The medical care of the neovagina of transgender women: a review
Vincent J. Cornelisse A B C F , Rosemary A. Jones D , Christopher K. Fairley B C and Sonia R. Grover E
+ Author Affiliations
- Author Affiliations
A Prahran Market Clinic, Pran Central, 325 Chapel St, Prahran, Victoria, 3183, Australia.
B Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, 3800, Australia.
C Melbourne Sexual Health Centre, 580 Swanston St, Carlton, Victoria, 3053, Australia.
D The Adelaide Private Menopause Clinic, suite 22/183 Tynt St, North Adelaide, South Australia, 5006, Australia.
E Department of Obstetrics and Gynaecology, The University of Melbourne, Victoria, 3010, Australia.
F Corresponding author. Email: vcornelisse@mshc.org.au
Sexual Health 14(5) 442-450 https://doi.org/10.1071/SH17044
Submitted: 2 March 2017 Accepted: 5 July 2017 Published: 25 August 2017
Abstract
For transgender women, genital adjustment surgery involves removal of the natal reproductive organs and creation of a neovagina, vulva and clitoris. We conducted a review of the medical literature in order to summarise the issues that can affect the health of the neovagina in the long term, and to make recommendations on how to manage these issues.
References
[1] Karim RB, Hage JJ, Mulder JW. Neovaginoplasty in male transsexuals: review of surgical techniques and recommendations regarding eligibility. Ann Plast Surg 1996; 37 659–75.| Neovaginoplasty in male transsexuals: review of surgical techniques and recommendations regarding eligibility.Crossref | GoogleScholarGoogle Scholar |
[2] Fang RH, Chen TJ, Chen TH. Anatomic study of vaginal width in male-to-female transsexual surgery. Plast Reconstr Surg 2003; 112 511–4.
| Anatomic study of vaginal width in male-to-female transsexual surgery.Crossref | GoogleScholarGoogle Scholar |
[3] McQuillan SK, Grover SR. Dilation and surgical management in vaginal agenesis: a systematic review. Int Urogynecol J 2014; 25 299–311.
| Dilation and surgical management in vaginal agenesis: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[4] Bizic M, Kojovic V, Duisin D, Stanojevic D, Vujovic S, Milosevic A, et al An overview of neovaginal reconstruction options in male-to-female transsexuals. The Scientific World Journal 2014; 638919
[5] Toolenaar TA, Freundt I, Huikeshoven FJ, Drogendijk AC, Jeekel H, Chadha-Ajwani S. The occurrence of diversion colitis in patients with a sigmoid neovagina. Hum Pathol 1993; 24 846–9.
| The occurrence of diversion colitis in patients with a sigmoid neovagina.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3szosl2gsA%3D%3D&md5=5a8ded4919f398098b7973ef82dc82efCAS |
[6] Bouman MB, van der Sluis WB, Buncamper ME, Ozer M, Mullender MG, Meijerink WJ. Primary total laparoscopic sigmoid vaginoplasty in transgender women with penoscrotal hypoplasia: a prospective cohort study of surgical outcomes and follow-up of 42 patients. Plast Reconstr Surg 2016; 138 614e–23e.
| Primary total laparoscopic sigmoid vaginoplasty in transgender women with penoscrotal hypoplasia: a prospective cohort study of surgical outcomes and follow-up of 42 patients.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28XhsFKkt7zN&md5=b1cfdfce879a6ac7bf73b6548e815365CAS |
[7] Van der Sluis WB, Bouman MB, Buncamper ME, Mullender MG, Meijerink WJ. Revision vaginoplasty: a comparison of surgical outcomes of laparoscopic intestinal versus perineal full-thickness skin graft vaginoplasty. Plast Reconstr Surg 2016; 138 793–800.
| Revision vaginoplasty: a comparison of surgical outcomes of laparoscopic intestinal versus perineal full-thickness skin graft vaginoplasty.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC28XhsFKkt7zM&md5=e94b05059527173a3e284fe0fd86e4e2CAS |
[8] Bouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG. Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function. J Sex Med 2014; 11 1835–47.
| Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function.Crossref | GoogleScholarGoogle Scholar |
[9] Horbach SE, Bouman MB, Smit JM, Ozer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med 2015; 12 1499–512.
| Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques.Crossref | GoogleScholarGoogle Scholar |
[10] Weyers S, De Sutter P, Hoebeke S, Monstrey G, Sjoen G, Verstraelen H, et al Gynaecological aspects of the treatment and follow-up of transsexual men and women. Facts Views Vis ObGyn 2010; 2 35–54.
| 1:STN:280:DC%2BC2M7gtVCntw%3D%3D&md5=d9fbf6e4f5dc78cb36b9a1c429f9ca0fCAS |
[11] Goddard JC, Vickery RM, Qureshi A, Summerton DJ, Khoosal D, Terry TR. Feminizing genitoplasty in adult transsexuals: early and long-term surgical results. BJU Int 2007; 100 607–13.
| Feminizing genitoplasty in adult transsexuals: early and long-term surgical results.Crossref | GoogleScholarGoogle Scholar |
[12] Condous G, Jones R, Lam AM. Male-to-female transsexualism: laparoscopic pelvic floor repair of prolapsed neovagina. Aust N Z J Obstet Gynaecol 2006; 46 254–6.
| Male-to-female transsexualism: laparoscopic pelvic floor repair of prolapsed neovagina.Crossref | GoogleScholarGoogle Scholar |
[13] Bucci S, Mazzon G, Liguori G, Napoli R, Pavan N, Bormioli S, et al Neovaginal prolapse in male-to-female transsexuals: an 18-year-long experience. BioMed Research International 2014; 240761
[14] Frederick RW, Leach GE. Abdominal sacral colpopexy for repair of neovaginal prolapse in male-to-female transsexuals. Urology 2004; 64 580–1.
| Abdominal sacral colpopexy for repair of neovaginal prolapse in male-to-female transsexuals.Crossref | GoogleScholarGoogle Scholar |
[15] Loverro G, Bettocchi C, Battaglia M, Cormio G, Selvaggi G, Di Tonno P, et al Repair of vaginal prolapse following penoscrotal flap vaginoplasty in a male-to-female transsexual. Gynecol Obstet Invest 2002; 53 234–6.
| Repair of vaginal prolapse following penoscrotal flap vaginoplasty in a male-to-female transsexual.Crossref | GoogleScholarGoogle Scholar |
[16] Stanojevic DS, Djordjevic ML, Milosevic A, Sansalone S, Slavkovic Z, Ducic S, et al Sacrospinous ligament fixation for neovaginal prolapse prevention in male-to-female surgery. Urology 2007; 70 767–71.
| Sacrospinous ligament fixation for neovaginal prolapse prevention in male-to-female surgery.Crossref | GoogleScholarGoogle Scholar |
[17] Kondo W, Ribeiro R, Tsumanuma FK, Zomer MT. Laparoscopic promontofixation for the treatment of recurrent sigmoid neovaginal prolapse: case report and systematic review of the literature. J Minim Invasive Gynecol 2012; 19 176–82.
| Laparoscopic promontofixation for the treatment of recurrent sigmoid neovaginal prolapse: case report and systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |
[18] Popov A, Gumina D, Mironenko K, Slobodyanyuk B, Manannikova T, Fedorov A, et al Laparoscopic sacrocolpopexy in a patient with vault prolapse of the sigmoid stump. Int Urogynecol J 2016; 27 315–6.
| Laparoscopic sacrocolpopexy in a patient with vault prolapse of the sigmoid stump.Crossref | GoogleScholarGoogle Scholar |
[19] Swenson CW, DeLancey JO, Schimpf MO. Left-sided sacrospinous ligament suspension for treating recurrent sigmoid neovagina prolapse. Int Urogynecol J 2014; 25 1593–5.
