Genital Self-image Research Articles

Egyptian female genital “norm” and female genital self-image

Female genital mutilation/cutting (FGM/C) is an ancient Egyptian practice. Its impact on genital self-image has not been thoroughly investigated. Many studies explore its effect on sexual function, however, its effect on genital self-image is not fully explored. This study determined whether FGM/C is still a “norm” and to assess its impact on genital self-image. Sexual function and genital self-image were assessed using the Arabic version of the Female Sexual Function Index (AVFSFI) scores and Arabic version of the female genital self-image scale (AVFGSIS), respectively. A cross-sectional survey of 1952 women was conducted. Data were gathered through personal interviews and examinations to identify the type of FGM/C. There was a statistically non-significant difference in AVFGSIS scores between type I, II FGM/C and non-FGM/C ( P > 0.05). Comparison of different AVFSFI domains with the total score on the AVFGSIS revealed a non-significant correlation with each domain (all P -values > 0.05). The overall female genital self-image was not affected, in spite of, the presence of a negative correlation between type II FGM/C and sexual satisfaction ( P < 0.05). FGM/C is still considered the “norm” in the modern world.

The Effect of Sexual Assertiveness Training on women’s genital self-image: A Randomized Clinical Trial

Background & aim: The genital self-image refers to women's attitudes, beliefs, and feelings about their genitalia and genital system that are involved in sexual intercourse. Sexual assertiveness is individuals' ability to meet their sexual needs. Considering the dearth of study on women�s genital self-image, this study aimed to evaluate the effectiveness of a sexual assertiveness training program on women�s genital self-image. Methods: This parallel randomized clinical trial was performed on 60 married women referred to Imam Reza Health Center in Mashhad during September and October 2016. A sample size of 30 subjects was assigned to intervention and control groups. The training classes including two 90 minutes sessions were held once a week for 2 consecutive weeks. The tools for data collection consisted of Hulbert sexual assertiveness and women�s genital self-image questionnaires. A pretest was completed in two groups at the beginning of the study and a post-test was done for both groups one week after training the intervention group. To analyze data student t-test, paired t-test, Mann-Whitney, Wilcoxon, Chi-square and one-way analysis of variance were used. Results: The score of genital self-image was the same in two groups before carrying out the intervention (z= -1.762, p= 0.780). However, following the implementation of training program the two groups showed significant differences and the score of genital self-image  was higher in intervention group (z = - 4.077, p E� 0.001).  Conclusion: Sexual assertiveness training can improve women�s genital self-image. So it is recommended to tailor training programs to enhance women's genital self-image, particularly, in women with sexual dysfunction in order to improve their sexual health.

Gender affirmation surgeries in transgender women: Aesthetic, sexual, and urinary results of an initial series of vaginoplasties

Introduction and objectivesGender dysphoria is associated with mental health comorbidity, such as depression and suicide. “Gender affirming surgeries” improve sexuality and psychosocial well-being. The goal of vaginoplasty is for the genitalia to resemble in form and function to a biological vagina with a depth of at least 11 cm and a sensitive clitoris. In addition, the urethra must be shortened and allow voiding in a sitting position. Our objective is to describe the aesthetic, sexual and urinary results. Patients and methodRetrospective study of all patients undergoing feminizing genitoplasty, at Hospital Sótero del Río between 2018 and 2019, that met WPATH requirements. Vaginal dimensions, neo-clitoral sensitivity, aesthetic and sexual satisfaction of the neovagina, questionnaires Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS), IPSS-QoL, uroflowmetry and post-void residue were evaluated. Results10 women who underwent feminizing genitoplasty were identified. The neovaginal depth average was 14.2 cm. There was no rectal injury or reoperation. There was 100% of Neoclitoris sensitivity and 88% satisfaction with the neovaginal width.The FGSIS averaged 25.4 points and the FSFI averaged 16 points. The IPSS was 6.7 points, the average Qmax was 22 ml/s and post-void residual volume average was 22 ml. There was no neomeatal stenosis. ConclusionsFeminizing Genitoplasty is a complex, demanding and not completely standardized surgery. However, it is a relatively safe procedure that achieves adequate aesthetic, sexual and urinary results.

Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients

Current literature on surgical outcomes after gender affirming genital surgery is limited by small sample sizes from single-center studies. To use a community-based participatory research model to survey a large, heterogeneous cohort of transmasculine patients on phalloplasty and metoidioplasty outcomes. A peer-informed survey of transmasculine peoples' experience was constructed and administered between January and April 2020. Data collected included demographics, genital surgery history, pre- and postoperative genital sensation and function, and genital self-image. Of the 1,212 patients completing the survey, 129 patients underwent genital reconstruction surgery. Seventy-nine patients (61 percent) underwent phalloplasty only, 32 patients (25 percent) underwent metoidioplasty only, and 18 patients (14 percent) underwent metoidioplasty followed by phalloplasty. Patients reported 281 complications requiring 142 revisions. The most common complications were urethrocutaneous fistula (n = 51, 40 percent), urethral stricture (n = 41, 32 percent), and worsened mental health (n=25, 19 percent). The average erect neophallus after phalloplasty was 14.1 cm long vs 5.5 cm after metoidioplasty (P < .00001). Metoidioplasty patients report 4.8 out of 5 erogenous sensation, compared to 3.4 out of 5 for phalloplasty patients (P < .00001). Patients who underwent clitoris burial in addition to primary phalloplasty did not report change in erogenous sensation relative to primary phalloplasty patients without clitoris burial (P = .105). The average postoperative patient genital self-image score was 20.29 compared with 13.04 for preoperative patients (P < .00001) and 21.97 for a historical control of cisgender men (P=.0004). These results support anecdotal reports that complication rates following gender affirming genital reconstruction are higher than are commonly reported in the surgical literature. Patients undergoing clitoris burial in addition to primary phalloplasty did not report a change in erogenous sensation relative to those patients not undergoing clitoris burial. Postoperative patients report improved genital self-image relative to their preoperative counterparts, although self-image scores remain lower than cisgender males. These results are unique in that they are sourced from a large, heterogeneous group of transgender patients spanning 3 continents and dozens of surgical centers. The design of this study, following a community-based participatory research model, emphasizes patient-reported outcomes with focus on results most important to patients. Limitations include the recall and selection bias inherent to online surveys, and the inability to verify clinical data reported through the web-based questionnaire. Complication rates, including urethral compromise and worsened mental health, remain high for gender affirming penile reconstruction. Robinson IS, Blasdel G, Cohen O, etal. Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients. J Sex Med 2021;18:800-811.

A cross-sectional study on pelvic floor symptoms in women living with Female Genital Mutilation/Cutting

BackgroundFemale Genital Mutilation/Cutting (FGM/C) concerns over 200 million women and girls worldwide and is associated with obstetric trauma and long-term urogynaecological and psychosexual complications that are often under-investigated and undertreated. The aim of this study was to assess the pelvic floor distress and the impact of pelvic floor and psychosexual symptoms among migrant women with different types of FGM/C.MethodsThis cross-sectional study was conducted between April 2016 and January 2019 at the Division of Gynaecology of the Geneva University Hospitals. The participants were interviewed on socio-demographic and background information, underwent a systematic gynaecological examination to assess the presence and type of FGM/C and eventual Pelvic Organ Prolapse (POP), and completed six validated questionnaires on pelvic floor and psychosexual symptoms (PFDI-20 and PFIQ7 on pelvic floor distress and impact, FISI and WCS on faecal incontinence and constipation, PISQ-IR and FGSIS on sexual function and genital self-image). The participants’ scores were compared with scores of uncut women available from the literature. The association between selected variables and higher scores for distress and impact of pelvic floor symptoms was assessed using univariate and multivariable linear regression models.Results124 women with a mean age of 31.5 (± 7.5), mostly with a normal BMI, and with no significant POP were included. PFDI-20 and PFIQ-7 mean (± SD) scores were of 49.5 (± 52.0) and 40.7 (± 53.6) respectively. In comparison with the available literature, the participants’ scores were lower than those of uncut women with pelvic floor dysfunction but higher than those of uncut women without such disorders. Past violent events other than FGM/C and forced or arranged marriage, age at FGM/C of more than 10, a period of staying in Switzerland of less than 6 months, and nulliparity were significantly associated with higher scores for distress and impact of pelvic floor symptoms, independently of known risk factors such as age, weight, ongoing pregnancy and history of episiotomy.ConclusionsWomen with various types of FGM/C, without POP, can suffer from pelvic floor symptoms responsible for distress and impact on their daily life.Trial registration. The study protocol was approved by the Swiss Ethics Committee on research involving humans (protocol n°15-224).

