Motivations and expectations for feminizing genital gender-affirming surgery: A qualitative exploration of perspectives from trans feminine individuals and health care professionals

Background: Decision-making around feminizing genital gender-affirming surgery (gGAS) is a highly individualized process in which personal preferences interact with professional standards around eligibility and beneficence. In-depth knowledge of motivations and expectations of all stakeholders is key in supporting the conduct of affirmative surgical care. The present study aimed to explore these factors in both trans feminine individuals with a gGAS request, along with their healthcare professionals (HCPs). Methods: A qualitative study was performed in which 12 trans feminine individuals were interviewed and 12 HCPs participated in a focus group. Trans participants were eligible if they sought gGAS and were recruited at a center of expertise in the Netherlands. Qualitative data was analyzed using reflexive thematic analysis. Results: The data yielded three main themes, including (i) the overarching aims of reducing genital dysphoria and support of gender-affirmation and social wellbeing, regardless of type of gGAS, (ii) the personal motives attributed to each surgical option, and (iii) dealing with changing motives, and possible uncertainties and/or regret. Trans and HCP participants generally identified similar topics, while describing different roles or priorities. Discussion: Our findings indicate the importance of explicit conversations between trans women and HCPs on the overall aims of gGAS, the different attributes of the available (non-)surgical options, and the expected roles of both parties during decision-making. By doing so, normative assumptions are expected to be less guiding, and the surgical outcomes are expected to better-match the intended objectives.