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Objective: This study aims to identify the problems experienced by women undergoing assisted reproductive treatment due to progesterone use, as well as their coping strategies. Methods: The study included 145 women who were admitted to an infertility outpatient clinic of a university hospital between July 25 and August 8, 2022. The researchers collected data using a questionnaire designed to assess the problems that might arise due to the use of various types of progesterone-containing drugs and coping methods. The data were evaluated using descriptive statistics in the SPSS program. Results: The mean age of the women was 30.76±5.53 years, and the mean duration of their marriages was 6.6±4.51 years. Of women 64.8% had primary infertility and 68.3% of women underwent assisted reproductive treatment (ART) at least once before. Women who received intramuscular progesterone treatment during ART frequently experienced pain, swelling, abscess, redness at the injection site. Women who received progesterone treatment vaginally experienced vaginal wetness, drying of the drug in the vagina, lumps, the drug leaving the body, the drug not being completely absorbed, vaginal itching. Women who received progesterone treatment orally experienced sleepiness, nausea, dizziness, headache, fatigue. Women coped with these problems using various methods. Conclusion: The study revealed that women undergoing ART experienced many problems related to the use of progesterone and they attempted to address these issues through their own means. It is necessary to inform patients and to plan nursing interventions to minimize/eliminate these problems. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long‐term outcomes for Mayer–Rokitansky–Küster–Hauser syndrome (MRKH) patients undergoing vaginoplasty using acellular porcine small intestinal submucosa grafts (SIS). Design: A case series. Population: Seventy‐eight MRKH syndrome patients and a post‐SIS patient who delivered a baby following the world's first robot‐assisted uterus transplantation. Methods: Mayer–Rokitansky–Küster–Hauser syndrome patients were grouped based on the postoperative time and the diagnosis–surgery interval. Outcomes of sexual function and psychological status were assessed using the female sexual function index (FSFI), self‐rating scale of body image (SSBI) and self‐acceptance questionnaire (SAQ). Anatomical outcomes were measured by clinicians. Main Outcome Measures: The primary outcome was restoration of sexual function, defined by an FSFI score in the 'good' range. Anatomical and psychological outcomes were also analysed. Results: Sexual function was restored in 42.3% (33/78) of patients and the total FSFI score was 23.44 ± 4.43. Three factors (body defect, recognition of physical appearance and willingness to change physical appearance scores) in the SSBI and two in the SAQ decreased as the postoperative time increased. Based on the interval between diagnosis and surgery, the total SSBI score was lower in the short‐interval group than in the long‐interval group (7.25 ± 5.55 versus 12.04 ± 10.21, p = 0.038). Conclusions: Nearly half of MRKH patients in our study had good long‐term sexual function after SIS vaginoplasty. Sexual function and psychological status improved as postoperative time increased. In addition, reducing the diagnosis to surgery interval was associated with improved psychological function. [ABSTRACT FROM AUTHOR]

Introduction: The sheep was evaluated as a potential model for preclinical evaluation of urethral slings in vivo based on: (1) anatomical measurements of the sheep vagina and (2) histological tissue integration and host response to polypropylene (PP) slings. Methods: Eight female, multiparous sheep were utilized. Three of 8 animals underwent surgery mimicking human tension-free vaginal tape protocols for midurethral slings and were euthanized at 6 months. The following measurements were obtained: vaginal length, maximum vaginal width with retraction, symphysis pubis length, and distance from the pubic bone to incision. Explanted sling samples from sheep and human were stained with hematoxylin and eosin for host reaction assessment. Results: Geometric measurements were similar between humans and sheep. Sheep vaginal anatomy allowed sling placement similar to procedures in human surgeries, and all sheep recovered without problems. Comparative histology between the sheep and human indicated similar host reaction and collagen deposition around implants, confirming suitability of the sheep model for biomaterial response assessment. Conclusion: Sheep vaginal length is comparable to humans. Tissue integration and host response to PP slings showed chronic inflammation with rich collagen deposition around the material in both sheep and human specimens, highlighting the sheep as a potential animal model for preclinical testing of midurethral slings. [ABSTRACT FROM AUTHOR]

