Impact of the initial experience in the penile inversion vaginoplasty technique on satisfaction levels: a pilot retrospective cohort study

Abstract

Background: There is a growing interest in reporting satisfaction levels of transgender women undergoing vaginoplasty surgery. The lack of information regarding satisfaction during the initial experience of the vaginoplasty technique, and the moderate morbidity related to the surgery, could discourage the immersion of new groups in initiating a program of this kind. Therefore, we aim to report patients' level of satisfaction during our initial experience in the penile inversion vaginoplasty technique.Methods: Retrospective study of patients who underwent penile inversion vaginoplasty in our center between September 2019 and August 2021. Surgery technique, demographic data, preoperative clinical variables, and short and long-term follow-up are described. Six months after surgery, a survey elaborated by the research team was conducted by phone. The score goes from 1 to 5, and it evaluates satisfaction on esthetics, functional, psychosocial, and global aspects.Results: Twenty patients underwent penile inversion vaginoplasty in our center during the described period. The average age was 35.6 years old, the mean body mass index (BMI) was 24.7 kg/m 2 , and they presented low comorbidity. Half of the patients presented at least one complication, most of which were minor. One patient was urgently reoperated due to bleeding, and three patients were reoperated on a scheduled basis from minor surgeries. 90% of the patients answered the questionnaire. The most common answers to all four areas covered (esthetics, functional, psychosocial, and global) were satisfied or very satisfied, resulting in a mean over four points in each one of the sections. Lastly, 94.4% of the patients reported being satisfied with their choice of having undergone surgery.Conclusions: Our initial experience in penile inversion vaginoplasty reveals good satisfaction results at short follow up.

Vaginoplasty for Gender Dysphoria and Mayer-Rokitansky-Küster-Hauser Syndrome: A Systematic Review and Meta-analysis

“…Urinary issues (urgency, stress incontinence, stream misdirection -Clavien-Dindo classification I-II) were reported during follow up after Penile-inversion-, Penoscrotal-and Combined-GAS (Figure S4E). 25,48,[56][57][58][59][60] Only Lawrence 49 and Kuhn et al 55 used self-made and established questionnaires. [52][53][54] Urinary issues were caused by small prostates, perineal dissection and urethral sphincter injury and often non-surgically resolved by medication or pelvic floor physiotherapy.…”

“…Body self-image was often assessed with the General Health Survey (SF-36) 62,63 and Female Genital Self-Image Satisfaction (FGSIS) questionnaire. 16,17,25,47,64 Diverse evaluation tools assessed 2-point, 14,43,[65][66][67] 3point, 68 5-point 56,60 or 10-point satisfaction scales 42,69 or surgeons' view on aesthetics. 70,71 Dissatisfaction was assessed with 2-point, 58,65,72,73 3-point 17,25,47 or 5-point 50,70,71 scales or by examiner's rating of the vulva 59 and the Short Questionnaire for Self-Evaluation of Vaginoplasty (SQSV) was applied most often.…”

“…17,25 Gender Dysphoria Aesthetic satisfaction (Figure S5A) was high after Penoscrotal-, Intestinal-and Combined-GAS. Penileinversion-, Penoscrotal-and Intestinal-GAS reported dissatisfaction (Figure S5E) and highanatomical satisfaction (Figure S5C), based on patient-reported outcome as yes/no 14,50,58,60,65,66,74 or 'deep enough for vaginal intercourse with a man'. 17,25,59 Regret was solely investigated after GAS, absent in 2-point evaluations, 65,66,69,74 sporadic and present after Penile-Inversion-and Penoscrotal-GAS (Figure S5G).…”

“…Sexual activity varied gravely as 21-100% at 1-132 post-operative months during assessment (Figure S6A/B). The definitions of sexual activity in the included articles varied as regular activity, 58,73,74,77 any 14,17,[78][79][80]41,44,60,61,66,70,72,75 in the last month, 47,62 vaginal intercourse 43,45,81,82 with a man 25 or married with sexual activity. 83 Sexual function was assessed most often with the Female Sexual Function Index (FSFI).…”

“…83 Sexual function was assessed most often with the Female Sexual Function Index (FSFI). 16,17,76,78,80,81,84,25,47,[62][63][64]70,72,73 Dyspareunia was also reported by 5-point, 60 4-point, 59 3-point 68 and 2-point 17,25,70,72,73,76,79,83,43,44,48,55,58,61,64,66 self-made questionnaires and present after all but the Wharton-Sheares-George-technique (Figure S6C/D).…”