Patient-Reported Outcomes of Penile Inversion Vaginoplasty: A Single-Center Prospective Study

OBJECTIVE: Few studies have rigorously assessed patient-reported outcomes for patients undergoing penile-inversion vaginoplasty (PIV). The Gender Congruence and Life Satisfaction Scale (GCLS) is a validated patient-reported outcome tool to measure health-related outcomes in the gender diverse community (Jones et al.). The goal of this study was to prospectively assess long-term, patient-reported outcomes of patients undergoing PIV using the GCLS. METHODS: Individuals who underwent PIV at a single institution from September 2018 to February 2023 were eligible for the study. The Genital Satisfaction, Social Gender Role Recognition, Psychological Functioning, and Physical and Emotional Intimacy GCLS subscales were administered to patients preoperatively and at 3.5 months and 12 months postoperatively. GCLS subscale outcomes were scored according to scoring guidelines and bivariate analysis was performed using paired, non-parametric testing. RESULTS: Of the 76 patients who enrolled, 46 completed all three surveys (60.5% response rate). Genital Satisfaction subscale scores significantly increased postoperatively at both 3.5 months (Median: 4.33, IQR: [4.0;4.8], p<0.001) and 12 months (Median: 4.55, IQR: [4.2;5.0], p<0.001) compared to preoperative scores (Median: 2.0, IQR: [1.66;2.66]), but did not change significantly between 3.5 and 12 months (p=0.15). Social Gender Role Recognition subscale scores significantly increased postoperatively at both 3.5 months (Median: 3.25, IQR: [3.0;3.75], p=0.01) and 12 months (Median: 3.5, IQR: [3.25;4.0], p<0.001) compared to preoperative scores (Median: 3.0, IQR: [2.75;3.25]), and continued to significantly increase between 3.5 and 12 months (p=0.04). Psychological Functioning subscale scores significantly increased postoperatively at both 3.5 months (Median: 4.0, IQR: [3.4;4.45], p=0.03) and 12 months (Median: 4.25, IQR: [3.8;4.7], p<0.001) compared to preoperative scores (Median: 3.9, IQR: [3.4;4.3]), and continued to significantly increase between 3.5 and 12 months (p=0.02). Physical and Emotional Intimacy subscale scores did not change significantly postoperatively at either 3.5 months (Median: 3.25, IQR: [3;4], p=0.36) or 12 months (Median: 3.75, IQR: [3.25;4.0], p=0.08) compared to preoperative scores (Median: 3.5, IQR: [3.0;3.75]), nor did they change significantly between 3.5 and 12 months (p=0.21). CONCLUSION: Patients who undergo gender-affirming PIV report significant postoperative improvements in body image, social functioning, and psychological functioning. These benefits often continue to improve over time and may not necessarily stabilize at 3 or 12 months. CORRESPONDING AUTHOR: Caleb Haley, MD, 2101 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109. [email protected]. (208) 350-3282