Increased Vaginal Cuff Dehiscence Among Gender-Diverse People on Testosterone [ID: 1377373]

INTRODUCTION: Testosterone-induced vaginal atrophy is hypothesized to increase the risk of vaginal cuff dehiscence (VCD); however, current studies are limited and conflicting. This study compares risk of VCD among gender-diverse people on testosterone (GDT) and ciswomen (CW) and evaluates factors associated with VCD. METHODS: An IRB-approved retrospective cohort study was conducted among adults who underwent total hysterectomy (June 1, 2014 to December 31, 2019) for benign indications at Kaiser Permanente Northern California. Patients had 6 months postoperative follow-up, and GDT had greater than 6 months testosterone use prior to hysterectomy. Differences between GDT and CW were evaluated using Wald χ 2 , Fisher’s exact, Student’s t test, or Kruskal–Wallis tests. Unadjusted logistic regression was conducted to estimate odds ratios (OR) for VCD. RESULTS: The cohort (n=22,109) included 154 (0.7%) GDT and 21,995 (99.3%) CW. GDT were younger (median 27 [interquartile range (IQR) 22–36] versus 47 [IQR 42–52] years, P <.001) and had lower proportion with Charlson Comorbidity Index (CCI) greater than or equal to 1 (18.2% versus 27.1%, P =.013) than CW. A greater proportion of GDT experienced VCD (5.8% versus 2.5%, P <.016; OR 2.42, 95% CI 1.23–4.77, P =.011). Patients with CCI greater than or equal to 1 or had hypertension were associated with 25% (95% CI 4–50%, P =.015) and 41% (95% CI 18–68%, P <.001) higher odds of VCD, respectively. CONCLUSION: The odds of VCD was 2.4 times higher in GDT despite being younger and healthier than CW. Charlson Comorbidity Index of 1 or higher and hypertension were also associated with higher risk of VCD. These findings support the theory of testosterone-induced vaginal atrophy as a risk factor for VCD. Additional studies are needed to better understand the pathophysiology of VCD among GDT and prevent this morbid complication.