| Left-sided sacrospinous ligament suspension for treating recurrent sigmoid neovagina prolapse.Crossref | GoogleScholarGoogle Scholar |
[20] Neron M, Ferron G, Vieille P, Letouzey V, Fatton B, de Tayrac R. Treatment of neovaginal prolapse: case report and systematic review of the literature. Int Urogynecol J 2017; 28 41–7.
| Treatment of neovaginal prolapse: case report and systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |
[21] Shimamura Y, Fujikawa A, Kubota K, Ishii N, Fujita Y, Ohta K. Perforation of the neovagina in a male-to-female transsexual: a case report. J Med Case Rep 2015; 9 24
| Perforation of the neovagina in a male-to-female transsexual: a case report.Crossref | GoogleScholarGoogle Scholar |
[22] Liguori G, Trombetta C, Buttazzi L, Belgrano E. Acute peritonitis due to introital stenosis and perforation of a bowel neovagina in a transsexual. Obstet Gynecol 2001; 97 828–9.
| 1:STN:280:DC%2BD3M3ovFWmuw%3D%3D&md5=91a65906ecbf2773ba65e1a660bc3bd0CAS |
[23] Amirian I, Gogenur I, Rosenberg J. Conservatively treated perforation of the neovagina in a male to female transsexual patient. BMJ Case Rep 2011; bcr0820103241
[24] Buncamper ME, Honselaar JS, Bouman MB, Ozer M, Kreukels BP, Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals. J Sex Med 2015; 12 1626–34.
| Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals.Crossref | GoogleScholarGoogle Scholar |
[25] Weyers S, Elaut E, De Sutter P, Gerris J, T’Sjoen G, Heylens G, et al Long-term assessment of the physical, mental, and sexual health among transsexual women. J Sex Med 2009; 6 752–60.
| Long-term assessment of the physical, mental, and sexual health among transsexual women.Crossref | GoogleScholarGoogle Scholar |
[26] Bouman MB, van der Sluis WB, van Woudenberg Hamstra LE, Buncamper ME, Kreukels BP, Meijerink WJ, et al Patient-reported esthetic and functional outcomes of primary total laparoscopic intestinal vaginoplasty in transgender women with penoscrotal hypoplasia. J Sex Med 2016; 13 1438–44.
| Patient-reported esthetic and functional outcomes of primary total laparoscopic intestinal vaginoplasty in transgender women with penoscrotal hypoplasia.Crossref | GoogleScholarGoogle Scholar |
[27] Wierckx K, Elaut E, Van Hoorde B, Heylens G, De Cuypere G, Monstrey S, et al Sexual desire in trans persons: associations with sex reassignment treatment. J Sex Med 2014; 11 107–18.
| Sexual desire in trans persons: associations with sex reassignment treatment.Crossref | GoogleScholarGoogle Scholar |
[28] Gooren L. Hormone treatment of the adult transsexual patient. Horm Res 2005; 64 31–6.
| 1:CAS:528:DC%2BD2MXht1WgtL%2FM&md5=551ffe650df4e025dd14095fc2c34e2fCAS |
[29] Elaut E, De Cuypere G, De Sutter P, Gijs L, Van Trotsenburg M, Heylens G, et al Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels. Eur J Endocrinol 2008; 158 393–9.
| Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXjsFyluro%3D&md5=ca409e0a91d885e661d41482dc45bd1bCAS |
[30] Sobel JD. Bacterial vaginosis. Annu Rev Med 2000; 51 349–56.
