Our Summary

This research paper is about the challenges and complications that can arise after transgender patients undergo gender-affirming genital reconstructive surgery, such as creating a vagina (vaginoplasty) or a penis (phalloplasty). The paper emphasizes the importance of healthcare providers, including urologists, understanding the new anatomy and common complications in order to effectively diagnose and treat patients. Even though there have been improvements and new methods developed over the years, complications after these surgeries are still common. The article mainly discusses these complications and how to identify and manage them.

FAQs

  1. What are the common complications that can arise after gender-affirming genital reconstructive surgery such as vaginoplasty or phalloplasty?
  2. Why is it crucial for healthcare providers to understand the new anatomy after gender-affirming genital reconstructive surgery?
  3. Despite improvements and new methods, why are complications after these surgeries still common?

Doctor’s Tip

One helpful tip a doctor might tell a patient about vaginoplasty is to closely follow post-operative care instructions provided by their healthcare provider. This may include proper wound care, taking prescribed medications, attending follow-up appointments, and refraining from certain activities or behaviors that could interfere with the healing process. By following these instructions carefully, patients can help reduce the risk of complications and promote a successful outcome from their surgery.

Suitable For

Patients who are typically recommended vaginoplasty are transgender individuals who are assigned male at birth and are seeking to align their physical body with their gender identity as female. This surgery is often recommended for transgender women who have undergone hormone therapy and have completed the necessary psychological evaluations to ensure they are ready for the procedure. Additionally, patients who have experienced gender dysphoria and desire to have a vagina as part of their transition may also be recommended for vaginoplasty.

It is important for patients considering vaginoplasty to have realistic expectations about the surgery and be prepared for the physical and emotional changes that may come with it. Patients should also be in good overall health and have a stable support system in place to help them through the recovery process.

Ultimately, the decision to undergo vaginoplasty is a personal one that should be made in consultation with a qualified healthcare provider who specializes in transgender healthcare. The provider can help assess the patient’s readiness for surgery and provide guidance on the potential risks and benefits of the procedure.

Timeline

Before vaginoplasty:

  • Patient decides to undergo vaginoplasty as part of their gender-affirming treatment plan
  • Patient meets with a healthcare provider to discuss the procedure, risks, benefits, and expectations
  • Patient undergoes pre-operative evaluations and tests to assess their overall health and readiness for surgery
  • Patient prepares for surgery by following specific pre-operative instructions, such as stopping certain medications or adjusting their diet
  • Patient undergoes vaginoplasty surgery, which involves creating a vagina using tissue from the penile skin or other sources

After vaginoplasty:

  • Patient stays in the hospital for a few days following surgery for monitoring and recovery
  • Patient experiences post-operative pain, swelling, and discomfort, which are managed with pain medications and other supportive measures
  • Patient follows a strict post-operative care plan, which includes keeping the surgical site clean, avoiding strenuous activities, and attending follow-up appointments with their healthcare provider
  • Patient may experience complications such as infection, bleeding, wound dehiscence, urinary retention, vaginal stenosis, or fistula formation
  • Patient may undergo revision surgery or additional treatments to address complications and improve outcomes
  • Patient continues to receive ongoing care and support from their healthcare provider to monitor their progress and address any concerns or issues that arise.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with vaginoplasty surgery?
  2. How long is the recovery process expected to be, and what can I expect during the recovery period?
  3. What are the potential long-term effects of vaginoplasty surgery?
  4. How often will I need follow-up appointments after the surgery, and what should I look out for in terms of complications?
  5. Are there any specific lifestyle changes or restrictions I need to follow post-surgery?
  6. What can I do to minimize the risk of complications during and after the surgery?
  7. How experienced are you in performing vaginoplasty surgeries, and what is your success rate?
  8. Are there any alternative treatments or procedures that I should consider before deciding on vaginoplasty?
  9. How will vaginoplasty surgery affect my sexual function and sensation?
  10. Can you provide me with before and after photos of patients who have undergone vaginoplasty surgery with you to get a better understanding of the potential outcomes?

Reference

Authors: Schardein JN, Zhao LC, Nikolavsky D. Journal: Urol Clin North Am. 2019 Nov;46(4):605-618. doi: 10.1016/j.ucl.2019.07.012. Epub 2019 Aug 31. PMID: 31582033