Vaginal tightening or vaginoplasty has been gaining popularity, while validated methods of evaluation and treatment are still lacking. Herein, we describe a bilateral wall tightening technique for vaginal laxity and evaluate the feasibility of this method. From April 2020 to September 2021, 25 women with vaginal laxity underwent vaginal tightening, and 22 women were included in this retrospective observational study. The inclusion criteria were as follows: participants with at least one delivery and reported vaginal laxity, but without a history of underlying diseases. Vaginal pressure tests and questionnaires were used to evaluate vaginal laxity and sexual quality before and 6 months after the surgery. The study included 22 women (aged 29–46 years), and the follow-up period was 14.1 ± 3.3 months. The score based on the vaginal laxity questionnaire was improved as a result of surgery (preoperative median: 2.00, interquartile range [IQR]: 1.00–2.00; postoperative median: 5.00, IQR: 5.00–6.25, p < 0.001). The vaginal pressure increased from 2.3 ± 1.8 mm/Hg to 21.4 ± 3.7 mm/Hg. Sexual distress changed from 24.2 ± 8.9–16.1 ± 4.8 after surgery (p < 0.001), and sexual dysfunction with an average score of 20.1 ± 10.6 before surgery improved after the procedure (26.0 ± 10.8, p < 0.001). Women also reported improved scores in desire, arousal, orgasm, and satisfaction. In addition, there were no intraoperative complications or significant events during the follow-up period. Bilateral vaginal tightening without mucosal excision is a feasible and effective surgical approach for the management of vaginal laxity. [ABSTRACT FROM AUTHOR]

Background: Aesthetic Gynecology is an upcoming and challenging sub-specialty of Gynecology. It comprises of surgical and non-surgical procedures that cater to the emotional and pathological needs of many women worldwide. Objective: The purpose of this study was to provide an overview about Cosmetic/Aesthetic Gynecology, assess the existing knowledge, awareness, and approach of the Gen-next Indian doctors towards this field. Materials and methods: We designed a questionnaire which entailed the basic idea, routine procedures, and the go-to specialists for the said field. Consenting individuals belonging to the target population (MBBS students between 18-32 years) took the survey and based on their answers, conclusions were drawn. Results: A total of 394 students agreed to be a part of the study. Thirty-four forms were incomplete, so 360 forms were assessed in total. Their responses were analyzed with the help of SPSS 23, using the Chi-square test and those with a p value of <0.05, were considered statistically significant. Nearly 50.6 % of the students were aware of Aesthetic Gynecology and 37 % of them felt that the practices and procedures were important in the society. Many other aspects to understand their awareness and attitude were also touched upon. Conclusion: It could be assumed that the young aspiring doctors had a positive and accepting outlook towards the field but their information was compromised and not extracted from legitimate sources. Many of them believed, that the procedures were done to enhance cosmesis more than addressing a pathology. Many felt that this sub-specialty is handled by dermatologists. There may be a potential overlap in the years to come, given the increasing demand, innovation, and technology. Due to social media and the growing self-love and individuality, the need for this specialty is sure to go uphill. [ABSTRACT FROM AUTHOR]

Purpose: To study the long-term results of utero-vaginal anastomosis in cases of cervical malformations. Methods: This is a retrospective cohort study. Nine patients presented with cryptomenorrhea due to cervical malformations (5 patients with cervical agenesis and vaginal aplasia, 2 patients with cervical agenesis and upper vaginal aplasia, and two patients with cervical dysgenesis in form of cervical obstruction). Five patients had utero-vaginal anastomosis (UVA) with McIndoe vaginoplasty. Four patients had UVA without vaginoplasty. Follow-up was done by transabdominal and/or transvaginal ultrasound monthly for the first 3 months then every 6 months thereafter for a duration that ranged from 15 to 82 months. The main outcome measures are achieving menstruation, dysmenorrhea, pelvic inflammatory disease (PID), needed interventions after primary surgery, infertility, and pregnancy rate. Results: Nine (100%) patients achieved menstruation, one (12%) experienced severe dysmenorrhea, two (22%) had PID, seven (78%) needed dilatation of the anastomosis site, three (33%) needed reoperation, nine (100%) had primary infertility, two (28.5%) achieved clinical pregnancy, and only one (14%) ended by live birth. Conclusion: Conservative surgery for cervical malformation is a promising choice for relieving the obstructive symptoms. Regular dilatation is recommended. Pregnancy is a remote hope that is hindered by many challenges. [ABSTRACT FROM AUTHOR]

