Symptomatic Neovaginal Candidiasis in Transgender Women After Penile Inversion Vaginoplasty: A Clinical Case Series of Five Consecutive Patients

Abstract

Background: Vaginoplasty is performed as gender-affirming surgery in transgender women. While multiple surgical techniques exist for this goal, penile inversion vaginoplasty is performed most frequently. Neovaginal symptoms may impede sexual functioning after surgery.Methods: A total of five consecutive patients with symptoms and positive swabs for neovaginal candida infection were described.Results: All patients presented with white-colored neovaginal discharge and some with neovaginal itching and/or malodor. All were topically treated with miconazole, which resulted in symptom clearance. Follow-up swabs were negative for candida.Conclusions: To our knowledge, this is the first report on (symptomatic) candidiasis of the penile-inverted neovagina.

A Narrative Review on Factors Shaping the Vaginal Microbiome: Role of Health Behaviors, Clinical Treatments, and Social Factors

“…One study found that the neovaginal microbiome was highly diverse, composed largely of anaerobic bacteria, and triggered a host response similar to the response to BV 59 . Another study examining the neovaginal microbiome of five women with candida infection following neovaginal surgery found these women also had more BVAB in their vaginal microbiome 60 . Importantly, all five women in this study experienced several negative vaginal symptoms that were attributed to the microbiome and not just candida infection.…”

The Effect of Gender-Affirming Medical Care on the Vaginal and Neovaginal Microbiomes of Transgender and Gender-Diverse People

“…Until recently, data on the microbiota colonizing the neovagina were limited to case reports and small studies that used limited culture-based detection methods or targeted PCR to detect the presence of specific species of interest (classic STI pathogens or Lactobacillus spp.) (Bodsworth et al, 1994;Haustein, 1995;Weyers et al, 2009;Weyers et al, 2010;de Haseth et al, 2018;Radix et al, 2019). These assays fail to capture the vast majority of species present and provide no information on the composition or structure of bacterial communities in the neovagina.…”

“…Neovaginal swabs sent for clinical diagnostics frequently return the results "altered vaginal flora inconsistent with bacterial vaginosis" and treatments established for the EDV (metronidazole) are frequently ineffective (Jain and Bradbeer, 2007;van der Sluis et al, 2020). Candidiasis is another common cause of vaginal itching in the EDV; there has been one case series published reporting neovaginal candidiasis in five individuals (de Haseth et al, 2018), warranting further characterization of neovaginal candida species and the development of clinical guidelines for prevention and treatment. The cause of neovaginal malodour also warrants further investigation.…”

Midwifery Care for Transfeminine Individuals

“…Vaginal flora is primarily bacteria typically found on the skin and occasionally lactobacilli. Bacterial vaginosis is unlikely, and Candida is rare . If an infection is noted, take aerobic and anaerobic bacterial cultures and recommend that the client douche for a few days to a week.…”