Presentation Authors: Virginia Li*, Amanda Chi, Melissa Poh, Polina Reyblat, Los Angeles, CA
Introduction: Gender dysphoria affects 0.6% of adults in the United States (US). Gender affirmation surgery (GAS) helps patients align their genitalia with their gender identity. Historically, access to surgery was scattered and limited in the US, which impeded long term follow-up of patient's sexual function. We report sexual function outcomes of the first 50 penile inversion vaginoplasties done at a single institution.
Methods: All patients who underwent a penile inversion vaginoplasty at Kaiser Permanente Southern California 2017-2018 were included. Patients satisfied criteria for GAS per World Professional Association for Transgender Health (WPATH) guidelines. Preoperative data includes age, genitourinary exam, sexual preference, length of hormone therapy, and medical comorbidities. Postoperatively, clitoral sensation, vaginal sensation, sexual satisfaction/ability to orgasm, and satisfaction with genital appearance were recorded.
Results: The first 50 consecutive vaginoplasties were reviewed. All patients were followed for a minimal of 6 months with 100% patient follow-up (range 6-24 months). Mean age was 44 (range 18-74). All patients reported erogenous clitoral sensation (100%), and interested patients have reported ability to participate in satisfactory vaginal penetrative intercourse. Additionally, 24% reported orgasm with vaginal intercourse. 20% of patients underwent minor revision procedures (labiaplasty/clitoroplasty/urethroplasty) to improve cosmetic appearance and/or direction of urine flow. Overall satisfaction has been high with no regret from our patient population.
Conclusions: GAS within an integrated system allows comprehensive long-term follow-up of patients. Single stage vaginoplasty in our first 50 patients has excellent outcomes. It results in functional vagina, sensate clitoris, cosmetically appropriate external genitalia and preservation of urinary function. Minor revisions were only needed in 20% of patients. Overall satisfaction with penile inversion vaginoplasty is high in terms of sexual functionality, genital appearance, and ability to achieve orgasm.