The demand for sexual life makes vaginoplasty a crucial need for patients who had complete vagina agenesis. We present our experience on vaginoplasty by using a maximum amount of meshing oral mucosal grafts in a case series study on 43 patients. The patients were followed up for an average of 19 months, ranging from 6 months to 4 years. No serious complications were reported. The patients gained good results also at neovagina and donor sites. These results were proved on clinical, endoscopy images, and biopsies. We recommend seven tips in the techniques to be used to achieve these significant results. [ABSTRACT FROM AUTHOR]

Background: Around 1 in 400-5000 live births of females result in vaginal agenesis, a malformation of the female genital tracts. Using an amnion graft to treat vaginal agenesis is a straightforward, widely accessible, economically advantageous, and physiological surgery that leaves no additional scars on the body. This study sought to ascertain whether individuals with vaginal agenesis may successfully undergo laparoscopic-assisted vaginoplasty utilising amnion as a transplant to create a neovagina. Methods: Ten cases of vaginal agenesis linked to Mayor- Rokitansky-Kuster-Hauser (MRKH) Syndrome were included in this case series and were hospitalised within a year. The ladies with MRKH condition were either previously married or unable to consummate their marriage due to a blind vagina when they were brought for surgical intervention. To maintain the patency of the neo-vagina, a laparoscopically guided vaginoplasty was carried out as part of the care. Results: In all but one of the patients, laparoscopy-guided vaginoplasty with an amnion graft was effective. The procedure was stopped when the rectum was hurt, and the harm to the rectum was repaired. Except for one example, the functional outcomes of the neovagina were quite good. None experienced any major postoperative problems. The patients were happy with the postoperative results. Also, the neovagina was psychologically acceptable and sufficiently patent for sexual function. Conclusion: Over the past few years, the new vaginoplasty technique has developed. The most common practice, however, is a laparoscopic approach using several graft materials. A safe and efficient method for treating MRKH syndrome patients with vaginal agenesis is vaginoplasty with amnion grafts. [ABSTRACT FROM AUTHOR]

The article discusses the diagnosis and medical care of men who seek ablation of their genitalia without a desire for feminization. Topics include reasons for not electing vaginoplasty, subgroups of men who seek genital ablation outside of any desire for feminization, and endocrine treatment considerations.

Purpose: To limit the burden of long-term immunosuppression (IS) after uterus transplantation (UTx), removal of the uterine allograft is indicated after maximum two pregnancies. Hitherto this has required graft hysterectomy by laparotomy. Our objective was to demonstrate, as a proof of concept, the feasibility of less traumatic transplantectomy by total laparoscopic hysterectomy (TLH). Patient: A 37-year-old woman with uterovaginal agenesis due to Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS) who had undergone neovaginoplasty at age 19 years prior to living-donor (LD) UTx in 10/2019 at age 35 years gave birth to a healthy boy by primary cesarean section in 06/2021. During pregnancy, she developed impaired renal function, with bilateral hydronephrosis, necessitating early allograft removal in 09/2021 to prevent chronic kidney disease, particularly during a potential second pregnancy. Methods: Transplantectomy by TLH essentially followed standard TLH procedures. We paid meticulous attention to removing as much donor tissue as possible to prevent postoperative complications from residual donor tissue after stopping IS, as well as long-term vascular damage. Results: TLH was performed successfully without the need to convert to open surgery. Surgical time was 90 min with minimal blood loss. No major complications occurred intra- or postoperatively and during the subsequent 9-month follow-up period. Kidney function normalized. Conclusions: To our knowledge, we report the first successful TLH-based removal of a uterine allograft in a primipara after LD UTx, thus demonstrating the feasibility of TLH in uterus recipients with MRKHS. [ABSTRACT FROM AUTHOR]

