Cosmetic Revision Surgeries after Transfeminine Vaginoplasty

• DOI: 10.1007/s00266-022-03029-9
• Publication Date: 2022-08-24T20:02:30Z
• Authors: Ivan Mañero; Anna I. Arno; Roberto Herrero; Trinidad Labanca
• Keywords: Male; Reoperation; Social Psychology; Social Sciences; Introitus; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; Intersectionality in LGBTQ+ Mental Health; Health Sciences; Sex Reassignment Surgery; Humans; Psychology; Prospective Studies; Health Consequences of Female Genital Mutilation/Cutting; Public Health, Environmental and Occupational Health; Female Genital Mutilation; Sex reassignment surgery (male-to-female); 3. Good health; FOS: Psychology; Clinical Psychology; Vaginoplasty; Body Dysmorphic Disorder: Psychosocial, Clinical, and Treatment Aspects; Vagina; Medicine; Original Article; Female; Surgery; Transsexualism

Abstract Background Vaginoplasty is the most frequent genital gender-affirming surgery. Although both functional and aesthetic outcomes after transfeminine vaginoplasty have improved over the years, cosmetic revision surgeries demand after transfeminine vaginoplasty appears to be increasing and requires updated knowledge.

Methods All patients who underwent vulvar cosmetic revision surgeries at our institution following transfeminine vaginoplasty from January 2014 to April 2022 were studied. The prevalence, topography and surgical techniques of cosmetic revision surgeries after transfeminine genital gender-affirming surgery were examined using clinical charts review and statistical analysis.

Results During the study period, 354 patients underwent gender-affirming vaginoplasty at our single institution (212 penile inversion vaginoplasty, 122 colovaginoplasty and 20 penile inversion vaginoplasty with scrotal skin graft patients). Forty out of these 354 patients (11.29%) required cosmetic revision surgery after transfeminine vaginoplasty; additionally, 44 patients with vaginoplasty performed at other centres also underwent vulvar cosmetic revision surgery at our clinic during the study period. From all performed cosmetic revision surgeries, most of them (31.42%) were labia corrections, followed by clitoris (23.26%) repair surgeries. Mons Venus (10.20%), urethral meatus (9.38%), spongiosus tissue remnants (8.57%) and introitus (6.53%) revisions followed in frequency. Corrections of peri-inguinal scars (5.30%), anterior commissure (2.84%) and inferior fourchette (2.42%) were less prevalent. No differences were found among the different studied vaginoplasty techniques regarding cosmetic revision surgery prevalence or topography following transfeminine vaginoplasty (p < 0.05).

Conclusions Cosmetic revision surgeries after transfeminine vaginoplasty are frequent. In our large and long-term cohort study, labiaplasty followed by clitoroplasty were found as the most required cosmetic revision surgical procedures. Further multicentre, prospective and controlled studies are necessary to improve cosmetic outcomes and scientific evidence after transfeminine vaginoplasty.

Level of evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.