Hysterectomy with Bilateral Salpingo-Oophorectomy in Female-to-Male Gender Affirmation Surgery: Comparison of Two Methods

Abstract

Introduction The optimal route for hysterectomy with bilateral salpingo-oophorectomy in female-to-male gender affirmation surgery is still under debate, due to the quite limited and inconsistent published data. The aim of this study is to present and compare the results of vaginal and laparoscopic hysterectomy as part of gender affirmation surgery in female-to-male transsexuals. Materials and Methods Between 2012 and 2017, 124 female-to-male transsexuals, aged 18–43 years (mean age: 28.5), underwent hysterectomy with bilateral salpingo-oophorectomy, followed by colpocleisis and gender affirmation surgery. Transvaginal and laparoscopic hysterectomy were performed in 92 and 32 patients, respectively. Standard outcome measures (types and rates of complications, operative time, blood loss, and postoperative hospital stay) were used to compare the two groups of patients. Results The mean follow-up was 41 months (ranged from 6 to 65 months). The duration of transvaginal approach was significantly shorter (51 minutes compared to 76 minutes, p < 0.001). The total complication rates (less than 3%), reoperation rates (0%), blood loss, and postoperative hospital stays (4.3 days compared to 4.5 days) showed no statistical difference. Conclusions Both approaches are safe, with minimal complications. However, we prefer transvaginal hysterectomy due to its shorter operative time, cost-effectiveness, and simpler continuation with one-stage female-to-male gender affirmation surgery.

A narrative review of outcomes following metoidioplasty: complications and satisfaction

“…Ring metoidioplasty combines the previous steps with that of urethral elongation. The ring flap elongates the urethra by using an anterior vaginal wall flap in conjunction with labia minora flaps [7,13] . The Belgrade metoidioplasty technique follows concepts and techniques used in hypospadias repair [14] .…”

“…In their 2019 series of 593 patients undergoing one-stage Belgrade metoidioplasty, Djordjevic et al reported stricture and fistula rates of 2% (n = 10) and 8% (n = 48), respectively; all cases required surgical revision [7] . Lin-Brande et al [12] , 2020 33 ± UL 0 0 4 (2 from each group)…”

“…Metoidioplasty constructs a phallus typically between 5-9 cm, preserves tactile and erogenous genital sensation, and avoids the donor site morbidity and complexity associated with a phalloplasty. While some individuals report the ability to engage in penetrative intercourse, these reports are largely anecdotal [7] .…”

Phalloplasty: understanding the chaos

“…The sequencing of hysterectomy, salpingo-oophorectomy, and vaginectomy can vary. Hysterectomy and salpingo-oophorectomy are commonly performed using a transvaginal or standard laparoscopic approach during a separate stage in advance of masculinizing genital surgical procedures [13] . A primary advantage of this staging is to avoid the longer operative times, increased procedural blood loss, and greater physiologic disturbance when combining these with other procedures [14] .…”

Feasibility, Safety, and Satisfaction of Combined Hysterectomy with Bilateral Salpingo-Oophorectomy and Chest Surgery in Transgender and Gender Non-Conforming Individuals

“…Chest masculinization and removal of female organs are often required by transgender men and gender non-conforming individuals as a first step of gender affirming surgery. All routes of hysterectomy are feasible and safe when performed for gender affirmation, with no documented increased risk of complications compared to the cisgender population and are associated with an improved quality of life [ 3 , 4 , 5 , 6 ]. Minimally invasive approaches are the most common (laparoscopy, vaginal, laparoscopic-assisted vaginal, and robot-assisted laparoscopic route), each with particular benefits for transmen in terms of scarring, hospitalization time, and conservation of vasculature for potential future gender affirming surgeries [ 3 , 7 , 8 ].…”