Gender Affirming Surgery: Considerations for the Urogynecologist

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This educational presentation by Dr. Ann Tran from Mount Sinai Hospital focuses on gender-affirming pelvic reconstructive surgery and its complications, outlining surgical techniques, potential complications, and the urogynecologist's role. It references the World Professional Association for Transgender Health (WPATH) Standards of Care, emphasizing criteria like persistent gender dysphoria, informed consent, and hormone therapy.<br /><br />Common surgeries discussed include hysterectomy, vaginectomy, metoidioplasty, urethral lengthening, and scrotoplasty for transmasculine patients; and orchiectomy, penile inversion vaginoplasty, and its variations for transfeminine patients. Surgical strategies may combine multiple procedures and decisions such as bilateral salpingo-oophorectomy depend on patient factors like fertility desires.<br /><br />Specific procedures reviewed include vaginal reconstruction techniques such as Penile Inversion Vaginoplasty (PIV) with graft or flap augmentations (e.g., tunica vaginalis, peritoneal, intestinal grafts). Surgeons aim for functional, aesthetic vulvar and vaginal creation enabling receptive intercourse, clitoral sensation, and appropriate urinary stream. Postoperative care stresses the critical importance of regular vaginal dilation to maintain neovaginal patency.<br /><br />Complications vary by procedure and can include wound infections, dehiscence, flap necrosis, urethral strictures, fistulas, rectal injuries, vaginal stenosis, and prolapse. Urethral stricture management may require staged urethroplasty, utilizing techniques such as buccal mucosal grafts. Revision surgeries like peritoneal or intestinal vaginoplasty are options in complex or failed cases, each with their own risks including ileus and anastomotic leaks.<br /><br />The presentation highlights the psychological aspects of care, stressing mental health support pre- and post-operatively for body image, sexual function, and adjustment. It underscores the urogynecologist’s role in managing these complex surgical cases and complications within a multidisciplinary team. References provide a comprehensive foundation including WPATH guidelines and recent literature on transgender healthcare outcomes.

Keywords

gender-affirming surgery

pelvic reconstructive surgery

WPATH Standards of Care

transmasculine surgeries

transfeminine surgeries

Penile Inversion Vaginoplasty

postoperative care

surgical complications

urogynecologist role

mental health support