Effects of water pilates on urinary loss, genital self-image and sexual function of elderly women

Descriptive, quasi experimental study with pre and post-test, which aimed to investigate the effects of Water Pilates (PA) on urinary incontinence, genital self-image and sexual function of elderly women. The sample consisted of seventeen elderly women aged 60 years or over, from a city in the interior of Rio Grande do Sul. The International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF) was used as instruments to assess the impact of UI in quality of life and qualify urinary loss, the Female Sexual Function Index (FSFI) to assess sexual function and Female Genital Self-Image Scale (FGSIS) to assess women's perception of their own genitalia. The PA protocol was performed twice a week for 50 minutes performed for eight weeks, totaling 16 sessions. The protocol was divided into warm-up, strengthening exercises and stretching. It was observed that the sample was composed of young elderly women (69.5 ± 5.9 years), overweight and with low FSFI and FGSIS scores. There was no significant change in the mean values before and after the intervention of the ICIQ-SF, FGSIS and FSFI scores. It was concluded that the PA method had no effect on urinary loss, sexual function and genital self-image.

Male Circumcision Due to Phimosis as the Procedure That Is Not Only Relieving Clinical Symptoms of Phimosis But Also Improves the Quality of Sexual Life.

IntroductionMale circumcision is recognized as the most effective method of phimosis treatment. Analyzing the literature, the information about the influence of male circumcision due to phimosis for patients' subjective symptoms such as itching, burning, penile pain, pain during intercourse, and quality of sexual life is insufficient.AimTo investigate the effect of male circumcision due to phimosis to patients' subjective symptoms, including erectile function and satisfaction with their genitals.MethodsThe single-center prospective study began in January 2018 and ended in January 2020. Sixty-nine male, adult patients, who were qualified for circumcision due to phimosis, were included in the study.Main Outcomes MeasuresThe study outcomes were obtained using questionnaires such as visual analog scale 0-10 for itching, burning, penile pain, and penile pain during intercourse; International Index of Erectile Function (IIEF-5) and Male Genital Self Image Scale 7 (MGSIS-7) to assess the changes in patients sexual functioning.ResultsBefore the circumcision of the 69 patients included in the study, 59 patients (86%) reported some subjective symptoms of phimosis. The most frequent and most severe complaint was pain during intercourse, then itching and burning of the penis. Penile pain at rest was the least frequent. After 3 months from circumcision, subjective symptoms almost completely disappeared. All of 69 patients declared to have a sexual partner. 3 months after circumcision, all patients achieved significant improvement in both obtaining and maintaining an erection based on IIEF-5 score. Their sexual intercourse was more satisfying for them.All patients suffering from phimosis were embarrassed about their genitals before surgery. 3 months after circumcision, satisfaction with genital self-image increased significantly.ConclusionMale circumcision due to phimosis is not only relieving the clinical symptoms of phimosis, but it also improves the quality of sexual life.Czajkowski M, Czajkowska K, Zarańska K, et al. Male Circumcision Due to Phimosis as the Procedure That Is Not Only Relieving Clinical Symptoms of Phimosis But Also Improves the Quality of Sexual Life. Sex Med 2021;9:100315.