| Bacterial vaginosis.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD3cXisVeltro%3D&md5=e914575dacc068eef1c68eafb1b11c26CAS |
[31] Weyers S, Verstraelen H, Gerris J, Monstrey S, Santiago Gdos S, Saerens B, et al Microflora of the penile skin-lined neovagina of transsexual women. BMC Microbiol 2009; 9 102
| Microflora of the penile skin-lined neovagina of transsexual women.Crossref | GoogleScholarGoogle Scholar |
[32] Petricevic L, Kaufmann U, Domig KJ, Kraler M, Marschalek J, Kneifel W, et al Molecular detection of Lactobacillus species in the neovagina of male-to-female transsexual women. Sci Rep 2014; 4 3746
| Molecular detection of Lactobacillus species in the neovagina of male-to-female transsexual women.Crossref | GoogleScholarGoogle Scholar |
[33] Cornelisse VJ, Chow EP, Huffam S, Fairley CK, Bissessor M, De Petra V, et al Increased detection of pharyngeal and rectal gonorrhea in men who have sex with men after transition from culture to nucleic acid amplification testing. Sex Transm Dis 2017; 44 114–7.
| Increased detection of pharyngeal and rectal gonorrhea in men who have sex with men after transition from culture to nucleic acid amplification testing.Crossref | GoogleScholarGoogle Scholar |
[34] Petricevic L, Kaufmann U, Domig KJ, Kraler M, Marschalek J, Kneifel W, et al Rectal Lactobacillus species and their influence on the vaginal microflora: a model of male-to-female transsexual women. J Sex Med 2014; 11 2738–43.
| Rectal Lactobacillus species and their influence on the vaginal microflora: a model of male-to-female transsexual women.Crossref | GoogleScholarGoogle Scholar |
[35] Kaufmann U, Domig KJ, Lippitsch CI, Kraler M, Marschalek J, Kneifel W, et al Ability of an orally administered lactobacilli preparation to improve the quality of the neovaginal microflora in male to female transsexual women. Eur J Obstet Gynecol Reprod Biol 2014; 172 102–5.
| Ability of an orally administered lactobacilli preparation to improve the quality of the neovaginal microflora in male to female transsexual women.Crossref | GoogleScholarGoogle Scholar |
[36] Toolenaar TA, Freundt I, Wagenvoort JH, Huikeshoven FJ, Vogel M, Jeekel H, et al Bacterial flora of the sigmoid neovagina. J Clin Microbiol 1993; 31 3314–6.
| 1:STN:280:DyaK2c7ktFSisg%3D%3D&md5=64c21f7d5dd082517119a719c0974f9cCAS |
[37] Pal K, Tinalal S, Al Buainain H, Singh VP. Diversion proctocolitis and response to treatment with short-chain fatty acids–a clinicopathological study in children. Indian J Gastroenterol 2015; 34 292–9.
| Diversion proctocolitis and response to treatment with short-chain fatty acids–a clinicopathological study in children.Crossref | GoogleScholarGoogle Scholar |
[38] van der Sluis WB, Bouman MB, Meijerink WJ, Elfering L, Mullender MG, de Boer NK, et al Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics. Fertil Steril 2016; 105 834–9.e1.
| Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics.Crossref | GoogleScholarGoogle Scholar |
[39] van der Sluis WB, Neefjes-Borst EA, Bouman MB, Meijerink WJ, De Boer NK, Mullender MG, et al Morphological spectrum of neovaginitis in autologous sigmoid transplant patients. Histopathology 2016; 68 1004–12.
| Morphological spectrum of neovaginitis in autologous sigmoid transplant patients.Crossref | GoogleScholarGoogle Scholar |
[40] Syed HA, Malone PS, Hitchcock RJ. Diversion colitis in children with colovaginoplasty. BJU Int 2001; 87 857–60.
| Diversion colitis in children with colovaginoplasty.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzkvFaiug%3D%3D&md5=bd4273d1cd2922b19703fdeeb0fdcb03CAS |
[41] Gabarain G, Garcia-Naveiro R, Ponsky TA, Boulanger SC, Parry RL. Ulcerative colitis of the neovagina as a postsurgical complication of persistent cloaca. J Pediatr Surg 2012; 47 e19–22.