To address instances when there is insufficient remnant tissue to perform revision following canal-deepening gender affirming vaginoplasty revisions as indicated by insufficient depth. Options for lining of the vaginal canal include skin grafts, peritoneal flaps, or intestinal segment. Our center uses robotically harvested peritoneal flaps in vaginal canal revisions. When the peritoneal flap is insufficient for full canal coverage, we use AlloDerm, an acellular dermal matrix, for additional coverage. Retrospective analysis of 9 patients who underwent revision RPV with AlloDerm was performed. Tubularized AlloDerm grafts were used to connect remnant vaginal lining to the peritoneal flaps. Revision indications, surgical and patient outcomes, and patient-reported post-op dilation were recorded. Nine patients underwent revision RPV using AlloDerm for canal deepening. Median follow-up was 368 days (Range 186-550). Following revision, median depth and width at last follow-up were 12.1 cm and 3.5 cm, and median increase in depth and width were 9.7 cm and 0.9 cm, respectively. There were no intraoperative complications. Two patients had focal areas of excess AlloDerm that were treated with in-office excision without compromise of the caliber or depth of the otherwise healed, epithelialized canal. AlloDerm is an off-the-shelf option that does not require a secondary donor site. The use of AlloDerm for a pilot cohort of patients lacking sufficient autologous tissue for revision RPV alone was demonstrated to be safe and effective at a median 1-year follow-up. [ABSTRACT FROM AUTHOR]

Vaginal yolk sac tumors are rare pediatric malignant tumors and the most common form of vaginal germ-cell tumors in children. They are almost exclusively found in females under 3 years of age. Treatment involves local excision either with or without chemotherapy. Herein, we describe a case of a 3-year-old girl with vaginal Yolk sac tumor, who underwent buccal mucosa vaginoplasty through an anterior sagittal transrectal approach , as an effective oncological procedure, with preservation of reproductive function. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the prevalence and course of endometriosis in adolescents with obstructive Müllerian anomalies. Methods: The study group involved 50 adolescents undergoing surgeries (median age 13.5 (range 11.1–18.5)) for rare obstructive malformations of the genital tract: 15 girls had anomalies associated with cryptomenorrhea and 35 were menstruating. The median follow-up period was 2.4 (ranging from 0.1 to 9.5) years. Results: We diagnosed endometriosis in 23 of the 50 subjects (46%), including 10 of the 23 patients (43.5%) with obstructed hemivagina ipsilateral renal anomaly syndrome (OHVIRAS), six of eight patients (75%) with a unicornuate uterus with a non-communicating functional horn, two of three patients (66.7%) with distal vaginal aplasia, and five of five patients (100%) with cervicovaginal aplasia. Persistent dysmenorrhea, following treatment, affected 14 of the 50 adolescents (28%), including 8 of the 17 subjects (47.1%) diagnosed with endometriosis at the time of surgical correction and six adolescents diagnosed with endometriosis during the follow-up. Conclusions: Endometriosis affects about half of young adolescents undergoing surgical treatment of obstructive Müllerian anomalies after menarche. The incidence of endometriosis is highest in girls with cervical aplasia. The risk of developing endometriosis decreases after surgical correction of obstruction but is still significant in patients with uterine anomalies. [ABSTRACT FROM AUTHOR]

