Our Summary

This research paper examines the initial results of a new program for gender-affirming surgeries, which involve changing a person’s physical appearance and function to match their gender identity. The program involved both plastic surgeons and urologists.

The researchers looked back at patients who had genital surgeries from April 2018 to May 2021. They analyzed if there were any links between risk factors before surgery and complications after surgery.

77 surgeries were performed at their institution during this time - 56 vaginoplasties (construction or reconstruction of the vagina) and 21 vulvoplasties (surgery to modify the vulva). The average age of the patients was about 40 years, and the average Body Mass Index (BMI) was 26.2. High blood pressure and depression were the most common conditions patients had before surgery, and almost 14% had attempted suicide before.

Within the first 30 days after surgery, about 54% of vaginoplasty patients and 57% of vulvoplasty patients had complications. The most common complications were yeast infections and blood clots for vaginoplasty, and urinary tract infections and excessive tissue growth for vulvoplasty. However, most of these complications were low grade.

The researchers found no link between patient factors before surgery and complications after surgery. However, about 39% of vaginoplasty patients needed more surgeries during the study period, most commonly to revise the urethra and the labia.

The researchers conclude that having plastic surgeons and urologists work together is a safe and effective way to provide gender-affirming surgeries.

FAQs

  1. What are the most common complications after gender-affirming vaginoplasty and vulvoplasty surgeries?
  2. What percentage of patients needed revision surgeries after undergoing a vaginoplasty?
  3. How does collaboration between urology and plastic surgery contribute to the safety and effectiveness of a GAS program?

Doctor’s Tip

A helpful tip a doctor might tell a patient about vaginoplasty is to carefully follow postoperative care instructions to reduce the risk of complications. This may include keeping the surgical area clean and dry, avoiding strenuous activities, taking prescribed medications as directed, and attending follow-up appointments with your healthcare provider. It’s also important to communicate any concerns or changes in symptoms to your healthcare team promptly.

Suitable For

Vaginoplasty is typically recommended for transgender women who wish to undergo gender-affirming surgery to align their physical appearance with their gender identity. Patients who undergo vaginoplasty may have been diagnosed with gender dysphoria and have undergone hormone therapy as part of their transition process. It is important for patients to have realistic expectations about the outcomes of surgery and to be in good overall health before undergoing vaginoplasty. Additionally, patients should have the support of mental health professionals and a multidisciplinary team of healthcare providers to ensure comprehensive care throughout the surgical process.

Timeline

Before vaginoplasty:

  • Patient undergoes psychological evaluation and counseling to ensure readiness for surgery
  • Patient may undergo hormone therapy to achieve desired secondary sexual characteristics
  • Patient meets with a multidisciplinary team including urologists and plastic surgeons to discuss surgical options and goals
  • Patient undergoes preoperative medical evaluations and testing
  • Patient receives instructions on preoperative care and preparations

After vaginoplasty:

  • Patient is monitored closely for complications in the immediate postoperative period
  • Patient may experience discomfort, swelling, and bruising in the surgical area
  • Patient follows a strict postoperative care plan including wound care, pain management, and activity restrictions
  • Patient attends follow-up appointments to monitor healing and address any concerns
  • Patient may undergo revision surgeries to address any complications or to achieve desired aesthetic outcomes
  • Patient continues to receive psychological support and follow-up care to ensure successful recovery and adjustment to their new anatomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about vaginoplasty may include:

  1. What is the specific technique you will be using for my vaginoplasty?
  2. What are the potential risks and complications associated with vaginoplasty?
  3. How long is the recovery period after vaginoplasty?
  4. What kind of postoperative care will I need to follow?
  5. Are there any specific restrictions or lifestyle changes I will need to make after surgery?
  6. How often will I need follow-up appointments after the surgery?
  7. What are the chances that I may need a revision surgery in the future?
  8. How experienced are you in performing vaginoplasty procedures?
  9. Can you show me before and after photos of previous patients who have undergone vaginoplasty?
  10. Are there any alternative treatments or procedures that I should consider before deciding on vaginoplasty?

Reference

Authors: Blickensderfer K, McCormick B, Myers J, Goodwin I, Agarwal C, Horns J, Hotaling J. Journal: Urology. 2023 Jun;176:232-236. doi: 10.1016/j.urology.2023.03.002. Epub 2023 Mar 16. PMID: 36931571