| Ulcerative colitis of the neovagina as a postsurgical complication of persistent cloaca.Crossref | GoogleScholarGoogle Scholar |
[42] Webster T, Appelbaum H, Weinstein TA, Rosen N, Mitchell I, Levine JJ. Simultaneous development of ulcerative colitis in the colon and sigmoid neovagina. J Pediatr Surg 2013; 48 669–72.
| Simultaneous development of ulcerative colitis in the colon and sigmoid neovagina.Crossref | GoogleScholarGoogle Scholar |
[43] Malka D, Anquetil C, Ruszniewski P. Ulcerative colitis in a sigmoid neovagina. N Engl J Med 2000; 343 369
| Ulcerative colitis in a sigmoid neovagina.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3czmt1ylsg%3D%3D&md5=9c8503ac02c8c934c50dfc80a4b15fd2CAS |
[44] Hennigan TW, Theodorou NA. Ulcerative colitis and bleeding from a colonic vaginoplasty. J R Soc Med 1992; 85 418–9.
| 1:STN:280:DyaK38zjtlGjsA%3D%3D&md5=4cdda9a4868beac71cbdec786d06a94eCAS |
[45] Shinozaki M, Watanabe T, Sato H, Nagawa H. Chronic colitis promotes tumor development. Oncol Rep 2006; 15 1485–90.
[46] Jess T, Loftus EV, Velayos FS, Harmsen WS, Zinsmeister AR, Smyrk TC, et al Risk of intestinal cancer in inflammatory bowel disease: a population-based study from Olmsted county, Minnesota. Gastroenterology 2006; 130 1039–46.
| Risk of intestinal cancer in inflammatory bowel disease: a population-based study from Olmsted county, Minnesota.Crossref | GoogleScholarGoogle Scholar |
[47] Sahastrabuddhe S, Gupta A, Stuart E, Godbole S, Ghate M, Sahay S, et al Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India. J Acquir Immune Defic Syndr 2012; 59 72–8.
| Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune, India.Crossref | GoogleScholarGoogle Scholar |
[48] Centre for Disease Control and Prevention. 2015 Sexually transmitted diseases treatment guidelines. 2015. Available online at: http://www.cdc.gov/std/tg2015/screening-recommendations.htm [verified 22 May 2016]
[49] Matsuki S, Kusatake K, Hein KZ, Anraku K, Morita E. Condylomata acuminata in the neovagina after male-to-female reassignment treated with CO2 laser and imiquimod. Int J STD AIDS 2015; 26 509–11.
| Condylomata acuminata in the neovagina after male-to-female reassignment treated with CO2 laser and imiquimod.Crossref | GoogleScholarGoogle Scholar |
[50] Yang C, Liu S, Xu K, Xiang Q, Yang S, Zhang X. Condylomata gigantea in a male transsexual. Int J STD AIDS 2009; 20 211–2.
| Condylomata gigantea in a male transsexual.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1M7otVCgug%3D%3D&md5=c206c0f45d8a6fbeb84d48141d145994CAS |
[51] Liguori G, Trombetta C, Bucci S, De Seta F, De Santo D, Siracusano S, et al Condylomata acuminata of the neovagina in a HIV-seropositive male-to-female transsexual. Urol Int 2004; 73 87–8.
| Condylomata acuminata of the neovagina in a HIV-seropositive male-to-female transsexual.Crossref | GoogleScholarGoogle Scholar |
[52] Wasef W, Sugunendran H, Alawattegama A. Genital warts in a transsexual. Int J STD AIDS 2005; 16 388–9.
| Genital warts in a transsexual.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD2MzgtlCqug%3D%3D&md5=9f1390995879c07f490093ac6943c682CAS |
[53] Fiumara NJ, Di Mattia A. Gonorrhoea and condyloma acuminata in a male transsexual. Br J Vener Dis 1973; 49 478–9.
