Clinical Scorecard: Evaluating Health Care Models, Surgical Outcomes, and Psychosocial Well-Being in Transgender and Gender-Diverse Individuals Undergoing Vaginoplasty: Findings from a Retrospective Study at a Single Institution

At a Glance

Key Highlights

• Gender-affirming genital surgery reduces gender dysphoria and improves quality of life, mental health, and sexual health.
• Stenosis of the neo-meatus is the primary surgical complication, occurring in approximately 11% of cases.
• Centralized versus decentralized delivery of transgender health services may influence treatment satisfaction and psychosocial outcomes.

Guideline-Based Recommendations

Diagnosis

• Diagnosis based on ICD-11 Gender Incongruence and DSM-5 Gender Dysphoria criteria.

Management

• Use of hormonal therapy and gender-affirming genital surgery as key interventions.
• Provision of care in centralized interdisciplinary centers to potentially improve tailored service delivery.

Monitoring & Follow-up

• Use standardized patient-reported outcome measures including Transgender Congruence Scale, Brief Symptom Inventory-18, WHOQOL-BREF, Female Genital Self Image Scale, Female Sexual Functioning Index, and adapted Short Questionnaire for Self-Evaluation of Vaginoplasty.

Risks

• Monitor for surgical complications such as neo-meatus stenosis.
• Consider variability in aesthetic and functional outcomes and their impact on psychosocial well-being.

Patient & Prescribing Data

Transgender and gender-diverse individuals aged 16 years and older undergoing penile inversion vaginoplasty between 2014 and 2018.

Patients receiving care in centralized settings may experience different psychosocial outcomes compared to those treated in decentralized settings; patient satisfaction and holistic outcome measures are essential for evaluating treatment success.

Clinical Best Practices

• Employ interdisciplinary, centralized care models to enhance comprehensive transgender health services.
• Incorporate standardized, validated patient-reported outcome measures to assess surgical and psychosocial outcomes.
• Address both aesthetic and functional surgical outcomes alongside mental health and quality of life in postoperative evaluations.
• Recognize the diversity within transgender and gender-diverse populations including non-binary identities in care planning.

References

• World Professional Association for Transgender Health Standards of Care, Version 8
• ICD-11 Gender Incongruence
• DSM-5 Gender Dysphoria