Clinical and Transvaginal Sonographic Evaluation of the Prostate in Transsexual Women

Abstract

To assess feasibility and diagnostic performance of prostate examination through transvaginal palpation and transvaginal ultrasound in transsexual women (TSW). Fifty TSW who were at least 6 months' posttransition were recruited in a University Hospital. Speculum examination and digital vaginal examination were performed by a gynecologist. Transvaginal ultrasound of the prostate was performed by a radiologist. The information gathered included: ease of insertion of the speculum, vaginal length, palpability of the prostate, vaginal mobility and presence of scar tissue, ease of introduction of the ultrasound probe, ability to visualize prostate and seminal vesicles, echogenicity of the peripheral zone and the central gland, presence of calcifications and delineation of prostatic capsule, attitude toward gynecologic examinations, and anticipated and experienced painfulness of the different examinations. Speculum examination was possible in all but 1 patient and was easy in 78% of the patients. Median vaginal length was 7 cm. A regular digital vaginal examination was possible in 44% of the patients, the vagina was rather mobile and with limited scar tissue on average. In 48% of the patients, the prostate was palpable. In 94% of the patients, the prostate was visible on transvaginal ultrasound. Mean prostate volume was 14 mL, calcifications were present in 33%, and none had cysts. Capsule of the prostate was well delineated in 74% and seminal vesicles were visualized in 80%. All examinations were very well tolerated and nearly painless. Gynecologic examination and prostate assessment were acceptable to TSW. Transvaginal palpation of the prostate is of poor clinical value, yet transvaginal ultrasound allows for proper evaluation of the prostate status.