235 patients, representing four institutions. 2.55% of patients experienced cuff separation. 66.7% of patients had mucosal separation, versus 33.3% with complete separation. 50% of patients with separation had vaginal atrophy, versus 22.2% without separation. 16.7% of patients with separation discontinued testosterone compared to 3.6% without separation. 100% of patients who had cuff separation experienced vaginal bleeding, versus 52.4% without. 4.8% of patients after a speculum exam required intervention with silver nitrate, suturing, or monitoring. 0% of patients without bleeding who underwent invasive examination had a complication identified. CONCLUSIONS/IMPLICATIONS: Our finding of 2.55% of patients with cuff separation is greater than previous reports of cisgender patients at a rate of 0.39%. Cuff separation was associated with vaginal atrophy, indicating that there may be a role for vaginal estrogen. Testosterone discontinuation is unlikely to be protective. Cuff separation was associated with vaginal bleeding, so examinations should be performed in the setting of vaginal bleeding, but can be deferred for asymptomatic patients. This study is limited by sample size.
Fuchs et al. (Thu,) studied this question.