Hysterectomy and Oophorectomy for Transgender Patients: Preoperative and Intraoperative Considerations

Abstract

ObjectiveTo review the preoperative and intraoperative considerations for gynecologic surgeons when performing hysterectomy with or without oophorectomy for transgender patients. DesignStepwise demonstration of techniques with narrated video footage. SettingApproximately 0.3% of hysterectomies performed annually in the United States are for transgender men. While some transgender men choose hysterectomy for the same indications as cisgender women, the most prevalent diagnosis for the performed surgeries is gender dysphoria.1 Hysterectomy with or without oophorectomy can be offered to patients who have met the World Professional Association for Transgender Health (WPATH) criteria.2 InterventionsImportant perioperative counseling points for transgender patients include: establishing terminology for relevant anatomy as well as the patient's name and pronouns; if applicable, discussing options for fertility preservation if the patient desires biological children3,4 and discussing the use of hormone therapy post-oophorectomy to reduce the loss of bone density;5,6 and reviewing intraoperative and postoperative expectations.When performing an oophorectomy on a transgender patient for gender affirmation, it is especially important to minimize the risk for ovarian remnant syndrome and the need for additional surgery, such as due to persistent menstruation. The performance of a two-layer vaginal cuff closure should be considered to reduce the risk of vaginal cuff complications, which is preferable for patients whose pelvic organs cause gender dysphoria.7,8 ConclusionSpecial considerations outlined in this video and the WPATH guidelines should be reviewed by gynecologic surgeons to minimize transgender patients’ experiences of gender dysphoria before, during, and after surgery.