Clinical Report: Outcomes and Well-Being After Vaginoplasty in Transgender Care

Overview

This retrospective study evaluated surgical outcomes, treatment satisfaction, and psychosocial well-being in 45 transgender and gender-diverse individuals undergoing penile inversion vaginoplasty. It compared centralized versus decentralized healthcare delivery settings and assessed patient-reported outcomes including gender congruence, mental health, and quality of life.

Background

Transgender and gender-diverse individuals often experience gender dysphoria due to incongruence between their experienced gender and sex assigned at birth. Gender-affirming medical interventions, including hormonal therapy and genital surgery such as vaginoplasty, are effective in alleviating dysphoria and improving quality of life. However, prior research has been limited by low-quality evidence, heterogeneous outcome measures, and lack of holistic frameworks assessing surgical and psychosocial outcomes. This study aims to address these gaps by analyzing standardized patient-reported outcomes in a single-institution cohort.

Data Highlights

Among 116 contacted patients who underwent vaginoplasty between 2014 and 2018, 45 (38.8%) participated. Outcomes assessed included the Transgender Congruence Scale, Brief Symptom Inventory-18, WHOQOL-BREF, Female Genital Self Image Scale, Female Sexual Functioning Index, and a Short Questionnaire for Self-Evaluation of Vaginoplasty. Participants were categorized by healthcare delivery setting: centralized interdisciplinary care versus decentralized surgical-only care.

Key Findings

• Penile inversion vaginoplasty was performed in a two-step procedure by a single surgeon, ensuring procedural consistency.
• Centralized healthcare delivery, involving interdisciplinary counseling and treatment, was associated with improved psychosocial outcomes compared to decentralized care.
• Primary surgical complications included neo-meatus stenosis, consistent with prior literature reporting approximately 11% incidence.
• Patient-reported measures demonstrated significant improvements in gender congruence, mental health symptoms, and quality of life postoperatively.
• Standardized outcome measures enabled a more comprehensive evaluation of both functional and aesthetic surgical results alongside psychosocial well-being.

Clinical Implications

Clinicians should consider the benefits of centralized, interdisciplinary transgender healthcare delivery models to optimize surgical and psychosocial outcomes for patients undergoing vaginoplasty. Utilizing standardized patient-reported outcome measures can guide individualized care and improve evaluation of treatment efficacy. Awareness of common complications such as neo-meatus stenosis is essential for surgical planning and postoperative management.

Conclusion

This study supports the positive impact of penile inversion vaginoplasty on psychosocial well-being in transgender and gender-diverse individuals and highlights the advantages of centralized care delivery. Future research should continue to employ standardized outcome measures to refine care models and optimize patient-centered results.

References

1. World Professional Association for Transgender Health (WPATH) Standards of Care, Version 8
2. Systematic Reviews on Gender-Affirming Surgery Outcomes
3. Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, UKE, Hamburg-Eppendorf, 2020