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This publication will discuss the diversity of procedures that are common to those with intersex traits,/differences of sex development (I/DSD), and transgender and gender diverse (TGD) patients. It will address how these procedures are performed, and common after care and long-term considerations which are relevant to the pediatric radiologist. Some surgeries offered to these patient populations have shared surgical approaches and radiographic considerations. With the growth of TGD procedures as a field, more pediatric subspecialties are performing these procedures, and the approaches are informing the surgical care of the growing number of I/DSD individuals who are seeking surgery in adolescence and young adulthood. Surgeries discussed will include procedures to masculinize or feminize breast/chest tissue, facial bony contours, as well as internal and external genital structures. Patients are diverse and this includes their embodiment goals. As such, not all TGD and I/DSD patients will desire to undergo these procedures. It is important for radiologists to have a foundational understanding of this heterogenous set of procedures so they can provide optimal care for these patient populations. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: There are sparse data on the use of postoperative pelvic floor physical therapy (PFPT) in patients undergoing vaginoplasty. The primary objective of this study was to compare the impact of PFPT on the ease of vaginal dilation after vaginoplasty in transgender women. We hypothesized that patients undergoing PFPT would report better ease of vaginal dilation following surgery. Methods: This was a randomized trial of transgender women undergoing vaginoplasty. Patients were randomized to either no PFPT or PFPT 3 and 6 weeks following surgery. Subjects completed the Pelvic Floor Disorders Inventory and the Pelvic Floor Impact Questionnaire at baseline and at 12 weeks. At 12 weeks, subjects underwent vaginal length measurement and completed the Patient Global Impression of Improvement and a visual analogue scale (0–10) for ease of vaginal dilation and pain with dilation. A total of 17 subjects in each arm were needed to detect a significant difference in ease of dilation between the two groups. Results: Forty-one subjects were enrolled and 12-week data were available for 37 subjects (20 PFPT, 17 no PFPT). Mean age and BMI were 31 ± 13 years and 24.9 (± 4.0) kg/m2. Subjects were on hormone therapy for a median of 39 (20–240) months and 5 (13.5%) patients had undergone previous orchiectomy. At 12 weeks, the median vaginal length was 12.5 (10–16) cm, reported mean ease of dilation was 7.3 (± 1.6), and pain with dilation was 2.4 (± 1.7). There were no differences in these outcomes or in pelvic floor symptoms between the groups. Conclusions: In this study, routine postoperative PFPT did not improve outcomes in patients undergoing vaginoplasty. [ABSTRACT FROM AUTHOR]

Purpose of Review : Summarize the effects gender-affirming hormone therapy (GAHT) and gender-affirming surgical therapy (GAST) have on fertility of the transgender and gender diverse (TGD) patient as well as current clinical approaches in fertility preservation for transgender individuals. Recent Findings: There are relatively limited data specific to fertility preservation for TGD individuals and current approaches to treatment are extrapolated from options for fertility preservation in cisgender individuals. Contemporary updates in this review include evolving research defining the reproductive potential of gametes that are exposed to pubertal suspension and GAHT in sequence, the persistent challenges of previously experimental ovarian tissue cryopreservation for TGD patients, and additional evidence that fertility can be largely conserved in TGD patients after testosterone use. Ultimately, several forms of fertility preservation options are available depending on the pubertal status of a transgender individual. Summary: Fertility treatment and preservation options should be discussed with transgender individuals regardless of stage of transition, but ideally before gender-affirming hormonal treatment or gonadectomy. Relatively few transgender individuals are seen for fertility care due to lack of provider awareness and patient perception of bias. [ABSTRACT FROM AUTHOR]