Obstructive vaginal and uterine anomalies including imperforate hymen, transverse vaginal septum, and vaginal and/or cervical atresia or aplasia, might rarely present in infancy or childhood with hydrocolpos and/or hydrometra but they usually go unrecognized until presentation with amenorrhea and hematocolpos and/or hematometra in puberty. They should always be included in the differential diagnosis of a suprapubic and/or introital mass; in the latter case, vaginal vascular malformations and vaginal tumors should also be considered. Uterovaginal aplasia typically manifests with amenorrhea in puberty and needs to be differentiated from complete androgen insensitivity syndrome and gonadal dysgenesis of genetic males. Uterine fusion anomalies usually present with fertility and/or obstetrical complications in adulthood. However, a unicornuate uterus with a blind rudimentary contralateral horn containing functioning endometrium, and didelphys or septate uterus with a deviating obstructive septum might present in childhood or puberty with sequelae related with secretions or menstrual retention. This review provides a collective account of the most clinically important information about vaginal and uterine anomalies in childhood and adolescence for clinicians involved in the care of young females with the aim to provide guidance in appropriate evaluation and management. Synopsis: An overview of the most important aspects of the surgical anomalies of the vagina and the uterus in children and adolescents. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Vesico-cervical (VCxF) is an uncommon entity among the gamut of genitourinary fistulas. The common causes include prolonged labor, previous lower-segment cesarean sections (LSCS), difficult vaginal deliveries, and traumatic injuries. Methods: A 31-year-old woman presented with a history of LSCS for prolonged labor 4 years ago followed by a failed robotic repair for diagnosed VCxF and vesico-uterine fistula (VUtF) 1 year ago. The patient developed a recurrence 4 weeks after catheter removal. The patient underwent cystoscopic fulguration 6 months after the robotic surgery, but this failed after 2 weeks. Now, the patient presented with continuous urine leakage through the vagina for 6 months. On evaluation, she was diagnosed with recurrent VCxF and a repeat transabdominal repair was planned. On cystovaginoscopy, there was difficulty in negotiating the fistulous tract from either end. With great difficulty, we placed the guidewire from the vaginal end, which reached a false paracervical passage. Although in the false tract, the guidewire helped with localization of the intraoperative fistula site. After docking, port placement, and localization of the fistula site (tug on the guide wire), a mini cystostomy was performed. A plane was created between the bladder and cervicovaginal layer and dissected up to 1 cm beyond the fistula. The cervicovaginal layer was closed. An omental tissue interposition was followed by cystotomy closure and drain placement. Results: The postoperative period was uneventful, and the patient was discharged on the 2nd day after drain removal. The catheter was removed after 3 weeks and the patient is doing fine under regular follow-up for 6 months. Conclusions: It is challenging to diagnose and repair VCxF. Transabdominal repair is better than transvaginal repair owing to its location. Patients can opt for open or minimally invasive (laparoscopic/robotic) surgery, with better postoperative outcomes in minimally invasive techniques. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Rectovaginal fistula is an epithelium-lined direct communication route between the vagina and the rectum. The gold standard of fistula management is surgical treatment. Rectovaginal fistula after stapled transanal rectal resection (STARR) may be challenging to treat, due to the extensive scarring, the local ischemia, and the risk of rectal stenosis. We aimed to present a case of iatrogenic rectovaginal fistula after STARR that was successfully treated with a transvaginal primary layered repair and bowel diversion. Methods: A 38-year-old woman was referred to our division for continuous fecal discharge through her vagina that developed a few days after she had a STARR for prolapsed hemorrhoids. Clinical examination revealed a 2.5 cm-wide direct communication between the vagina and rectum. After proper counseling, the patient was admitted to transvaginal layered repair and temporary laparoscopic bowel diversion Results: No surgical complications were observed. The patient was successfully discharged home on postoperative day 3. Bowel diversion was reversed after 2 months. At the current follow-up (6 months), the patient is asymptomatic and without recurrence. Conclusions: The procedure was successful in obtaining anatomical repair and relieving symptoms. This approach represents a valid procedure for the surgical management of this severe condition. [ABSTRACT FROM AUTHOR]

This article discusses the barriers that transgender and gender-diverse individuals face when accessing gender-affirming surgery in Canada. Two qualitative research studies highlight the stigmatization and trauma experienced by these patients within the healthcare system. The Canadian Census of 2021 revealed that approximately 0.33% of individuals older than 15 years in Canada identify as transgender, nonbinary, or gender diverse. While not all individuals seek medical interventions, many desire the ability to express their gender physically and seek medical care to do so. The article emphasizes the importance of healthcare practitioners delivering compassionate care to this population, as it can significantly impact their well-being. The inclusion of transgender health care in medical curricula and the availability of continuing medical education resources are positive steps towards improving care for transgender and gender-diverse patients. [Extracted from the article]

