Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery

Abstract

Background Surveys on quality of life (QOL) of male-to-female (MTF) transsexuals have found low QOL scores before and increased satisfaction scores after sex-reassignment surgery (SRS). To our knowledge, many of them lack standardized questionnaires and comparisons with normative data to evaluate different vaginoplasty techniques. Aim To analyze patient satisfaction and QOL after SRS. Methods Forty-seven patients participated in this study. All patients had surgery with our self-developed combined technique on average 19 months before the survey. They completed a self-developed indication-specific questionnaire concerning demographic and socioeconomic issues and postoperative satisfaction. Furthermore, a standardized self-assessment questionnaire on satisfaction and QOL (Fragen zur LebenszufriedenheitModule [FLZM]; Questions on Life SatisfactionModules) was used. The FLZM consists of three modules (general life satisfaction, satisfaction with health, and satisfaction with body image) with scores of weighted satisfaction for each item. Results of the general and health modules were compared with normative data. Outcomes Demographics, QOL, general life satisfaction, satisfaction with health, and satisfaction with body image. Results The self-developed indication-specific questionnaire showed that 91% experienced an improvement of QOL. All patients stated they would undergo SRS again and did not regret it at all. Patients stated their femininity significantly increased. For the FLZM, the sum score for general life satisfaction (P < .001) was significantly lower than the normative data, whereas the sum score of the satisfaction with health module (P = .038) did not reach statistical significance. The two modules also showed positive trends for different items. Values of the body image module showed a significant increase in satisfaction with breasts (P < .001) and genitals (P = .002). Clinical Implications The findings of this survey emphasize the importance of SRS in the interdisciplinary gender-reassignment process. The detailed description of our combined technique could help to improve the surgical outcome and patient satisfaction of this complex and non-standardized surgery. Strengths and Limitations This is the first description of a new surgical technique (combined technique) for MTF SRS. QOL was assessed by a large number of patients by standardized questionnaires and could be compared with normative data. Because this is a retrospective study, we can draw only careful conclusions for pre- and postoperative changes. Conclusion Our self-developed combined surgical technique seemed to have a positive influence on QOL after SRS. Satisfaction with breasts, genitals, and femininity increased significantly and show the importance of surgical treatment as a key therapeutic option for MTF transsexuals.

Age-Related Differences for Male-to-Female Transgender Patients Undergoing Gender-Affirming Surgery

“…In addition, we used the German versions of standardized and validated QOL questionnaires during both time points in our study (Table 4). These included the German Questions on Life Satisfaction questionnaire (FLZ M , Fragebogen zur Lebenszufriedenheit Module ), which has 3 modules: General, Health, and Body Image 17, 18. The patients also answered the Patient Health Questionnaire 4 (PHQ-4) 19 assessing symptoms of depression or anxiety, the Freiburg Personality Inventory—Revised Version 20 used to evaluate emotional status, as well as the Rosenberg Self-Esteem Scale (RSES) 21 for estimates of patients’ self-esteem.…”

Orchiectomy in transgender individuals: A motivation analysis and report of surgical outcomes

“…This procedure offers the advantages of providing female external genitalia and being able to engage in neovaginal penetrative sexual intercourse. After surgery, a higher quality of life is reported Lawrence, 2006;Manrique et al, 2018;Papadopulos et al, 2017). There are several surgical techniques available for this purpose and different grafts can be used as a neovaginal lining, such as inverted penile skin flaps, scrotal flaps, skin grafts, pedicled intestinal segments, or peritoneum (Horbach et al, 2015).…”

Inequalities in Crowdfunding for Transgender Health Care

“…Access to gender-affirming care is associated with improvements in psychological health [12][13][14][15][16] and quality of life, 15,[17][18][19] reduced HIV incidence, 16,20 decreased viral load, 21 decreased substance use, 22 and increased engagement in preventive health services. 23 However, trans people face numerous and extraordinary barriers in obtaining gender-affirming care.…”