Labia Minora Surgery in the Adolescent Population: A Cross-Sectional Satisfaction Study

BackgroundLabia minora surgeries are gaining popularity and we have limited data available to help counseling patients, especially in the adolescent population. AimThis study is meant to assess the complications and satisfaction of patients who had the surgery as adolescent. MethodsWe identified and reviewed all labia minora surgeries performed to address symptoms within the adolescent population from 2006 to 2016. A cross-sectional study was then performed. Questionnaires were sent through an Internet-based survey. Adolescent and adult populations from the literature were used for comparison. OutcomesA three-part questionnaire assessed surgical indications, current satisfaction regarding the surgery, and the sexual function, including the Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS). ResultsA total of 44 cases, from 12 to 18 years old, were included for the retrospective review. The major complaint leading to surgery was described as daily basis discomfort (39%) and aesthetics (33%). Surgical indications were similar for the survey responder group. 3 patients (6.8%) underwent redo surgery. We were able to reach 28 of the 44 potential participants for the cross-sectional study. A total of 17 questionnaires were completed (39%). We found a 20.5% rate of complication with 14% dehiscence, 9.3% significant bleeding, and 1 case of wound infection. This complication rate is higher than what has been found in the literature so far. All responders were partially (53%) or fully (47%) satisfied with the surgery. Results of FSFI were different in two of the 6 domains: lower lubrification (P = .0416) and higher orgasm (P = .0495) score compared to adolescent controls. The cutoff criteria for Hypoactive Sexual Desire Disorder was met by 75%.. Patients responded positively to the FGSIS questionnaire (M = 21.65, 95% CI: 20.31-22.98). Clinical ImplicationsThis study helps to identify specificities of the adolescent population who underwent labia minora surgery, potential increased complication rates compared to the adult population, even with overall significant postoperative satisfaction. Strengths & LimitationsLack of adequate control group for the FSFI and FGSIS, a small sample size, and a low response rate could have biased our results. To our knowledge, this is the biggest study to date to address this issue exclusively within the adolescent population, with the addition of validated questionnaires. The long delay since surgery (Mean = 8.3 yrs) permits to highlight temporal changes and potential long term complications. ConclusionsPatients seem to have no regret about the surgery and sexual dysfunction rate comparable to the literature data, except for possible increased hypoactive sexual desire disorder.A Jodoin, E Dubuc. Labia Minora Surgery in the Adolescent Population: A Cross-Sectional Satisfaction Study. J Sex Med 2020;XX:XXX–XXX.

Factors influencing stress, anxiety, and depression among Iranian pregnant women: the role of sexual distress and genital self-image

BackgroundPregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image (GSI).MethodsThis was a descriptive, correlational, cross-sectional study performed using the two-stage cluster sampling method between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R).ResultsAnalysis of Variance (ANOVA) showed significant differences in the mean scores of SD between the groups with varying degrees of depression, anxiety, and stress (P < 0.001) and in the mean score of GSI between the groups with varying degrees of depression (P = 0.01) and anxiety (P < 0.001). In multivariate linear regression analysis, higher (worse) depression, anxiety, and stress scores were found in women with more advanced age and higher SD scores; however, these scores were lower (better) in those with increased gestational age. Lower depression and anxiety scores were associated with moderate satisfaction with income, moderate satisfaction with BI in pregnancy, and lower stress and depression scores were linked to planned pregnancy. Higher (better) GSI score was a predictor of lower depression score, complication in a previous pregnancy was a predictor of higher stress score, and finally, fear of fetal abortion and being a housewife were predictors of a higher anxiety score.ConclusionVarious factors contribute to the development of antenatal depression, anxiety, and stress. A positive correlation was found between SD and the severity of depression, anxiety, and stress, while a negative correlation was noted between GSI and the severity of depression and anxiety. Therefore, raising awareness regarding SD and GSI through screening and counseling sessions can have beneficial effects for mothers and their fetuses.

Roles of Genital Self-Image, Distraction, and Anxiety in Women’s Sexual Pleasure: A Preregistered Study

Women with negative genital self-image are more likely to experience sexual dysfunction , but the processes underlying this association are unknown. We theorized that this association is mediated by distraction from the arousing sexual cues that foster pleasure and orgasm . In a sample of 1,619 women who had sex in the previous four weeks, women with negative genital self-image were more likely to be distracted by self-critical concerns (i.e., appearance- and performance-based distraction and embarrassment) during sex, and in turn, experienced less sexual pleasure and worse sexual function. Additionally, this indirect effect via appearance-based distraction was strongest among women with trait-level anxiousness and social anxiety. We found a similar pattern of results when investigating the indirect effect of genital self-image on sexual function. Implications for understanding sexual function and therapeutic approaches are discussed.