Introduction: Many urologic surgeries and urologic conditions that urologists manage (e.g. STD's, genital pain and injury, wound care) involve the genital area. Throughout the process of urologic care, urologists depend on patients to be able to assess the appearance of their genital area so that they can alert their urologist of worrisome changes. Urologists assume that patients can see their genital areas clearly. However, there is no literature to date that assesses how reliable this assumption is. That is, to date, we do not know how much of the genital area is commonly visible to people with female genital anatomy. Objective: In the present work, we ask adult women to indicate how far posteriorly in their genital area they can see. We also query whether patient age and BMI predict visibility in genital sub-fields. Methods: A total of 82 cis-gender and 12 transgender women participated in our study. No subjects had visual or ambulation deficits. Each was shown an anatomic illustration with genital anatomy subdivided into various subfields (anterior to posterior). Subjects were asked to circle each field that they are able to see with their own eyes, on their body, without the aid of a camera or mirror. Age, height, and weight were recorded. Logistic regression was performed for visibility by age and BMI. Results: Average visibility decreased the more posteriorly the visual field was located. Visibility decreased precipitously for all fields posterior to the clitoris. For cis-gender women, 44-91% could not see their vulva below their clitoris (i.e. peri-urethral area, vaginal introitus, majority of their Labia, and anus. These results were more extreme for transgender women who have undergone vaginoplasty surgery. Interestingly, BMI was not a significant predictor of field-visibility. Conclusions: Visibility of the genital areas posterior to the clitoris is limited among cis and transgender women. Visibility decreases the more posterior a visual field is, and elevated BMI significantly reduces genital visibility. Providers should bear in mind that many women cannot directly see a significant portion of their genital area. This is especially important during monitoring after genital area surgery, and may other urologic, primary, and gynecologic care conditions. This is the first study to describe how much of the genital area is directly visible to patients. Disclosure: No. [ABSTRACT FROM AUTHOR]

In the vast field of gynaecology, Female Cosmetic Genital Surgery (FCGS) is the newest and fastest growing sub specialty due to sexual distress and vaginal laxity. It includes operations intended to alter the genitalia of women in terms of function and/or aesthetics. Using electronic databases including MEDLINE/PubMed, Embase, and Scopus, a literature review search with current advancements was carried out without regard to dates or research designs. The search was based on 40 different cosmetic gynaecological terms, including “surgical vaginoplasty,” “labiaplasty,” “vaginal rejuvenation,” “vaginismus,” and “energy based devices,” amongst others. All english full-text prospective, retrospective, and interventional studies describing cosmetic gynaecological procedures that included at least five participants were considered. Efficacy and satisfaction metrics were highly variable ranging from validated questionnaires to no outcome subjectively or objectively quantified. This review provides an overview of the developing field of cosmetic gynaecology as well as the opinions of the authors and current developments in the study of this therapeutic area. Vaginal laxity is common and may impact sexual function and quality of life. Expanding aesthetic gynaecology may benefit the patients in their Female Sexual Function Inventory (FSFI) scores, intimate wellness, and psychosocial function.

Introduction and hypothesis: We report our experience with a transvaginal approach with overlapping anal sphincter repair. The aim of this cohort study was to evaluate long-term functional outcomes. Women who had undergone transvaginal anal sphincteroplasty for anal incontinence from July 2005 to July 2020 and attended a multidisciplinary team of urogynaecologists and colorectal surgeons at the Mercy Hospital Perineal clinic were included. Methods: One hundred seven women were included in the study with a median follow-up of 57.5 months. We analysed outcomes by comparing patient's St Mark's score difference before and after surgery. Meaningful clinical difference (MID) was set at 5 points; complications and patient demographics were recorded along with a question about whether they would recommend this treatment to a friend. Results: An improvement was seen in 69.3% of women with a marked improvement in 46.5%. Furthermore, 70% said they would recommend the procedure to a friend, if they were in a similar situation. Wound infection or partial perineal breakdown was reported in 45% of women but did not have a significant impact on outcomes. Conclusion: Transvaginal anal sphincter repair is associated with significant improvements in patients' St. Mark's score. Our data show that the long-term success rate of transvaginal/perineal AS repair may be better than previously reported in the literature with 70% of women satisfied at 57 months. Another benefit of the transvaginal route is the possibility of performing a pelvic floor and perineal repair at the time of surgery. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of this study is to compare the perioperative, anatomical and functional outcomes of patients with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), undergoing Sheares vaginoplasty, vaginoplasty using acellular porcine small intestinal submucosa (SIS) graft or laparoscopic peritoneal (Davydov) vaginoplasty. Methods: In this retrospective study, a total of 117 patients with MRKHS undergoing creation of a neovagina from 2017 to 2020 were retrospectively investigated. Comparisons between continuous variables were performed using Student's t-test and between qualitative variables using chi-squared tests. Results: The operative time, return of bowel activity and return to work were the longest in the laparoscopic Davydov group (P < 0.001). The total cost was the highest in the SIS graft group (P < 0.001). The length of the neovagina was 7.9 ± 1.2 cm in the Sheares group, 7.1 ± 0.8 cm in the SIS graft group and 8.1 ± 1.1 cm in the laparoscopic Davydov group. The difference in the length of the neovagina was significant (P < 0.001). There was significant difference in the duration of continuous mould wearing (P < 0.001). There were no significant differences in the total female sexual function index (FSFI) scores or in the satisfaction scores of the male partner among the three groups. Conclusion: Sheares vaginoplasty and the vaginoplasty using SIS graft caused less trauma and provided similar functional results to laparoscopic peritoneal vaginoplasty. However, the patients in the Sheares group and SIS graft group needed to wear the mould for a longer duration post-surgery. Sheares vaginoplasty can provide a valuable and economic alternative method for the creation of a neovagina in patients with MRKHS. [ABSTRACT FROM AUTHOR]

