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Background As transmasculine persons utilize androgen gender affirming hormone therapy as a part of transition, guidance has been lacking on the effects of the therapy on the ovaries, especially for those who may desire retention. Aim To describe the ovarian histopathology of transmasculine persons on testosterone therapy following oophorectomy at the time of hysterectomy performed for gender affirmation. Methods This was a multicenter case series study of transmasculine patients on testosterone therapy who underwent hysterectomy with oophorectomy for gender affirmation between January 2015 and December 2017 at 5 tertiary care referral centers. Patients were identified by their current procedural and International Classification of Diseases codes. Outcomes Pre-, perioperative, and pathologic data were obtained from the electronic medical records and ovarian tissue descriptions from pathology reports were grouped into the following classifications: (i) simple/follicular cysts; (ii) polycystic ovaries; (iii) complex cysts; (iv) endometriomas; (v) other masses; (vi) atrophy; and (vii) normal. Results 85 patients were included in the study. At the time of oophorectomy, the mean age and body mass index of the cohort were 30.4 ± 8.4 years and 30.2 ± 7.3 kg/m2, respectively, and the average interval from the initiation of testosterone to oophorectomy was 36 0.3 ± 37.9 months. On examination of ovarian histopathology, 49.4% (42) of specimens were found to have follicular/simple cysts, 5.9% (5) were polycystic, and 38.8% (33) had normal pathology. For those specimens with volume documented (n = 41), the median volume was 9.6 (range 1.5–82.5) cm3. There was no association between the duration of testosterone therapy or body mass index and the presence of cysts in the ovaries. Clinical Implications The results of this study reported benign histopathology in ovaries of a large cohort of transmasculine persons on testosterone which should be included when counseling patients on ovarian retention, as transmasculine patients may choose to retain their ovaries while on testosterone for a variety of reasons (including no desire to undergo surgery, desire for backup sex steroids, and potential use for future fertility). Strengths & Limitations This is a large multicenter study seeking to address the uncertainty in present counseling surrounding ovarian conservation in transmasculine persons on testosterone therapy. Its limitations included its retrospective nature and inability to address ovarian function after testosterone discontinuance. Conclusion In this cohort of transmasculine patients on testosterone therapy undergoing hysterectomy with oophorectomy for gender affirmation, ovarian histopathology was benign in all the specimens.

Context Women with classic congenital adrenal hyperplasia (CAH) are exposed to elevated androgens in utero causing varying levels of 46,XX virilization. The majority undergo feminizing genitoplasty early in life, with potential impact on sexual function and health-related quality of life (HRQoL). Objective We aimed to determine how sexual and lower urinary tract function, body image and global HRQoL differs between patients with classic CAH and controls, and characterize how gynecologic anatomy contributes to outcomes. Methods 36 women with classic CAH and 27 age-, race- and marital-status-matched controls underwent standardized gynecological examination and validated questionnaires. The responses were analyzed in relation to gynecological measurements, genotype and disease status. Results Compared to controls, women with CAH were more likely to have sexual dysfunction (P=0.009), dyspareunia (P=0.007) and other pelvic pain (P=0.007), were less likely to be heterosexual (P=0.013) or ever have been sexually active (P=0.003), had poorer body image independent of BMI (P&0.001) and had worse HRQoL in the areas of general health (P=0.03) and pain (P=0.009). Women with CAH had smaller vaginal calibers and perineal body lengths and larger clitoral indexes when compared to controls (P&0.001). A larger vaginal caliber in CAH women was associated with better overall sexual function (P=0.024), increased sexual satisfaction (P=0.017), less pain (P&0.001), and greater number of sexual partners (P=0.02). Conclusions Women with CAH have increased rates of sexual dysfunction, poor body image and poor HRQoL, which is mitigated in women with a larger vaginal caliber. Management aimed at optimizing vaginal caliber might improve sexual function.

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To our knowledge, there are no guidelines in the dermatology literature for performing anogenital examinations in prepubescent children. Based on experience in our joint pediatric dermatology-gynecology vulvar clinic, we aim to provide a framework for conducting genital examinations in children, focusing on the vulvar examination. Our goal is to enhance confidence in the pediatric dermatologist's ability to perform thorough examinations by providing general principles as well as concrete "do's" and "don'ts" that will create a maximally comfortable and productive experience. These steps will help create a positive experience for the patient and family, encouraging further follow-up and enhancing the overall well-being of the child.