Genital self-image as predictor of sexual dysfunction in women with pelvic organ prolapse in Indonesia.

Background:The incidence of sexual dysfunction increases in women with pelvic organ prolapse. In addition to physical factors, other important components that influence each other in sexual dysfunction are psychological aspects and genital self-image. Sociocultural factors also affect individual sexuality and sexual behavior. Until now, there are no data and the relationship between genital self-image and sexual dysfunction in pelvic organ prolapse is not known in Indonesia.Objective:This study aims to analyze the correlation of genital self-image with sexual dysfunction in women with pelvic organ prolapse.Methods:In this cross-sectional study, 113 consecutive women with pelvic organ prolapse were selected in urogynecology referral centers in Jakarta. Demographic data, physical examination, and guided interviews were filled in to complete the Female Sexual Function Index and Female Genital Self-Image Scale-7 questionnaires. Preliminary research has been carried out in the form of language translation and cultural validation of the Indonesian version of the Female Genital Self-Image Scale-7 questionnaires.Results:There is a significant correlation between genital self-image and sexual dysfunction, where the lower Female Genital Self-Image Scale-7 score significantly predicts the lower Female Sexual Function Index score (p < 0.000; odds ratio: 14.17).Conclusion:Genital self-image is the main variable that affects sexual function in women with pelvic organ prolapse. It is necessary to evaluate and treat genital self-image because sexual function is an integrated component of quality of life.

Platelet-rich plasma administration to the lower anterior vaginal wall to improve female sexuality satisfaction.

Objective:To investigate the effect of platelet-rich plasma (PRP) injection to the lower one-third of the anterior vaginal wall on sexual function, orgasm, and genital perception in women with sexual dysfunction.Materials and Methods:Four sessions of PRP were administered to the anterior vaginal wall of 52 female patients with sexual dysfunction and orgasmic disorder [Female Sexual Function Index (FSFI) total score ≤26 orgasmic subdomain score ≤3.75]. Prior to the PRP administrations in each session, the FSFI validated in Turkish, the Female Genital Self-Image Scale (FGSIS), the Female Sexual Distress Scale-Revised (FSDS-R), and Rosenberg’s Self-Esteem Scale were used and in the final follow-up, and the Patient Global Impression of Improvement (PGI-I) was performed and the results were analyzed.Results:Following the application of the PRP, the total FSFI score was observed as 27.88±4.80 and the total score was 26 and above in 50% of the patients (p<0.001). Orgasm subdomain scores were found as 2.11±1.20 before the PRP treatment and 4.48±1.14 afterwards (p<0.001). A significant change was observed in all sub-domains after PRP and it was observed that this change started after the first administration (p<0.001). A statistically significant increase was determined in FGSIS genital perception scores, which was significant between the 1st and 2nd months (p<0.001). The FSDS-R scores showed a minimal increase in stress scores as the application number increased, but a statistically significant decrease was observed in the 4th administration (p<0.001). No statistically significant difference was found in Rosenberg Scale scores before and after treatment (p=0.389). High satisfaction was found in PGI-I scores.Conclusion:As a minimally invasive method, PRP administration to the distal anterior vaginal wall may improve female sexuality with high satisfaction.

