Condyloma Detection in Neovagina Raises the Demand for Transgender Screening Guidelines. A Case Report and Review of the Literature.

OBJECTIVE: Due to the progress in contemporary surgical methods and the increased awareness of gender dysphoria, vaginoplasty procedures have become more consistently standardized. In recent years, there has been a notable rise in gender-affirming surgeries, including breast reconstruction as well as genital modification procedures like hysterectomy, orchiectomy, and vaginoplasty. Current vaginoplasty techniques include penile inversion vaginoplasty, which uses penile and scrotal tissue, and intestinal vaginoplasty, which uses a segment of bowel to create a neovagina. Considering the tissues used for vaginoplasties, inversion vaginoplasties carry a potential risk of developing human papillomavirus (HPV)- related lesions, such as high-grade squamous intraepithelial lesions or squamous cell carcinomas. Similarly, intestinal vaginoplasties may be at risk of developing adenocarcinoma. Despite the occurrence of HPV-related lesions or malignancies in individuals with neovaginal structures, there is a lack of established screening guidelines for the suitable screening of neovagina-bearing transgender women and intersex patients.

CASE REPORT: We report a case of a transgender woman in her late 20s, status post-inversion vaginoplasty, who presented with peri-anal and vaginal condylomas associated with pain and vaginal bleeding. Examination of the neovagina revealed a 9.0 cm friable mass. Partial excision as well as plasma jet ablation was performed and revealed a low-grade squamous vaginal intraepithelial lesion (VAIN 1).

CONCLUSION: Due to the scarcity of reported cases, we would like to bring the need for routine screening for this patient group to reduce this substantial disparity in cancer screening for lesbian, gay, bisexual, transgender, and other sexual/ gender minority (LGBT +) patients.