Squamous cell carcinoma of the neovagina following transgender woman gender-affirming vaginoplasty: a case report and systematic review.

Abstract

Gender-affirming vaginoplasty is performed for transwomen desiring surgical alignment of their genitalia with their perceived gender. The commonest technique performed for vaginoplasty is penile skin inversion, which utilises penile and scrotal skin to construct a neovagina and vulva. An uncommon risk is squamous cell carcinoma of the neovagina. A systematic review was performed, which identified 9 cases of neovaginal squamous cell carcinoma following gender-affirming vaginoplasty for transgender women. In addition, the authors also presented a case of their own and their experience of managing such case. Squamous cell carcinoma may present at least 8 years following the initial vaginoplasty, and presenting symptoms include neovaginal bleeding, discharge, pain, urinary or bowel symptoms. Treatment depends on the stage of disease and include radical surgery, neoadjuvant, adjuvant or palliative chemoradiotherapy. Due to the rarity of neovaginal squamous cell carcinoma, it is important that clinicians are familiar with the anatomy and clinical examination of individuals who have had gender-affirming vaginoplasty. In addition, such cases should ideally be managed at an expert centre in a multidisciplinary setting. As squamous cell carcinoma can present decades following vaginoplasty, sexual health education is important as well as long-term sexual transmitted infection and cancer screening.