The surgical treatment of girls with cervical atresia and complete absence of the vagina remains a problem because of the rarity of cases and the controversial study results. To describe the surgical technique and long-term results of laparoscopically assisted uterovestibular anastomosis in patients with cervical atresia and complete absence of the vagina Sixteen consecutive patients with cervical atresia and complete absence of the vagina were conservatively treated with laparoscopically assisted uterovestibular anastomosis in 2 tertiary care referral centers. The follow-up assessments included clinical examination, determination of the presence and quality of sexual intercourse, and vaginoscopy. All patients underwent laparoscopically assisted uterovestibular anastomosis. No perioperative complications occurred. The mean follow-up period was 8 ± 3.2 years. In all patients, the length of the neovagina was greater than 4 cm at 1 year after the surgery and approximately 6 cm after 2 years. After the start of sexual intercourse, the neovagina exceeded 7 cm in length in 2 of the 11 sexually active patients. At 12 months after the surgery, iodine-positive epithelium was present in all patients and was maintained over time. The continuity of the neovagina, neocervix, and uterine body was maintained without further interventions in 15 of the 16 patients. During the follow-up, 11 patients were sexually active, 5 were married, 4 were seeking conception, and 2 had spontaneous pregnancy. Laparoscopically assisted uterovestibular anastomosis seems to be a safe and effective treatment for patients with cervical atresia and complete absence of the vagina, at least in terms of the recovery of menstrual function and sexual activity. [ABSTRACT FROM AUTHOR]

Importance: Vaginoplasty is a relatively common gender‐affirming surgery with approximately 200 Ontarians seeking this surgery annually. Although Ontario now offers vaginoplasty in province, the capacity is not meeting demand; the majority of trans and gender‐diverse patients continue to seek vaginoplasty out of province. Out‐of‐province surgery presents a barrier to accessing postsurgical follow‐up care leaving most patients to seek support from their primary care providers or providers with little experience in gender‐affirming surgery. Objective: To provide an account of the common postoperative care needs and neovaginal concerns of Ontarians who underwent penile inversion vaginoplasty out of province and presented for care at a gender‐affirming surgery postoperative care clinic. Design, Settings, and Participants: A retrospective chart review of the first 80 patients presenting to a gender‐affirming surgery postoperative care clinic who had undergone vaginoplasty at an outside surgical center was performed. Descriptive analyses were performed for all variables. Results: The sample consisted of 80 individuals with the mean age of 39 years (19–73). Most patients had surgery at another surgical center in Canada (76.3%). Many patients (22.5%) accessed care in the first 3 months after surgery, with the majority (55%) seeking care within the first perioperative year. Most patients (61.3%) were seen for more than one visit and presented with more than two symptoms or concerns. Common patient‐reported symptoms during clinical visit included pain (53.8%), dilation concerns (46.3%), and surgical site/vaginal bleeding (42.5%). Sexual function concerns were also common (33.8%) with anorgasmia (11.3%) and dyspareunia (11.3%) being the most frequent complications. The most common adverse outcomes identified by health care providers included hypergranulation (38.8%), urinary dysfunction (18.8%), and wound healing issues (12.5%). Conclusions and Relevance: Findings from chart review offer valuable insights into the postoperative needs and neovaginal concerns of Ontarians who have had vaginoplasty out of province. This study demonstrates the need for routine postoperative care in patients undergoing vaginoplasty. Patients experience numerous symptoms and concerns that often correlate with clinical findings and require multiple follow‐up appointments. Health care providers may benefit from further education on the more common nonsurgical issues identified in this study. [ABSTRACT FROM AUTHOR]

