Feminizing genital gender affirmation surgery: Patient-reported outcomes of urethral flap and classical penile inversion techniques

Abstract

Introduction: Although more and more transgender individuals are receiving gender-affirming medical interventions, there are limited data on patient-reported outcome measures (PROMs). We assessed PROMs in patients who received genital gender affirmation surgery (gGAS) with vaginoplasty by conventional penile inversion (PI) or urethral flap (UF). Methods: Consecutive patients undergoing vaginoplasty by PI or UF between 2015 and 2021 were candidates for this questionnaire-based cohort study. PROMs including satisfaction with body image and overall quality of life, esthetic, sensory, and functional parameters, including urological and sexual outcomes, and decision for surgery were assessed by using the Gender Congruence and Life Satisfaction scale, the Hamburg Body Drawing Scale, the Inclusive Sexual Function Inventory, and additional questions, and responses from PI and UF groups were compared. Results: With a response rate of 64%, total 41 patients were included in the study. Overall, patients reported high satisfaction with body image and quality of life after PI and UF. Patients with UF were significantly more comfortable being naked in front of a sexual partner compared to those with PI, but satisfaction with esthetics was high in both groups. The UF group had a significantly higher frequency of sanguineous discharge from the neovagina. Functional urological problems were rare in both groups, but urgency was reported more frequently in PI than in UF. Both groups reported generally high interest in sexual activity, and both frequently needed lubrication for neovaginal penetration. There were few regrets about the decision to undergo gGAS in either group. Conclusion: Patient satisfaction regarding body image, quality of life, functionality, sexuality, and decision for surgery was reasonably high, and UF seems to be a valid alternative to PI.