Our Summary
This research paper discusses a type of surgery often performed on transgender women known as gender-affirming vaginoplasty. In this procedure, doctors use skin from the penis and scrotum to create a vagina and vulva. However, one rare risk associated with this surgery is the development of squamous cell carcinoma (a type of skin cancer) in the newly created vagina.
The researchers looked at 9 previous cases of this type of cancer occurring after gender-affirming vaginoplasty and also discussed a case they personally treated. They noted that this type of cancer can occur at least 8 years after the initial surgery. Symptoms can include bleeding, discharge, pain, and issues with urination or bowel movements.
Treatment options depend on how advanced the cancer is and can include extensive surgery, chemotherapy, or radiation therapy either before or after surgery, or to alleviate symptoms if the cancer is very advanced.
Because this type of cancer is so rare, it’s important for doctors to be familiar with the anatomy and how to examine people who have had gender-affirming vaginoplasty. These cases should ideally be managed by experts in a team-based setting. They also highlight the importance of sexual health education and long-term screening for sexually transmitted infections and cancer for patients who have undergone this surgery, as this type of cancer can occur many years after the procedure.
FAQs
- What is the most common technique performed for vaginoplasty?
- What are some of the symptoms of squamous cell carcinoma of the neovagina?
- How important is long-term sexual transmitted infection and cancer screening after undergoing gender-affirming vaginoplasty?
Doctor’s Tip
One helpful tip a doctor might give a patient about vaginoplasty is to be vigilant about any changes or symptoms in the neovagina, such as bleeding, discharge, pain, urinary or bowel symptoms, as these could potentially be signs of squamous cell carcinoma. It is important to attend regular follow-up appointments and screenings to monitor for any potential complications or issues that may arise in the long term. Additionally, seeking care from a specialist center with expertise in managing complications of gender-affirming surgery can ensure the best possible outcomes.
Suitable For
Patients who are typically recommended vaginoplasty are transgender women who desire surgical alignment of their genitalia with their perceived gender. This procedure is performed as part of gender-affirming surgery to create a neovagina and vulva using penile and scrotal skin. It is important for patients to undergo a thorough evaluation and counselling process before undergoing vaginoplasty to ensure they understand the risks and benefits of the procedure.
It is also important for patients to be aware of the potential long-term risks associated with vaginoplasty, including the rare but serious risk of neovaginal squamous cell carcinoma. Clinicians should be familiar with the anatomy and clinical examination of individuals who have had gender-affirming vaginoplasty in order to detect any potential complications early on.
Overall, patients who are considering vaginoplasty should have a clear understanding of the procedure, its potential risks, and the importance of long-term follow-up care to ensure their overall health and well-being.
Timeline
Before vaginoplasty, a patient typically goes through a thorough consultation process with a gender-affirming healthcare provider to discuss their goals, expectations, and medical history. They may also undergo hormone therapy and psychological assessments to ensure readiness for surgery.
During vaginoplasty, the patient undergoes a surgical procedure to construct a neovagina using penile and scrotal skin. The surgery typically takes several hours and requires a hospital stay for post-operative care and monitoring.
After vaginoplasty, the patient will experience a recovery period that includes pain management, wound care, and follow-up appointments with their healthcare provider. They will also undergo dilation therapy to maintain the neovagina’s depth and width.
In the long term, the patient may experience improved self-esteem, body image, and sexual function following vaginoplasty. However, they will also need to continue regular monitoring for potential complications, such as neovaginal squamous cell carcinoma, which can present years after surgery. Early detection and treatment are crucial for managing this rare but serious complication.
What to Ask Your Doctor
What are the potential risks and complications associated with vaginoplasty, including the risk of squamous cell carcinoma of the neovagina?
How often should I have follow-up appointments to monitor for any potential complications or signs of squamous cell carcinoma?
What symptoms should I watch out for that may indicate the presence of squamous cell carcinoma in the neovagina?
How is neovaginal squamous cell carcinoma diagnosed and what are the treatment options available?
Is there a need for regular cancer screening or surveillance for individuals who have undergone gender-affirming vaginoplasty?
What are the long-term implications and considerations for sexual health and overall well-being following vaginoplasty?
Are there any specific precautions or lifestyle changes I should consider to reduce my risk of developing neovaginal squamous cell carcinoma or other complications?
Is it recommended to seek care at a specialized center or with a healthcare provider who has experience in managing complications related to gender-affirming surgeries?
Are there any specific guidelines or recommendations for self-examinations or monitoring of the neovagina for signs of potential issues?
Reference
Authors: Pang KH, Sahdev V, Haider A, Alnajjar HM, Rees R, Muneer A. Journal: Int J Impot Res. 2025 Mar 29. doi: 10.1038/s41443-025-01048-z. Online ahead of print. PMID: 40155487