Post-surgical outcomes in transgender women: a prospective analysis of sexual function and health-related quality of life.

Purpose: To prospectively evaluate patient and clinician reported outcomes of sexual function and health-related quality of life (QOL) of transgender women preoperatively (t0), 6 months (t1), and 12 months (t2) after gender-affirming surgery (GAS) with penile inversion vaginoplasty.

Methods: Transgender women undergoing two-stage GAS at our tertiary care center were included (04/2019-01/2023). Patients received a composed questionnaire including a validated questionnaire (SF-12). Clinical outcomes and adverse events were evaluated. A regression analysis was performed to identify possible risk factors for a deterioration in sexual function and QOL.

Results: Fifty-three patients with an average age of 40.27 ± 14.43 years were included. Complications were mostly minor (Clavien Dindo Classification grade I/II). The depth of the neovagina postoperatively was 11.98 ± 2.19 cm and the width 3.44 ± 0.98 cm. 79.4% of patients were able to experience an orgasm 12 months postoperatively. Orgasm quality increased significantly over the measurement time points (p = 0.003). The SF-12 average physical and mental scores of our collective were similar to the German populations average scores with no significant differences between the time measurement points (p = 0.405 and p = 0.198, respectively). The mental score was always lower than the physical score. A multiple linear regression analysis showed age < 40 years to be a significant influence factor regarding the physical QOL-score (p = 0.048) and the ability to experience an orgasm (p = 0.026).

Conclusion: Penile inversion vaginoplasty is a safe procedure that yields favorable outcomes regarding sexual function and health-related QOL. Younger age significantly predicts improved physical QOL and the ability to experience orgasm postoperatively.