Several problems common after vaginoplasty in trans women

NEW YORK - Trans women may experience several common but manageable problems following vaginoplasty, researchers from the U.K. report.

Although there are no official figures, a 2012 report estimated the global prevalence of male-to-female transgender individuals at approximately one per 11,900 to one per 45,000, but far fewer individuals undergo sex reassignment surgery. Little is known about the outcomes after vaginoplasty in these individuals.

Dr. Jane Hussey from City Hospitals Sunderland and colleagues present four examples of post-vaginoplasty problems presenting to their sexual health clinic in North East England.

Some women develop intravaginal hair resulting from the use of penile and scrotal skin to create the neovagina. Electrolysis before vaginoplasty can prevent this complication, and once it occurs, treatment options include plucking, the use of hair removal creams, and repeated electrolysis.

About 12% of women report inadequate vaginal length after vaginoplasty, the authors write in Journal of Family Planning and Reproductive Health Care, online June 10. Altering sexual practice to take into account the size of the neovagina is one option. Increasing the depth of the neovagina requires further surgery, most commonly using an isolated bowel segment in its vascular pedicle.

Urination problems commonly follow vaginoplasty, with as many as 20% of women requiring minor corrective urethral surgery to remove residual erectile tissue of the corpus spongiosum and reposition the urethra with a more ventral opening.

Vaginal discharge can occur as a result of infection or inflammation of granulation tissue in the vault of the neovagina. Silver nitrate application can address the over-granulation and antibacterial drugs can be used to resolve symptoms and signs of infection.

"Transgender issues are not currently on the specialist genitourinary medicine training curriculum in the UK, other than in the context of managing HIV in transgender patients (whose risk of HIV may indeed be very high), and they are also not on the Community Sexual and Reproductive Health curriculum," the researchers note. "We feel that this needs addressing, as demonstrated by the cases presented."

"Many health care providers are unaware of the Gender Recognition Act 2004 and the need to maintain confidentiality regarding gender reassignment surgery even if relevant to the referral, unless explicit consent has been given," they add. "This needs highlighting to those working in sexual and reproductive healthcare (SRH)."

Dr. Cecile Unger from Cleveland Clinic's Women's Health Institute in Cleveland, Ohio, who was not involved in the new report, recently surveyed gynecologists regarding the care of transgender patients.

"The transgender patient who presents to their local office with a neovaginal complication is difficult for inexperienced physicians - regardless of specialty, which complicates these patients' care," she told Reuters Health by email. "In the last 18 months, I believe those of us who care for these patients have done a good job teaching others about them, creating seminars at conferences, lecturing at outside institutions, but there is a still a lot of work to be done to inform physicians, and make them competent and confident."

"These patients often seek surgical care far from their homes since less than a dozen surgeons in the U.S. perform these surgeries; and they return home, experience these complications, and usually do not see their surgeons for them because of either cost, time or willingness," she explained. "I am a strong believer that surgeons should care for their own complications - it is part of the surgical process - but long-distance care can be very challenging. In my practice, I ask that patients provide me with the name and contact information of a provider that has agreed to follow them postoperatively if they do not live locally, so that I may contact that provider and keep the lines of communication open after surgery."

"Postoperative complications requiring care and even revision surgery after vaginoplasty procedures are not uncommon, but most issues can be managed conservatively, while others can be taken care of with a small revision surgery," Dr. Unger concluded. "Contacting the original surgeon is important and clear communication with him or her about the care of the patient is important and something that I believe is a must. It is also important to find out which surgeons/providers are available to care for these patients and have experience managing these issues. In my experience, providers who care for this patient community always welcome questions, referrals, etc. - so it is important to utilize these resources."

Dr. Hussey was not available to comment on the report.


J Fam Plann Reprod Health Care 2015.

References: Reuters Health
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