Sexual and Physical Health After Sex Reassignment Surgery

Abstract

A long-term follow-up study of 55 transsexual patients (32 male-to-female and 23 female-to-male) post-sex reassignment surgery (SRS) was carried out to evaluate sexual and general health outcome. Relatively few and minor morbidities were observed in our group of patients, and they were mostly reversible with appropriate treatment. A trend toward more general health problems in male-to-females was seen, possibly explained by older age and smoking habits. Although all male-to-females, treated with estrogens continuously, had total testosterone levels within the normal female range because of estrogen effects on sex hormone binding globulin, only 32.1% reached normal free testosterone levels. After SRS, the transsexual person's expectations were met at an emotional and social level, but less so at the physical and sexual level even though a large number of transsexuals (80%) reported improvement of their sexuality. The female-to-males masturbated significantly more frequently than the male-to-females, and a trend to more sexual satisfaction, more sexual excitement, and more easily reaching orgasm was seen in the female-to-male group. The majority of participants reported a change in orgasmic feeling, toward more powerful and shorter for female-to-males and more intense, smoother, and longer in male-to-females. Over two-thirds of male-to-females reported the secretion of a vaginal fluid during sexual excitation, originating from the Cowper's glands, left in place during surgery. In female-to-males with erection prosthesis, sexual expectations were more realized (compared to those without), but pain during intercourse was more often reported.

Surgical Satisfaction, Quality of Life, and Their Association After Gender-Affirming Surgery: A Follow-up Study

“…Most studies point out the substantial risks of these surgeries (Horbach et al, 2015), whereas data collection via surveys obtained similarly high self-reported complication rates (Lawrence, 2006). The high number of satisfied respondents found in the present study is comparable to earlier studies (Bouman et al, 2016;Buncamper et al, 2015;De Cuypere et al, 2005;Horbach et al, 2015;Lawrence, 2003;Lawrence, 2006;Nelson, Whallett, & McGregor, 2009;Rehman et al, 1999;Smith et al, 2005;Weigert et al, 2013) and emphasizes the effectiveness of gender-affirming procedures. Yet, most treatment evaluation studies have collected data in a clinical setting, whereas the present study reports on a cohort that was surveyed in their home environment with limited dependence on clinicians (although the participants were invited through the clinics).…”

“…Yet, most treatment evaluation studies have collected data in a clinical setting, whereas the present study reports on a cohort that was surveyed in their home environment with limited dependence on clinicians (although the participants were invited through the clinics). With regard to regret, similar to other studies (De Cuypere et al, 2005;Lawrence, 2006;Smith et al, 2005), only a few study participants reported feelings of regret, which was exclusively related to disappointment and not to the wish to detransition. Amongst the eight people who reported dissatisfaction or/and regret with GAS, both genders and most surgical procedures were represented.…”

“…Minor regret is considered as disappointment and can overlap with dissatisfaction. In general, the literature gives high percentages of satisfaction with GAS procedures: breast augmentation 87% to 100% (De Cuypere et al, 2005;Smith, van Goozen, Kuiper, & Cohen-Kettenis, 2005;Weigert, Frison, Sessiecq, Al Mutairi, & Casoli, 2013), vaginoplasty 83% to 100% (De Cuypere et al, 2005;Horbach et al, 2015;Lawrence, 2003;Rehman, Lazer, Benet, Schaefer, & Melman, 1999;Smith et al, 2005), subcutaneous mastectomy 92% to 100% (De Cuypere et al, 2005;Nelson, Whallett, & McGregor, 2009;Smith et al, 2005), and phalloplasty 100% (De Cuypere et al, 2005). Clinical evaluation studies show positive appraisal of both genital functionality and aesthetics after surgery, whereas sexual outcomes were found to be less positive (Bouman et al, 2016;Buncamper et al, 2015).…”

Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels

“…Considering a possible role of testosterone in female sexual desire among the general population (3,4), the lack of ovarian androgen production and the effect of continuous oestrogen treatment on the production of sex hormone-binding globulin (SHBG) in transsexual women might lead to hypoactive sexual desire disorder (HSDD) due to low levels of free testosterone. Although an earlier study from our group showed decreased levels of free testosterone in a majority of transsexual women (8), the association between sexual desire and testosterone in this group remains to be examined. Considering the observation of sexual desire complaints in transsexual women, and the much debated (9, 10) high prevalence of a lack of sexual interest among women in the general population (25.6% in Northern European women (11)), it would be relevant to assess this prevalence in transsexual women.…”

The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults

“…As Lawrence (1999) points out, it is extremely difficult to assess such changes in individuals with a GID diagnosis, as they preoperatively might give information only to be admitted to hormonal and surgical treatment. However, there is no doubt that changes as to the preferred gender of sex partner do occur (De Cuypere et al, 2005;Lawrence, 2005;Schroder & Carroll, 1999; some 30 in a sample of more than 1,200 GID patients seen by F.P. ).…”