| 1:STN:280:DyaE2c%2FitFCntw%3D%3D&md5=18f650a8d84ff1004170b32bb67d5c1bCAS |
[54] Schober JM. Cancer of the neovagina. J Pediatr Urol 2007; 3 167–70.
| Cancer of the neovagina.Crossref | GoogleScholarGoogle Scholar |
[55] Hernon M, Sloan H, Thompson R, De Cruze B, Sanders C, Creighton SM. Should we vaccinate against and test for human papillomavirus infection in adolescent girls and women with a neovagina? J Fam Plann Reprod Health Care 2014; 40 161–4.
| Should we vaccinate against and test for human papillomavirus infection in adolescent girls and women with a neovagina?Crossref | GoogleScholarGoogle Scholar |
[56] Fernandes HM, Manolitsas TP, Jobling TW. Carcinoma of the neovagina after male-to-female reassignment. J Low Genit Tract Dis 2014; 18 E43–5.
| Carcinoma of the neovagina after male-to-female reassignment.Crossref | GoogleScholarGoogle Scholar |
[57] Kita Y, Mori S, Baba K, Uchikado Y, Arigami T, Idesako T, et al Mucinous adenocarcinoma emerging in sigmoid colon neovagina 40 years after its creation: a case report. World J Surg Oncol 2015; 13 213
| Mucinous adenocarcinoma emerging in sigmoid colon neovagina 40 years after its creation: a case report.Crossref | GoogleScholarGoogle Scholar |
[58] Kokcu A, Tosun M, Alper T, Sakinci M. Primary carcinoma of the neovagina: a case report. Eur J Gynaecol Oncol 2011; 32 588–9.
| 1:STN:280:DC%2BC3MbmvVWrtw%3D%3D&md5=14a2e24fc5f7d715e8d4188c0c499219CAS |
[59] Lara PN, Hearn E, Leigh B. Neovaginal malignant melanoma following surgery and radiation for vulvar squamous cell carcinoma. Gynecol Oncol 1997; 65 520–2.
| Neovaginal malignant melanoma following surgery and radiation for vulvar squamous cell carcinoma.Crossref | GoogleScholarGoogle Scholar |
[60] Peters WA, Kumar NB, Morley GW. Carcinoma of the vagina. Factors influencing treatment outcome. Cancer 1985; 55 892–7.
| Carcinoma of the vagina. Factors influencing treatment outcome.Crossref | GoogleScholarGoogle Scholar |
[61] Weyers S, Lambein K, Sturtewagen Y, Verstraelen H, Gerris J, Praet M.. Cytology of the ‘penile’ neovagina in transsexual women. Cytopathology 2010; 21 111–5.
| Cytology of the ‘penile’ neovagina in transsexual women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3cbltVOjug%3D%3D&md5=222271076e6dbff05e184616fe6d394aCAS |
[62] van de Laar TJ, Richel O. Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus. Sex Transm Infect 2016;
| Emerging viral STIs among HIV-positive men who have sex with men: the era of hepatitis C virus and human papillomavirus.Crossref | GoogleScholarGoogle Scholar |
[63] Fiumara NJ, Asvadi S. Asymptomatic gonococcal urethritis in a male transsexual female. Br J Vener Dis 1978; 54 130–1.
| 1:STN:280:DyaE1c7ksFyisw%3D%3D&md5=3e51c4863abed9faaa5439269fa3074bCAS |
[64] Jenness SM, Begier EM, Neaigus A, Murrill CS, Wendel T, Hagan H. Unprotected anal intercourse and sexually transmitted diseases in high-risk heterosexual women. Am J Public Health 2011; 101 745–50.
| Unprotected anal intercourse and sexually transmitted diseases in high-risk heterosexual women.Crossref | GoogleScholarGoogle Scholar |
[65] van der Sluis WB, Bouman MB, Gijs L, van Bodegraven AA. Gonorrhoea of the sigmoid neovagina in a male-to-female transgender. Int J STD AIDS 2015; 26 595–8.
