Patient-reported Outcomes of Penile Inversion Vaginoplasty Using Post-Affirming Surgery Form and Function Individual Reporting Measure: A Retrospective Single-institution Study.

BACKGROUND

Penile inversion vaginoplasty (PIV) is a common gender-affirming procedure for transgender women, but validated, transgender-specific patient-reported outcomes remain limited. This study evaluated long-term outcomes after PIV using the Post-Affirming Surgery Form and Function Individual Reporting Measure (AFFIRM), a validated instrument assessing appearance, urologic, and gynecologic domains.

METHODS

We conducted a single-institution retrospective cohort with a cross-sectional, anonymous AFFIRM survey distributed in 2024. Demographics, perioperative outcomes, and complications were obtained by chart review. AFFIRM domain scores, reported on a 0-200 scale with lower scores indicating better outcomes, were analyzed descriptively.

RESULTS

Of 193 eligible patients who underwent PIV between 2017 and 2023, surveys were delivered to 186 patients, and 47.8% responded. Median age at surgery was 34.3 years (interquartile range 26.1-49.1), with a median follow-up time of 50.0 months. Most respondents reported high satisfaction with genital appearance, and 90% strongly agreed their anatomy aligned with gender identity. Clitoral sensation was reported by 93%, most commonly as pleasurable. Urologic symptoms were generally minimally bothersome; although 59% reported a misdirected urine stream, mean bother score was low (1.64 ± 1.77). Vaginal dryness and dyspareunia were reported by 43% and 44%, respectively, with 27% describing symptoms as bothersome. Major complications occurred in 13.9% and revision surgery in 34.2%, most commonly for stenosis or depth concerns (13.5%).

CONCLUSIONS

AFFIRM captured meaningful, transgender-specific, long-term outcomes after PIV, complementing traditional surgical metrics and identifying opportunities to improve preoperative counseling, surgical refinement, and postoperative management of vaginal dryness and urinary symptoms.