Plastic and Reconstructive Surgery, Global Open (May 2023)

Gender-Affirming Vaginoplasty: A Comparison of Algorithms, Surgical Techniques and Management Practices across 17 High-volume Centers in North America and Europe

  • Devin Coon, MD, MSE,
  • Shane D. Morrison, MD, MS,
  • Martin P. Morris, MD, MBE,
  • Patrick Keller, MD,
  • Rachel Bluebond-Langner, MD,
  • Marci Bowers, MD,
  • Pierre Brassard, MD, FRCSC,
  • Marlon E. Buncamper, MD, PhD,
  • Daniel Dugi, III, MD, FACS,
  • Cecile Ferrando, MD, MPH,
  • Katherine M. Gast, MD,
  • Christine McGinn, DO,
  • Toby Meltzer, MD,
  • Stan Monstrey, MD, PhD,
  • Müjde Özer, MD,
  • Melissa Poh, MD,
  • Thomas Satterwhite, MD,
  • Jess Ting, MD,
  • Lee Zhao, MD,
  • William M. Kuzon, MD, PhD,
  • Loren Schechter, MD

DOI
https://doi.org/10.1097/GOX.0000000000005033
Journal volume & issue
Vol. 11, no. 5
p. e5033

Abstract

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Background:. Penile inversion vaginoplasty is the most common gender-affirming genital surgery performed around the world. Although individual centers have published their experiences, expert consensus is generally lacking. Methods:. Semistructured interviews were performed with 17 experienced gender surgeons representing a diverse mix of specialties, experience, and countries regarding their patient selection, preoperative management, vaginoplasty techniques, complication management, and postoperative protocols. Results:. There is significant consistency in practices across some aspects of vaginoplasty. However, key areas of clinical heterogeneity are also present and include use of extragenital tissue for vaginal canal/apex creation, creation of the clitoral hood and inner labia minora, elevation of the neoclitoral neurovascular bundle, and perioperative hormone management. Pathway length of stay is highly variable (1–9 days). Lastly, some surgeons are moving toward continuation or partial reduction of estrogen in the perioperative period instead of cessation. Conclusions:. With a broad study of surgeon practices, and encompassing most of the high-volume vaginoplasty centers in Europe and North America, we found key areas of practice variation that represent areas of priority for future research to address. Further multi-institutional and prospective studies that incorporate patient-reported outcomes are necessary to further our understanding of these procedures.