| Gonorrhoea of the sigmoid neovagina in a male-to-female transgender.Crossref | GoogleScholarGoogle Scholar |
[66] Fiumara NJ. The diagnosis and treatment of gonorrhea. Med Clin North Am 1972; 56 1105–13.
| The diagnosis and treatment of gonorrhea.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE383mtFansg%3D%3D&md5=620c0fda60cae28ba3d8b9aca78af6d4CAS |
[67] Bodsworth NJ, Price R, Davies SC. Gonococcal infection of the neovagina in a male-to-female transsexual. Sex Transm Dis 1994; 21 211–2.
| Gonococcal infection of the neovagina in a male-to-female transsexual.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2M%2FmsVeksw%3D%3D&md5=6a78e81f4513cfb4dee8990ec7da0559CAS |
[68] Haustein UF. [Pruritus of the artificial vagina of a transsexual patient caused by gonococcal infection.] Hautarzt 1995; 46 858–9.
| [Pruritus of the artificial vagina of a transsexual patient caused by gonococcal infection.]Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK287js1Citw%3D%3D&md5=f02b566cf6624914b0dddd642d53ab41CAS |
[69] Keshinro B, Crowell TA, Nowak RG, Adebajo S, Peel S, Gaydos CA, et al High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria. J Int AIDS Soc 2016; 19 21270
| High prevalence of HIV, chlamydia and gonorrhoea among men who have sex with men and transgender women attending trusted community centres in Abuja and Lagos, Nigeria.Crossref | GoogleScholarGoogle Scholar |
[70] Allan-Blitz LT, Leon SR, Bristow CC, Konda KA, Vargas SK, Flores JA, et al High prevalence of extra-genital chlamydial or gonococcal infections among men who have sex with men and transgender women in Lima, Peru. Int J STD AIDS 2017; 28 138–44.
[71] Leon SR, Segura ER, Konda KA, Flores JA, Silva-Santisteban A, Galea JT, et al High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in anal and pharyngeal sites among a community-based sample of men who have sex with men and transgender women in Lima, Peru. BMJ Open 2016; 6 e008245
| High prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in anal and pharyngeal sites among a community-based sample of men who have sex with men and transgender women in Lima, Peru.Crossref | GoogleScholarGoogle Scholar |
[72] Baral SD, Poteat T, Stromdahl S, Wirtz AL, Guadamuz TE, Beyrer C. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis 2013; 13 214–22.
| Worldwide burden of HIV in transgender women: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[73] Hernandez AL, Lindan CP, Mathur M, Ekstrand M, Madhivanan P, Stein ES, et al Sexual behavior among men who have sex with women, men, and Hijras in Mumbai, India–multiple sexual risks. AIDS Behav 2006; 10 5–16.
| Sexual behavior among men who have sex with women, men, and Hijras in Mumbai, India–multiple sexual risks.Crossref | GoogleScholarGoogle Scholar |
[74] Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. J Acquir Immune Defic Syndr 2008; 48 97–103.
| Sex work and HIV status among transgender women: systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[75] Saleem NH, Adrien A, Razaque A. Risky sexual behavior, knowledge of sexually transmitted infections and treatment utilization among a vulnerable population in Rawalpindi, Pakistan. Southeast Asian J Trop Med Public Health 2008; 39 642–8.
[76] Bauer GR, Scheim AI. Sampling bias in transgender studies. Lancet Infect Dis 2013; 13 832
| Sampling bias in transgender studies.Crossref | GoogleScholarGoogle Scholar |
[77] Bauer GR, Travers R, Scanlon K, Coleman TA. High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey. BMC Public Health 2012; 12 292
| High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey.Crossref | GoogleScholarGoogle Scholar |
[78] Center of Excellence for Transgender Health DoFaCM, University of California San Francisco. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people; 2nd edition. 2016. Available online at: http://www.transhealth.ucsf.edu/guidelines [verified 1 March 2017]
