Purpose: Improvements in mental health and quality of life are well documented for transgender patients following vaginoplasty. Patient-reported outcomes (PROs) regarding sexual health are lacking in this intervention, or have not been validated in transgender patients.
Methods: A community advisory board of transgender women informed an anonymous online survey utilizing PROs for those who were contemplative of (pre-) and post-vaginoplasty. They were recruited on online platforms not associated with an individual institution. Survey measures included the Female Genital Self-Image Scale (FGSIS) and Patient-Reported Outcomes Measurement Information System (PROMIS) sexual health measures. Welch approximation t-tests were performed for FGSIS and PROMIS questions using Bonferroni correction.
Results: 687 transgender patients pre-vaginoplasty (n = 522, 76%) and post-vaginoplasty (n = 165, 24%) responded. In PROMIS measures, the postoperative cohort reported higher ability to orgasm (p = 0.0003), satisfaction with sex life (p = 0.001), pleasure in sex life (p = 0.002), use of lubricant (p < 0.0001), and scar interfere with sexual satisfaction (p < 0.0001). FGSIS total score was higher among postoperative patients (27.8 ± 6.0) than preoperative patients (17.8 ± 5.3) (p < 0.0001). Using Spearman’s rho, no significant correlation between FGSIS total score and any PROMIS sub-sectional measures was observed for either cohort. 193 patients (133 preoperative, 60 postoperative) reported their responses about sex being influenced by the Covid-19 crisis.
Conclusion: Patients who are contemplating vaginoplasty have worse sexual health and genital self-image than those who have had vaginoplasty. FGSIS scores did not correlate with PROMIS sexual health measures when controlling for prior vaginoplasty, demonstrating that sexual health is multimodal for each individual patient.