A LITERATURE REVIEW ON GENITAL SELF IMAGE IN WOMEN AND AFFECTING FACTORS

Abstract The genital self-image, which is an important factor for women's health, has been defined as the self-attitude and the following emotion arising directly or indirectly from special interactions and experiences involving the genital organs. Women's beliefs and feelings about their genital organs are expressed as a sensitive subject because they are seen as secret and taboo. But nowadays many women find the appearance of their genital organs very important and are more interested in appearance. Although both women and men report negative genital self-images, research has shown that men tend to have a more positive genital self-image than women. Genital self image; body image, organ loss, sexual functions, genital hygiene practices, vaginal infections, culture, obesity, developmental periods and media. When we look at the literature, body image studies mostly focused on women's attitudes towards beauty, weight, and skin color, leaving the issue of genital self-image in the background. In fact, genital self-image plays an important role in the development of sexual health and body image. Recently, it has been found that women have an increasing desire to undergo genital cosmetic / plastic surgery operations and change the appearance and functions of their vulva and vagina due to their negative views on their genital self-image. It is important to examine all the factors that affect the genital self-image, which is of great importance for women's health, and to provide the necessary care by taking a holistic approach in terms of body perception and sexuality. Nurses / midwives should adopt approaches to increase the body and genital image of women and to increase the quality of life of individuals. Nurses / Midwives are healthcare professionals in the most appropriate position to provide the necessary support in developing a new genital self-image and positive lifestyle.

Evaluation of genital self-image and sexual dysfunction in women with vulvar lichen planus or lichen sclerosus

Introduction Vulvar lichen planus (LP) and vulvar lichen sclerosus (LS) are chronic inflammatory diseases that affect women’s sexual health. In this study, our aim was to investigate sexual function, anxiety level and genital self-image in vulvar LP and vulvar LS patients. Methods This study was conducted on a total of 178 women who presented to the gynecology clinic between February 2019 and January 2020. The patients were divided into the following groups: group 1, vulvar LP (n = 21); group 2, vulvar LS (n = 59); group 3, fungal vulvitis controls (n = 48); and group 4, healthy controls (n = 50). The validated Female Sexual Function Index (FSFI), Beck Anxiety Index (BAI), and Female Genital Self-Image Scale (FGSIS) questionnaires were assessed in all women. Results There were no significant differences among the groups with respect to age, parity, menopausal status, body mass index (BMI), vaginal intercourse past 1 month, marital status or educational status (p > .05). There were statistically significant differences between the vulvar LP and vulvar LS groups compared to control groups in terms of FSFI total scores and subscores (p < .001). When FGSIS and BAI scores were analyzed, significant statistical differences were found among the study groups (p < .001). A positive correlation was found between the FSFI and FGSIS scores in patients with vulvar LP and LS. Additionally, a negative correlation was found between the FSFI and BAI scores in patients with vulvar LP and LS. Conclusions Our study showed that sexual function, genital self-image and anxiety level were associated in vulvar LP and vulvar LS patients. Vulvar LP and vulvar LS patients with worse genital self-image have more sexual problems and anxious conditions.

Cirugías de afirmación de género en mujeres trans: resultados estéticos, sexuales y urinarios de una serie inicial de vaginoplastias

Introduction and objectivesGender dysphoria is associated with mental health comorbidity, such as depression and suicide. “Gender affirming surgeries” improve sexuality and psychosocial well-being. The goal of vaginoplasty is for the genitalia to resemble in form and function to a biological vagina with a depth of at least 11 cm and a sensitive clitoris. In addition, the urethra must be shortened and allow voiding in a sitting position. Our objective is to describe the aesthetic, sexual and urinary results. Patients and methodRetrospective study of all patients undergoing feminizing genitoplasty, at Hospital Sótero del Río between 2018 and 2019, that met WPATH requirements. Vaginal dimensions, neo-clitoral sensitivity, aesthetic and sexual satisfaction of the neovagina, questionnaires Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS), IPSS-QoL, uroflowmetry and post-void residue were evaluated. Results10 women who underwent feminizing genitoplasty were identified. The neovaginal depth average was 14.2 cm. There was no rectal injury or reoperation. There was 100% of Neoclitoris sensitivity and 88% satisfaction with the neovaginal width.The FGSIS averaged 25.4 points and the FSFI averaged 16 points. The IPSS was 6.7 points, the average Qmax was 22 ml/s and post-void residual volume average was 22 ml. There was no neomeatal stenosis. ConclusionsFeminizing Genitoplasty is a complex, demanding and not completely standardized surgery. However, it is a relatively safe procedure that achieves adequate aesthetic, sexual and urinary results.

