(079) Patient-Reported Functional, Sexual, and Psychosocial Outcomes During the First Year After Penile Inversion Vaginoplasty

Introduction Gender-affirming vaginoplasty is increasingly performed to align genital anatomy with gender identity, yet comprehensive data on patient-reported outcomes (PROs) during the first postoperative year remain limited. Improvements in gender congruence, sexual function, satisfaction with urinary function, and overall satisfaction may be expected, but detailed longitudinal data - especially relating to dilation experience, sensation recovery, and psychosocial outcomes - are limited. Understanding these outcomes is critical for preoperative counselling and optimizing care pathways. Objective To evaluate patient-reported functional, anatomical, sexual, urinary, and psychosocial outcomes over the first 12 months following penile inversion vaginoplasty. Methods We conducted a retrospective cohort study of 76 consecutive patients undergoing penile inversion vaginoplasty at a dedicated center between March 2021 and January 2024. A total of 59 patients (78%) who completed a purpose-designed questionnaire pre-operatively and at 1, 3-, 6-, 9- and 12-month post-operatively as part of clinical care, were included. The questionnaire, developed with community involvement, assessed gender congruence (genital alignment with gender identity, comfort in clothing, embarrassment/distress toward genitals), dilation experience (difficulty, caliber reached, vaginal depth), vulvar sensation, sexual function, urinary function, aesthetic, and overall satisfaction (“I am now happier after my surgery than before”). Statistical analyses included logistic regression for dichotomous outcomes, cumulative link mixed models for ordinal responses, and Mann-Whitney U tests where appropriate. Multiple time points allowed longitudinal analyses over the first postoperative year. Results Patients reported significant improvements in gender congruence postoperatively, including increased genital congruence (p<0.0001), comfort in clothing (p<0.0001), and reductions in distress and embarrassment when viewing or touching genitalia (each p<0.0001) (Figure 1). Up to 50% of patients reached the largest dilator (35mm caliber) in daily vaginal dilations by 6-12 months. At 12 months, median vaginal depth was 14.2 cm. Difficulties with dilation were common early, with 57% reporting slight-to-moderate difficulty in the first 3 months and up to 25% reporting ongoing severe difficulty or dilation cessation by 9 months. Reported vulvar sensation was gradual, with 100% reporting partial sensation by 6 months and 61% full sensation by 12 months (p<0.001). Among those who attempted, orgasmic function was reported by all by 9 months (p<0.001). Urinary function satisfaction increased (p<0.001) despite 25% experiencing a diverted stream. The prevalence of mental health concerns was stable throughout the first post-operative year (p=0.64). All but one participant, who had a complicated post-op course, agreed with the statement “I am now happier after my surgery than before my surgery” at 1-year post-op. Conclusions In this cohort of patients undergoing penile inversion vaginoplasty, substantial improvements in patient-reported outcomes-including gender congruence, sexual and urinary function, and overall satisfaction-were observed within the first postoperative year. Dilation challenges in the early postoperative period underscore the need for targeted counselling and pelvic-health support. Mental-health concerns remained prevalent throughout the first year, suggesting that while surgery enhances multiple domains of identity and function, ongoing psychosocial support remains essential during recovery. These data provide longitudinal evidence to guide patient expectation setting, improve shared decision-making, and inform postoperative care protocols for centers providing gender-affirming surgeries. Disclosure No