Patient-centered analysis of preoperative information before genital feminizing surgery: a multicenter French mixed-methods study

Over the past decade, requests for genital feminizing surgery have increased, alongside evolving international guidelines emphasizing informed, patient-centered decision-making. Grounded in shared decision-making frameworks, meaningful informed consent requires not only disclosure of surgical risks but also alignment between patient expectations and postoperative realities. Yet, how preoperative information is experienced by patients remains underexplored in the scientific literature. Without such data, it is difficult to evaluate whether informed consent is meaningful. We conducted a multicenter, cross sectional mixed-methods survey to assess patient-perceived adequacy and gaps in preoperative information prior to penile inversion vulvo- and/or vaginoplasty. We included transfeminine or nonbinary individuals aged of at least 18 years, who underwent penile inversion vulvo- and/or vaginoplasty in 3 tertiary academic referral centers between 3 and 18 months before participation and who are fluent in French (reading and writing). In all 3 centers, surgery was preceded by a multidisciplinary evaluation in accordance with WPATH Standards of Care criteria. A consultation with a mental health professional (psychiatrist or psychologist) was systematically offered to patient without a referring mental health professional. Preoperative consultations systematically included discussion of postoperative sexual function and patient expectations. Pelvic floor physiotherapy was not routinely offered preoperatively in our centers during the study period. Postoperative follow-up was coordinated with referring physicians for patients returned to their region of origin. All patient matching the inclusion criteria were invited by mail to complete an anonymous online questionnaire (Supplementary material - Appendix 1) developed through iterative refinement involving transfeminine patients and a multidisciplinary team. Although validated instruments were considered, their scope did not align with our aim of capturing perceived adequacy across specific clinical domains. Quantitative data were analyzed descriptively, with paired comparisons using Student’s t-tests. Statistical significance was defined as P < .05. Given the small sample size and exploratory nature of the instrument, all quantitative analyses are descriptive; paired comparisons are provided as indicative of within-subject perceptual change only. Qualitative data were analyzed using inductive thematic analysis by 2 independent researchers; divergences were resolved through consensus. Thematic saturation was considered reached when no new themes emerged. Mixed-method integration at the interpretation stage. As clinicians involved in the same care pathway, the research team acknowledges that our positionality may have influenced data interpretation.