A Systematic Review of Primary Vaginoplasty Techniques and Outcomes in the Male-to-Female Transgender Population: A Call to Action

PURPOSE: Primary vaginoplasty is an integral aspect of male-to-female (MtF) transgender surgery. Surgical techniques vary and outcomes, such as vaginal depth, complications, and patient-reported outcome measures (PROMs) are reported inconsistently. We aim to provide a synopsis of vaginoplasty technique variations and evaluation of outcomes. METHODS: A multi-database (EMBASE, Ovid, PubMed, and Web of Science) search (2008–2019) was performed using a search strategy executed with MeSH terms and keywords such as neovagina, vaginoplasty, and transgender. Studies describing primary MtF vaginoplasty that sufficiently detailed surgical technique and reported surgical outcomes and/or PROMs were selected. RESULTS: Twenty-three studies were included; 16 described unique populations representing 2021 MtF patients. Inversion vaginoplasty was performed in 96.6% of patients (n = 1952). Sixty-nine patients underwent intestinal vaginoplasty. Average length of admission was 8.5 days (range, 5.7–12.5 days). Average follow-up was 49.8 months (range, 6–92 months). Average vaginal depth achieved was 11.7 cm (range, 9.8–15 cm) with inversion vaginoplasty (n = 513) and 15.3 cm (range 12–16.3 cm) with intestinal vaginoplasty (n = 54). Neovagina was constructed with inversion flap only (69.8%), or augmented with full thickness skin graft (18.6%), spatulated urethra (9.5%), or both (2.0%). For intestinal vaginoplasty, either sigmoid (78.3%) or transverse (21.7%) colon was utilized. The most common complications were wound dehiscence after inversion vaginoplasty (19.2%) and introitus stricture after intestinal vaginoplasty (13.0%). Sixteen studies included PROMs. The most commonly utilized validated PROMs for sexual function were the Female Genital Self-Image Scale and Female Sexual Function Index. Patient satisfaction was high (88.7% inversion, 77.6% intestinal) while regret was low (1.0%). Rates of penetrative intercourse were similar (62.5% inversion, 51.2% intestinal). The majority of patients were able to achieve orgasm (74.5% inversion, 84.0% intestinal). CONCLUSIONS: Inversion vaginoplasty remains the most common method for neovagina creation. Utilization of adjunct tissue to augment neovaginal depth is more common, which correlates with increasing use of early hormonal therapy. Despite high satisfaction after primary vaginoplasty, standardized reporting of surgical complications and PROMs remains poor. Standardization of the way surgeons evaluate outcomes is critical to establish evidence-based guidelines for this surgical procedure.

Do external female genital measurements affect genital perception and sexual function and orgasm?

Objective:To provide baseline data for the anatomy of the external female genitalia and to investigate the correlation between those measurements and sexual function and genital perception.Materials and Methods:This prospective cohort study consisted of 208 healthy premenopausal women. The Female Sexual Function index (FSFI) and the Female Genital Self-image scale (FGSIS) questionnaires were administered. Participants were divided into two groups according to their female sexual dysfunction (FSD) status. External genital measurements and anterior and posterior vaginal length were measured.Results:The external female genital measurements were (cm, mean ± standard deviation): clitoral prepuce length 2.05±0.48; clitoral glans length 0.87±0.21; clitoral glans width 0.60±0.15; clitoris to urethra 2.24±0.55; anterior fornix depth 7.75±0.92; posterior fornix depth 9.25±0.75; labia minora width, right 2.12±0.86, left 2.20±0.96. A weak negative correlation was found between total FGSIS scores and clitoral prepuce length (p=0.01, r=-0.17), whereas a weak positive correlation was seen between total FGSIS scores and anterior-posterior vaginal lengths (p=0.04, r=0.13; p=0.02, r=0.15, respectively). No statistically significant difference was found between the genital measurements of participants with FSD (n=82, 39.4%) and those without FSD (n=126, 60.6%), and the total FSFI scores and orgasm subdomain scores.Conclusion:The female genital measurements were found to be distributed over a wide range. Although the relationship between genital measurements and genital perception varied, no significant relationship was found between genital measurements and sexual functions or orgasm. These findings suggest that a more cautious approach should be taken towards genital surgeries for cosmetic purposes.

