We sincerely thank Massie et al. for their interest in our article1 and valuable recommendations. This letter emphasizes the importance of more research in this field.
The main aim of gender-confirming surgery is to relieve the distress caused by a discrepancy between the biological gender identity and the gender identity perceived by the transgender person. In transgender women, vaginoplasty is one of the surgical procedures in the comprehensive treatment to alleviate this distress. Worldwide, the method of choice for vaginoplasty in trans women is the penile inversion vaginoplasty. However, few articles report on the outcomes of this procedure.2
Jonathan Massie and colleagues connect with the worldwide awareness that the outcome of a treatment as experienced by the patient is central for evaluating its success. Development of patient-reported outcome measures has really taken off. We agree that patient-reported outcomes are central for evaluation of treatment, especially if the treatment is aimed at alleviation of distress. In fact, we were one of the first to measure patient-reported outcomes after vaginoplasty in trans women.3–5 We also established that there is a need for transgender-specific questionnaires, because existing questionnaires are not very appropriate for this population.3
Massie and colleagues argue that knowledge about surgical outcomes is most important for providers, whereas patient-reported outcomes are more important for the patients and that a study reporting on just one of these outcomes would be incomplete. We propose that both surgical outcomes and patient-reported outcomes are important to evaluate. Of course it is great if you can assess both at the same time; nevertheless, information about either of these outcomes remains valuable. Knowledge about surgical outcomes is important for optimizing the technique and for adequately informing the patient. We suggest that a well-informed patient will be more satisfied with the outcome of treatment.
The need for transgender-specific questionnaires has been recognized in recent years. Because of increasing cooperation between gender health care providers, development of validated patient-reported measures for this growing population has now become feasible.
The authors have no financial interest to declare in relation to the content of this communication.
Marlon E. Buncamper, M.D., Ph.D.
Wouter B. Van der Sluis, M.D., Ph.D.
Mark-Bram Bouman, M.D., Ph.D.
Jan Maerten Smit, M.D.
Mujde Ozer, M.D.
Margriet G. Mullender, Ph.D.
Department of Plastic, Reconstructive, and Hand Surgery
VU Medical Centre
Amsterdam, The Netherlands
1. Buncamper ME, van der Sluis WB, van der Pas RS, et al. Surgical outcome after penile inversion vaginoplasty: A retrospective study of 475 transgender women. Plast Reconstr Surg. 2016;138:999–1007.
2. Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: A systematic review of surgical techniques. J Sex Med. 2015;12:1499–1512.
3. Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BP, Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals. J Sex Med. 2015;12:1626–1634.
4. Bouman MB, van der Sluis WB, van Woudenberg Hamstra LE, et al. Patient-reported esthetic and functional outcomes of primary total laparoscopic intestinal vaginoplasty in transgender women with penoscrotal hypoplasia. J Sex Med. 2016;13:1438–1444.
5. van der Sluis WB, Bouman MB, de Boer NK, et al. Long-term follow-up of transgender women after secondary intestinal vaginoplasty. J Sex Med. 2016;13:702–710.
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