Sexual satisfaction, sexual function, and orgasm after gender‐affirming vaginoplasty and vulvoplasty

Abstract

Objectives To examine sexual satisfaction, function, and orgasm following genital gender‐affirming surgeries (GGAS) among transgender and gender‐diverse (TGD) patients; we used the GENDER‐Q, a validated instrument for TGD individuals seeking gender‐affirming care that enables a more comprehensive evaluation of sexual experience. Patients and Methods Our cross‐sectional survey was distributed via e‐mail to patients; surveys were completed in May 2025. The primary outcome was sexual satisfaction measured by the GENDER‐Q Sexual Well‐Being scale. Secondary outcomes measured the relationship between ability to orgasm and orgasm changes pre‐ and postoperatively with identity, sexual wellness, social acceptance, body image, mental health, and surgical outcomes. Results Of 765 eligible individuals, 295 (39%) responded; 103 (35%) underwent vulvoplasty and 192 (65%) underwent vaginoplasty. In all, 89% were transgender women, and 80% were at least 1‐year postoperative. Sexual satisfaction did not differ by age, surgery type, race/ethnicity, revision history, timing of first postoperative orgasm, or anxiety symptomology. Higher sexual satisfaction was associated with postoperative orgasm and absence of orgasm‐related pain and correlated positively with higher scores on the GENDER‐Q Orgasm, Social Acceptance, Surgery Outcome, and Body Image scales. In all, 80% of participants able to orgasm preoperatively reported postoperative orgasm, while 29% who did not experience orgasm preoperatively achieved orgasm postoperatively. Inability to orgasm postoperatively was associated with older age and lower Sexual Well‐Being and Surgery Outcome scores. Conclusion These findings underscore the multifactorial nature of sexual well‐being after GGAS and highlight the value of assessing sexual function before and after surgery. Longitudinal studies are needed to further characterize sexual health trajectories following GGAS.