Abstract
BackgroundGender reassignment surgery is a procedure some transgender women (TW) undergo for gender-affirming purposes. This often includes the construction of a neovagina using existing penile and scrotal tissue and/or a sigmoid colon graft. There are limited data regarding the composition and function of the neovaginal microbiome representing a major gap in knowledge in neovaginal health.ResultsMetaproteomics was performed on secretions collected from the neovaginas (n = 5) and rectums (n = 7) of TW surgically reassigned via penile inversion/scrotal graft with (n = 1) or without (n = 4) a sigmoid colon graft extension and compared with secretions from cis vaginas (n = 32). We identified 541 unique bacterial proteins from 38 taxa. The most abundant taxa in the neovaginas were Porphyromonas (30.2%), Peptostreptococcus (9.2%), Prevotella (9.0%), Mobiluncus (8.0%), and Jonquetella (7.2%), while cis vaginas were primarily Lactobacillus and Gardnerella. Rectal samples were mainly composed of Prevotella and Roseburia. Neovaginas (median Shannon’s H index = 1.33) had higher alpha diversity compared to cis vaginas (Shannon’s H = 0.35) (p = 7.2E−3, Mann-Whitney U test) and were more similar to the non-Lactobacillus dominant/polymicrobial cis vaginas based on beta diversity (perMANOVA, p = 0.001, r2 = 0.342). In comparison to cis vaginas, toll-like receptor response, amino acid, and short-chain fatty acid metabolic pathways were increased (p < 0.01), while keratinization and cornification proteins were decreased (p < 0.001) in the neovaginal proteome.ConclusionsPenile skin-lined neovaginas have diverse, polymicrobial communities that show similarities in composition to uncircumcised penises and host responses to cis vaginas with bacterial vaginosis (BV) including increased immune activation pathways and decreased epithelial barrier function. Developing a better understanding of microbiome-associated inflammation in the neovaginal environment will be important for improving our knowledge of neovaginal health.A1pw-5DXJFMq35mSKHH2fxVideo
Highlights
Transgender is a term used to define people whose gender identity is different from their assigned sex at birth [1]
Demographic and clinical characteristics of study participants We examined rectal and neovaginal secretions from transgender women (TW) (n = 9) and compared them against vaginal secretions from cisgender women (CW) (n = 30)
We found very little bacterial protein-based compositional similarity between matching neovaginal and rectal profiles based on bacterial proteins measured, we were underpowered to properly evaluate this comparison
Summary
Transgender is a term used to define people whose gender identity is different from their assigned sex at birth [1]. Many transgender women (TW), defined here as people assigned as male at birth who identify as female, undergo medical interventions such as feminizing hormone therapy and gender reassignment surgery (GRS) for gender affirmation purposes [2]. Limited molecular sequencing studies have been conducted on neovaginas for the purposes of defining the microbiome [8, 9]. To address this gap, we chose to investigate the neovaginal microbiome using a metaproteomics technique [10]. Gender reassignment surgery is a procedure some transgender women (TW) undergo for genderaffirming purposes This often includes the construction of a neovagina using existing penile and scrotal tissue and/ or a sigmoid colon graft. There are limited data regarding the composition and function of the neovaginal microbiome representing a major gap in knowledge in neovaginal health
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