Pelvic Floor Dysfunction in the Transgender Patient: A Scoping Review.

INTRODUCTION AND HYPOTHESIS: There are scant pooled data on transgender individuals regarding pelvic floor dysfunction, with or without gender-affirming surgery (GAS).

METHODS

A scoping review following PRISMA-ScR guidelines was carried out using PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and Lilacs in June 2024. The following pelvic floor disorders were investigated: urinary and anorectal dysfunctions, pelvic organ prolapse (POP), sexual dysfunction and pelvic floor disorders after GAS.

RESULTS

Of 1284 studies, 35 remained for full-text analysis and data extraction. Urinary dysfunction was seen within 10 studies and prevalence of urinary incontinence (UI) varied from 15.4 to 53%, with age, BMI, and depression identified as factors in these studies. Anorectal dysfunction was found in four studies and constipation was the most frequent complaint, varying from 22 to 45%. Constipation was the main anorectal complaint (22%-45.6%). POP rate after neovaginoplasty ranged between 4% and 7.5%. Regarding sexual dysfunction, the Female Sexual Function Index, was the most commonly used questionnaire. Sexual desire appears to be affected by gender-affirming hormone therapy, whereas lubrication and pain were altered in trans women (TW) patients. Sexual dysfunction rates in trans men (TM) were high (54%-87.8%). Regarding complications, most common findings were vaginal stenosis in TW and urethral strictures and fistulas in TM.

CONCLUSION

There is a high prevalence of pelvic floor dysfunction among the transgender population. Future cohort studies with better defined instruments and standardized pelvic examinations are recommended.