Feminizing Genital Gender-Confirmation Surgery

Abstract

Introduction: For many patients with gender dysphoria, gender-confirmation surgery (GCS) helps align their physical characteristics with their gender identity and is a fundamental element of comprehensive treatment. This article is the 2nd in a 3-part series about the treatment of gender dysphoria. Non-operative management was covered in part 1. This section begins broadly by reviewing surgical eligibility criteria, benefits of GCS, and factors associated with regret for transgender men and women. Then, the scope narrows to focus on aspects of feminizing genital GCS, including a discussion of vaginoplasty techniques, complications, and sexual function outcomes. Part 3 features operative considerations for masculinizing genital GCS.

Aim: To summarize the World Professional Association for Transgender Health's (WPATH) surgical eligibility criteria and describe how patients with gender dysphoria benefit from GCS, provide an overview of genital and non-genital feminizing gender-confirmation procedures, and review vaginoplasty techniques, preoperative considerations, complications, and outcomes.

Methods: A review of relevant literature through April 2017 was performed using PubMed.

Main outcome measures: Review of literature related to surgical eligibility criteria for GCS, benefits of GCS, and surgical considerations for feminizing genitoplasty.

Results: Most transgender men and women who satisfy WPATH eligibility criteria experience improved quality of life, overall happiness, and sexual function after GCS; regret is rare. Penile inversion vaginoplasty is the preferred technique for feminizing genital GCS according to most surgeons, including the authors whose surgical technique is described. Intestinal vaginoplasty is reserved for certain scenarios. After vaginoplasty most patients report overall high satisfaction with their sexual function even when complications occur, because most are minor and easily treatable.

Conclusion: GCS alleviates gender dysphoria for appropriately selected transgender men and women. Preoperative, intraoperative, and postoperative considerations of feminizing genital gender-confirmation procedures were reviewed. Hadj-Moussa M, Ohl DA, Kuzon WM. Feminizing Genital Gender-Confirmation Surgery. Sex Med Rev 2018;6:457-468.

Keywords: Gender Dysphoria; Gender Reassignment; Gender-Confirmation Surgery; Transgender; Vaginoplasty.