Our Summary
This research paper is about the specific considerations that gynecologists need to keep in mind when performing a hysterectomy (removal of the uterus) or an oophorectomy (removal of the ovaries) for transgender men. These surgeries are conducted for a variety of reasons, but the main one for transgender men is to help alleviate gender dysphoria - a psychological condition where a person feels a mismatch between their biological sex and their gender identity.
The paper emphasizes the importance of respectful communication with patients, such as using the correct names and pronouns, and discussing the terminology for the anatomy involved. It advises doctors to talk about options for preserving fertility, in case the patient wants to have biological children in the future, and to discuss the use of hormone therapy after surgery to prevent loss of bone density.
When performing an oophorectomy, surgeons should aim to minimize the risk of ovarian remnant syndrome, a condition where ovarian tissue is inadvertently left behind, which could lead to complications like persistent menstruation. The research also suggests a specific technique of closing the vaginal cuff (the top of the vagina that’s left after a hysterectomy) to reduce complications and help patients whose gender dysphoria is linked to their internal reproductive organs.
In conclusion, the paper highlights the need for gynecologic surgeons to be aware of these specific considerations to help reduce the experiences of gender dysphoria for transgender patients before, during, and after surgery.
FAQs
- Why is respectful communication emphasized when performing a hysterectomy or an oophorectomy for transgender men?
- What is the importance of discussing options for preserving fertility and hormone therapy in these surgeries for transgender men?
- What are the specific surgical techniques suggested in the research to minimize complications and alleviate gender dysphoria in transgender men?
Doctor’s Tip
One helpful tip a doctor might tell a patient about hysterectomy is to make sure to follow the post-operative instructions provided by the healthcare team. This may include information about managing pain, avoiding heavy lifting or strenuous activities, and caring for the incision site. It is important to attend any follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider. Taking care of yourself during the recovery period can help ensure a smooth and successful healing process.
Suitable For
Typically, patients who are recommended for hysterectomy include those with:
Uterine fibroids: Non-cancerous growths in the uterus that can cause symptoms such as heavy menstrual bleeding, pelvic pain, and frequent urination.
Endometriosis: A condition where the tissue that normally lines the inside of the uterus grows outside of it, causing pain, heavy periods, and infertility.
Adenomyosis: A condition where the tissue that lines the uterus grows into the muscular wall of the uterus, causing heavy menstrual bleeding, severe cramps, and pressure in the pelvis.
Uterine prolapse: A condition where the uterus slips down into the vaginal canal, causing discomfort, urinary incontinence, and difficulty with bowel movements.
Gynecologic cancers: Hysterectomy may be recommended as part of treatment for cancers such as uterine, cervical, or ovarian cancer.
Chronic pelvic pain: Severe and persistent pelvic pain that does not respond to other treatments may warrant a hysterectomy.
Transgender men: As mentioned earlier, transgender men may undergo hysterectomy as part of gender affirmation surgery to alleviate gender dysphoria.
It is important for patients to discuss their individual circumstances and reasons for considering a hysterectomy with their healthcare provider to determine if the procedure is the best course of action for their health and well-being.
Timeline
Before the surgery, patients may have been experiencing gender dysphoria related to their reproductive organs. They may have undergone hormone therapy and counseling to prepare for the surgery. They would have also discussed the risks, benefits, and alternatives with their healthcare provider.
During the surgery, the gynecologic surgeon would perform the hysterectomy or oophorectomy while ensuring to use the correct terminology and respectful communication with the patient. They would aim to minimize the risk of complications and discuss options for preserving fertility and hormone therapy after the surgery.
After the surgery, patients may experience physical and emotional changes as they recover. They may need to adjust to the absence of their reproductive organs and may require ongoing hormone therapy. The surgeon would provide follow-up care and support to help the patient navigate these changes and address any concerns that may arise.
What to Ask Your Doctor
Some questions a patient should ask their doctor about hysterectomy for transgender men may include:
- What are the potential risks and complications associated with a hysterectomy in transgender men?
- Will I still be able to have biological children after a hysterectomy?
- How will hormone therapy be affected by a hysterectomy?
- What is the procedure for closing the vaginal cuff after a hysterectomy in transgender men?
- How can you ensure that all ovarian tissue is removed during an oophorectomy to prevent ovarian remnant syndrome?
- Can you provide information on post-operative care and potential long-term effects of the surgery?
- Are there any alternative treatments or procedures that I should consider before undergoing a hysterectomy?
- Will the surgery affect my hormone levels and overall health in the long term?
- How many hysterectomies have you performed on transgender men, and what is your experience with this specific procedure?
- Can you provide information on support resources for transgender individuals undergoing a hysterectomy?
Reference
Authors: Lee Cruz AS, Cruz J, Behbehani S, Nahas S, Handler S, Stuparich MA. Journal: J Minim Invasive Gynecol. 2024 Apr;31(4):265-266. doi: 10.1016/j.jmig.2023.12.009. Epub 2023 Dec 23. PMID: 38145751