Genital Self-Image in Adolescent Girls: The Effectiveness of a Brief Educational Video

The study investigated the effectiveness of a very brief video aimed at increasing adolescent girls’ knowledge of the variation in normal female genital appearance and improving their attitudes towards their own genitals. The video was developed by the researchers and included information about the anatomical features of cisgender female genitals and their function, as well as emphasizing the diversity in the appearance of these features, particularly the external genitalia or vulvar region. A sample of 343 female adolescents aged 16-18 years were randomly assigned to view the educational video or a control video. The educational video significantly increased the girls’ knowledge of female genital anatomy. The educational video also significantly increased genital appearance satisfaction and decreased consideration of undergoing cosmetic genital surgery or labiaplasty in the future. The participants who watched the educational video were also more likely to recommend focusing on the diversity in normal female genital appearance when educating other young people on the topic of female genital anatomy. Our results suggest that a very brief educational video could be a useful tool to assist young girls with their genital self-image.

Autoimagem genital de mulheres com incontinência urinária atendidas em um serviço de fisioterapia ambulatorial

Objetivo: Este artigo tem por objetivo analisar a autoimagem de mulheres com incontinência urinária atendidas no ambulatório de fisioterapia. Métodos: Estudo transversal, descritivo, quantitativo realizado a partir de uma análise documental de prontuários de fisioterapia de um serviço secundário de média complexidade de uma cidade do interior do Rio Grande do Sul. Os prontuários continham dados sociodemográficos, dados sobre a incontinência urinária, bem como, a utilização do questionário Female Genital Self-Image Scale (FGSIS). Utilizou-se análise estatística descritiva em frequência absoluta e relativa e teste de normalidade de Shapiro-Wilk. Resultados: A amostra foi de oito mulheres com média de idade de 52,75±13,5 anos, com predomínio de multíparas, partos vaginais e que realizavam reposição hormonal. Em relação a incontinência urinária, houve predomínio do tipo mista, na forma de jato, provocada por esforço e com o uso de proteção permanente. A pontuação média do FGSIS foi de 19,25±3,95 pontos, apresentando uma autoimagem genital negativa. Os domínios mais afetados foram funcionamento (2,25±0,88 pontos) e cuidado (média 2,25±0,46 pontos). Não houve diferença significativa entre os domínios do FGSIS. Considerações finais: Os achados do presente estudo demonstram que as mulheres apresentaram uma autoimagem negativa com piores resultados nos domínios funcionamento e cuidado.

Female Genital Self-Image in Women With and Without Female Genital Mutilation/Cutting in Jeddah, Saudi Arabia.

IntroductionThe consequences of female genital mutilation/cutting (FGM/C) on female genital self-image are not known.AimTo assess whether women with and without FGM/C differed with regard to female genital self-image.MethodsA survey was administered to a group of women attending the King Abdulaziz University Hospital obstetrics and gynecology clinic from December 2016 to August 2017. 963 consecutive adult women seen at the clinic completed the survey.Main outcome measuresThe main outcome measure of this study was female genital self-image being assessed with the female genital self-image scale (FGSIS).ResultsOne-fifth (18.2%) of the women self-reported having undergone FGM/C as young girls. Women with FGM/C had a similar FGSIS score as women with no FGM/C (21.3 ± 4.6, n = 175 vs 21.6 ± 4.8, n = 756, analysis of variance, P = .37). In multivariate regression analysis, only level of education remained independently associated with the FGSIS score. Women with some university education had a greater mean FGSIS score than women with no university education (22.1 ± 4.49, n = 564 vs 20.8 ± 5.03, n = 399, P < .0001).ConclusionsWomen with and without FGM/C in a Saudi Arabian clinic generally had a similarly positive genital self-image. Only level of education was independently associated with the FGSIS score.Rouzi AA, Berg RC, Alamoudi R, et al. Female Genital Self-Image in Women With and Without Female Genital Mutilation/Cutting in Jeddah, Saudi Arabia. Sex Med 2020;8:752–756.