(033) ABSENCE OF GENDER-AFFIRMING HYSTERECTOMIES FROM HYSTERECTOMY SEXUAL FUNCTION OUTCOMES LITERATURE

Abstract

Abstract Introduction Gender affirming healthcare is a multidisciplinary field that includes (but is not limited to) the following interventions: hormonal therapy and gender affirming surgery (chest surgery, hysterectomy, oophorectomy, metoidioplasty, phalloplasty, etc.). Gender-affirming hormone therapy has been shown to positively impact orgasm duration and satisfaction level among both transgender men and women. Research on sexual wellbeing after gender affirming surgery (GAS) indicates positive effects on sexual health outcomes; however, the literature lacks sufficient studies to make evidence-based recommendations. Objective To synthesize and review the current state of literature on sexual outcomes following gender affirming hysterectomies as background to inform a planned study on this topic. Methods This project is a literature review of peer-reviewed journal articles on sexual function and pleasure outcomes following hysterectomies, with a particular focus on gender affirming hysterectomies. We considered various cohort studies, systematic reviews, position statements, and meta-analyses in our review. Results No research currently exists on sexual function or orgasm experience after gender affirming hysterectomy. Current literature exploring sexual function post-hysterectomy only includes cisgender populations (indications typically include cancer risk reduction, pelvic pain, and/or abnormal uterine bleeding). Studies have found mixed results regarding sexual function in cisgender women post-hysterectomy and/or oophorectomy, including changes to anxiety and depression, sexual health and wellness, both in a positive and negative direction. Other analyses found no significant change in sexual function post-hysterectomy in cisgender women. Based on these findings, hysterectomies have mixed effects on sexual satisfaction & function in cisgender populations but there is no data to guide transgender populations. Conclusions More research is needed on sexual health outcomes (i.e., sexual pleasure, arousal, and orgasm) after gender affirming surgery, as very few studies examine the role of sexual function, including desire, arousal, pain and orgasm in patients’ lives post-GAS. No studies investigate sexual satisfaction post-gender affirming hysterectomy despite it being an important GAS for transgender men. Research on this procedure in this specific population will inform evidence-based practices and recommendations, elucidate sex outcomes when the main indication for a hysterectomy is gender affirmation, and advance our understanding of sexual pleasure overall. This author team is initiating a study to address this critical question. Disclosure No.