Using a novel and validated survey tool to analyze sexual functioning following vaginoplasty in transgender individuals
Alyxandra Ramsay
A , Jo Blankson A , Lara Finnerty-Haggerty B , Jiaxin Wu A , Joshua D. Safer A * and John Henry Pang A
A
B
Abstract
In the healthcare setting, transgender patients are often marginalized, face discrimination and have limited access to high-quality gender-affirming care, such as gender-affirming surgery (GAS). As a result, the available data pertaining to GAS are often based on convenience samples, and the majority of published studies in the US are cross-sectional. Transgender people may undergo GAS to align their bodies with their gender identities. There has been little emphasis on the GAS self-evaluated experience. GAS may be associated with improved quality of life in transgender people. This study aimed to analyze the functionality of transgender patients’ genitals following vaginoplasty.
A total of 306 transgender patients responded to a validated survey for patient-reported feminizing GAS outcomes. Surveys were given to patients prior to GAS, and then 2 weeks, 6 months and 12 months postoperatively. Pre- and post-GAS responses were compared using McNemar and Wilcoxon signed-rank tests. Self-identified race/ethnicity was available for all survey participants. All participants voluntarily took the same survey by using the same survey platform to eliminate bias.
Five questions showed significant improvement between the 2-week and 6-month responses. These questions assessed if respondents had sensation in their clitoris (P = 0.031), the frequency that clitoral stimulation was pleasurable (P = 0.018), the presence of sexual activity in the past 3 months (P < 0.001), the ability to have penetrative vaginal intercourse (P = 0.031) and if labial irritation while walking or exercising decreased (P = 0.051). Significant differences were not detected between the 6-month and 12-month responses for any of the survey questions.
The results of five different metrics regarding sexual activity and vaginal functioning showed a significant improvement for transgender people following GAS. Findings also similarly demonstrate a high success rate of sexual activity after GAS. These are significant patient-reported outcomes using tools validated for the transgender population. Respondent outcomes significantly improved between the 2-week and 6-month time period, but did not differ between the 6-month and 12-month period, suggesting the ideal time to assess the above-described patient-perceived outcomes with vaginoplasty is 6 months postoperatively.
Keywords: AFFRIM, gender-affirming surgery, patient-reported-outcomes, quality of life, sexual-satisfaction, transgender, transgender women, vaginoplasty.
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