(287) Characterizing Mental Health and Central Pain Sensitization in Gender-Affirming Vaginoplasty - Outcomes of the 1st Year

Introduction Penile inversion vaginoplasty (PIV) is the most common gender-affirming genital surgery for trans- and gender-diverse (TGD) people, with demonstrated safety and satisfaction. However, recovery may be challenging due to extensive healing and possible psychological distress. Data regarding baseline mental health association with recovery is limited for PIV. Given the high prevalence of mental health and pain conditions among TGD individuals, exploring these associations is of value. Objective This pilot study investigates changes in anxiety, depression, stress, and central sensitization (CS) symptoms in the 1st-year post surgery and their associations with postoperative outcomes. Methods Retrospective cohort of 20 PIV patients who filled routine clinical evaluation questionnaires (July 2023–March 2024). Preoperative measures included the Depression Anxiety Stress Scale (DASS-21) and the CS Inventory, Part A (CSI-A). Postoperative pain was measured using the Visual Analog Scale (VAS) on days 0-3, 7, and 14 post-surgery. Surgical complications were classified using the Clavien–Dindo system. Associations were tested with correlation and multivariable regression models adjusted for age and anesthesia type. Results Preoperatively, 56% of patients screened positive for symptoms of depression, 61% for anxiety, 44% for stress, and 37% for central sensitization. Domains were strongly intercorrelated. (Figure 1) One year post surgery, depression (R = 0.56, p < 0.05), stress (R = 0.55, p < 0.05), and CSI-A (R = 0.75, p < 0.004) scores showed correlations with preoperative values (Figure 2), indicating longitudinal stability. Early complications were minor (90% Clavien–Dindo I–II), with one grade III event. Preoperative DASS-D, A, S and CSI-A were associated with greater pain and medication use on postoperative day 14. (P<0.05) At 1-year, mean vaginal depth was 9.15 cm (range 8.9–12.7, SD 1.52), and mean dilator diameter was 3.4 cm (range 2.5–3.8, SD 0.47). 33% required surgical revision, 11% had vaginal stenosis, 17% reported mental health challenges, and 26% experienced pelvic pain. No associations were found between preoperative measures and the mentioned outcomes. Conclusions Mental health and central sensitization symptoms are prevalent and interrelated among TGD individuals undergoing PIV, with limited fluctuation after the first postoperative year. In this pilot cohort, these comorbidities correlated with early postoperative pain but not with long-term functional recovery. Disclosure No