(001) Descriptive Analysis of Sexual Function & Orgasm Experience Pre- and Post- Gender-Affirming Hysterectomy

Abstract Introduction Gender-affirming hysterectomy (GAH) comprises nearly 10% of gender-affirming surgeries performed in the United States, yet its relationship to sexual function and experience in transgender and gender-diverse (TGD) individuals assigned female at birth (AFAB) remains underexplored. Existing evidence largely derives from cisgender cohorts, with distinct demographics and indications. Descriptive data specific to TGD populations are needed to inform patient-centered counseling and perioperative support. Objective To describe sexual function and orgasm experience up to one year following GAH among TGD-AFAB individuals. Methods We conducted a prospective, descriptive study at a single tertiary academic center (November 2023–July 2024) of English-speaking AFAB adults undergoing GAH. Exclusions included concurrent genital reconstruction (ie, phalloplasty, metoidioplasty) or hysterectomy for unrelated medical indications (ie, symptomatic fibroids, abnormal uterine bleeding). Surveys were collected preoperatively and at 3-, 6-, 9-, and 12-month intervals; data beyond 3 months were consolidated into one late follow-up group (6–12 months). Observations were treated as independent cross-sectional samples. Measures included demographics, medical history, the Orgasm Rating Scale (ORS), and the Transmasculine Sexual Functioning Index (TM-SFI). TM-SFI totals were prorated when ≥4 items were answered; respondents with 4 items were excluded from TM-SFI scoring. Analyses were limited to counts, proportions, and means. Results 74 survey responses were received: 20 baseline, 19 early (3-month) follow-up, and 35 late (6–12 month) follow-up. Respondents were predominantly 21–35 years old, White, college-educated, and employed; most identified as transmasculine or non-binary, and approximately two-thirds reported testosterone use. Participants not attempting intercourse in the past month comprised 40% at baseline, 58% at early follow-up, and 29% at late follow-up. Orgasm frequency during sexual stimulation (0–5 scale) averaged 4.20 (SD 1.40) at baseline, 4.44 (SD 1.20) at early follow-up, and 4.41 (SD 1.13) at late follow-up. Mean ORS domain ratings (0–5) at baseline, early, and late follow-up, respectively, were: intimacy 2.11 (SD 1.82), 1.70 (SD 1.79), and 2.22 (SD 1.43); sensory 2.62 (SD 1.73), 2.38 (SD 1.57), and 2.90 (SD 1.52); rewards 2.20 (SD 1.53), 2.21 (SD 1.49), and 2.32 (SD 1.38); affective 3.33 (SD 1.37), 3.20 (SD 1.20), and 3.01 (SD 1.40). Mean TM-SFI totals were 19.38 (SD 4.60) at baseline, 18.94 (SD 5.09) at early follow-up, and 21.08 (SD 5.10) at late follow-up; by late follow-up, the mean shifted from the low (0–19) into the moderate (20–24) sexual functioning tertile. Conclusions Sexual function after GAH in TGD-AFAB individuals appeared preserved, with modest increases in late-follow-up orgasm frequency, TM-SFI totals, and ratings in most ORS domains. Interpretation is limited by self-reported, deidentified surveys unlinked between occasions and by small sample size. However, this study constitutes, to our knowledge, the first description of sexual function and orgasm experience after GAH. The findings underscore the need for larger longitudinal studies with paired data to clarify trajectories and causation, to support perioperative sexual healthcare tailored to TGD populations. Disclosure No.