The journal of sexual medicine · 2026
Long-term satisfaction after gender-affirming laparoscopic sigmoid vaginoplasty in transgender women: a comparison with penile inversion vaginoplasty.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Vallinga Marleen S, Hollander Julia E, van de Grift Tim C, de Boer Nanne K H, Tuynman Jurriaan B, Bouman Mark-Bram, Mullender Margriet G, van der Sluis Wouter B
Аннотация
BACKGROUND: Gender-affirming laparoscopic sigmoid vaginoplasty (SV) is an established alternative to penile-inversion vaginoplasty (PIV) when there is insufficient penoscrotal tissue available. However, long-term satisfaction with the sigmoid vagina remains unclear.
AIM: To assess the long-term patient-reported outcomes (PROs) after SV in transgender women, and compare these outcomes with a reference group of transgender women who underwent PIV.
METHODS: A single-center, cross-sectional survey study was conducted, including transgender women who underwent primary SV at least 5 years prior and matched transgender women who underwent PIV. Matching was based on age (±5 years) and operation date (±2 years). Outcomes were compared between groups. Retrieved clinical data comprised medical history, perioperative characteristics, complications, and reoperations.
OUTCOMES: Primary outcomes were satisfaction with vagina (GENDER-Q Vagina and Dilation scales) and genital self-image (Female Genital Self-Image Scale). Secondary outcomes were satisfaction with surgery, current complaints (self-constructed questionnaire), sexual well-being (GENDER-Q Sexual well-being scale), and satisfaction with life (Satisfaction with Life Scale and the Cantril Ladder).
RESULTS: Of 58 eligible SV candidates, 35 participated and were matched to 35 PIV participants. Follow-up was 10 years (IQR 7-12). The frequency and severity of intra- and postoperative complications did not differ significantly between groups. Reported satisfaction with the vagina was moderate in both groups (SV 44.4 ± 11.1; PIV 47.3 ± 18.2, P = .43), as was genital self-image (SV 18.8 ± 3.3; PIV 18.9 ± 5.4, P = .89) and sexual well-being (SV 52.2 ± 20.2; PIV 57.2 ± 18.4, P = .33). Sigmoid vaginoplasty and PIV groups rated their satisfaction with the surgical result 7.1 ± 1.7 vs 6.9 ± 1.9 out of 10 (P = .62). Satisfaction with genital appearance and longer time since surgery were associated with higher satisfaction with the vagina, whereas more severe postoperative complications predicted lower satisfaction. In both groups, 69% of individuals reported genital complaints. Stated reasons for dissatisfaction were related to genital esthetics, voiding complaints, genital pain, and an inability to use the vagina as desired.
CLINICAL IMPLICATIONS: The present findings support SV as a viable alternative to PIV when indicated and inform preoperative counseling on long-term clinical outcomes and PROs.
STRENGTHS AND LIMITATIONS: Strengths of the study include the comparative design with a matched reference group, long-term follow-up, and the use of validated questionnaires. Limitations include a single-center setup, cross-sectional design, and potential response and selection biases.
CONCLUSION: Across all clinical outcomes and PROs, no significant differences were found between SV participants and PIV participants. Overall satisfaction was moderate, and genital complaints were prevalent in both groups.
AIM: To assess the long-term patient-reported outcomes (PROs) after SV in transgender women, and compare these outcomes with a reference group of transgender women who underwent PIV.
METHODS: A single-center, cross-sectional survey study was conducted, including transgender women who underwent primary SV at least 5 years prior and matched transgender women who underwent PIV. Matching was based on age (±5 years) and operation date (±2 years). Outcomes were compared between groups. Retrieved clinical data comprised medical history, perioperative characteristics, complications, and reoperations.
OUTCOMES: Primary outcomes were satisfaction with vagina (GENDER-Q Vagina and Dilation scales) and genital self-image (Female Genital Self-Image Scale). Secondary outcomes were satisfaction with surgery, current complaints (self-constructed questionnaire), sexual well-being (GENDER-Q Sexual well-being scale), and satisfaction with life (Satisfaction with Life Scale and the Cantril Ladder).
RESULTS: Of 58 eligible SV candidates, 35 participated and were matched to 35 PIV participants. Follow-up was 10 years (IQR 7-12). The frequency and severity of intra- and postoperative complications did not differ significantly between groups. Reported satisfaction with the vagina was moderate in both groups (SV 44.4 ± 11.1; PIV 47.3 ± 18.2, P = .43), as was genital self-image (SV 18.8 ± 3.3; PIV 18.9 ± 5.4, P = .89) and sexual well-being (SV 52.2 ± 20.2; PIV 57.2 ± 18.4, P = .33). Sigmoid vaginoplasty and PIV groups rated their satisfaction with the surgical result 7.1 ± 1.7 vs 6.9 ± 1.9 out of 10 (P = .62). Satisfaction with genital appearance and longer time since surgery were associated with higher satisfaction with the vagina, whereas more severe postoperative complications predicted lower satisfaction. In both groups, 69% of individuals reported genital complaints. Stated reasons for dissatisfaction were related to genital esthetics, voiding complaints, genital pain, and an inability to use the vagina as desired.
CLINICAL IMPLICATIONS: The present findings support SV as a viable alternative to PIV when indicated and inform preoperative counseling on long-term clinical outcomes and PROs.
STRENGTHS AND LIMITATIONS: Strengths of the study include the comparative design with a matched reference group, long-term follow-up, and the use of validated questionnaires. Limitations include a single-center setup, cross-sectional design, and potential response and selection biases.
CONCLUSION: Across all clinical outcomes and PROs, no significant differences were found between SV participants and PIV participants. Overall satisfaction was moderate, and genital complaints were prevalent in both groups.