Background: Vaginoplasty is the most frequent genital gender-affirming surgery. Although both functional and aesthetic outcomes after transfeminine vaginoplasty have improved over the years, cosmetic revision surgeries demand after transfeminine vaginoplasty appears to be increasing and requires updated knowledge. Methods: All patients who underwent vulvar cosmetic revision surgeries at our institution following transfeminine vaginoplasty from January 2014 to April 2022 were studied. The prevalence, topography and surgical techniques of cosmetic revision surgeries after transfeminine genital gender-affirming surgery were examined using clinical charts review and statistical analysis. Results: During the study period, 354 patients underwent gender-affirming vaginoplasty at our single institution (212 penile inversion vaginoplasty, 122 colovaginoplasty and 20 penile inversion vaginoplasty with scrotal skin graft patients). Forty out of these 354 patients (11.29%) required cosmetic revision surgery after transfeminine vaginoplasty; additionally, 44 patients with vaginoplasty performed at other centres also underwent vulvar cosmetic revision surgery at our clinic during the study period. From all performed cosmetic revision surgeries, most of them (31.42%) were labia corrections, followed by clitoris (23.26%) repair surgeries. Mons Venus (10.20%), urethral meatus (9.38%), spongiosus tissue remnants (8.57%) and introitus (6.53%) revisions followed in frequency. Corrections of peri-inguinal scars (5.30%), anterior commissure (2.84%) and inferior fourchette (2.42%) were less prevalent. No differences were found among the different studied vaginoplasty techniques regarding cosmetic revision surgery prevalence or topography following transfeminine vaginoplasty (p < 0.05). Conclusions: Cosmetic revision surgeries after transfeminine vaginoplasty are frequent. In our large and long-term cohort study, labiaplasty followed by clitoroplasty were found as the most required cosmetic revision surgical procedures. Further multicentre, prospective and controlled studies are necessary to improve cosmetic outcomes and scientific evidence after transfeminine vaginoplasty. Level of evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Objectives: To develop a surgical technique to achieve greater depth of the neovaginal cavity in transgender patients undergoing scrotovaginoplasty, and to propose a method for restoring neovaginal integrity in case of lack of genital skin or reduction of the depth due to scarring after infections or ischaemic processes. Methods: Eight patients were selected to undergo scrotovaginoplasty with scrotal graft and peritoneal flap augmentation in one operating session as a modification of Zhao's original technique. The age of the patients ranged from 25 to 65 years. The first step of the procedure was standard penile inversion vaginoplasty, avoiding suturing of the superior side of the skin cylinder. The skin cylinder was pushed into the abdominal cavity through the perineal access. Afterwards a laparoscopic/robotic approach was used: a single peritoneal flap was harvested from the posterior bladder surface, incised, dissected, pedicled on the neovaginal dome, overturned and and sutured all‐round to the neovagina. The sides were adapted to obtain a 'cul‐de‐sac'. Results: The average operating time was 6 ± 1.5 h, and patients' hospitalization lasted 6 days. There were no intra‐ or postoperative complications. Postoperative management was the same as that usually reported in BJUI for patients undergoing standard scrotovaginoplasty. Conclusions: The use of this technique represents a good solution for increasing neovaginal depth by harvesting a large peritoneal vascularized flap, without significantly affecting postoperative management or increasing complications, as frequently observed using the colovaginoplasty technique. [ABSTRACT FROM AUTHOR]

Purpose/objective: Laparoscopic sacrocolpopexy has been demonstrated to be the gold standard of prolapse surgery in cases with apical defect. Most recurrences seem to occur in the anterior compartment, especially if a paravaginal defect is present. To reduce the incidence of anterior recurrence after laparoscopic sacrocolpopexy we modified our previous published technique by placing the anterior mesh not only deep under the bladder but also laterally and fixing it to the lateral edge of the vagina. With this video article, we would like to show and explain our modified technique and demonstrate how lateral mesh placement can be easily and safely performed using laparoscopy. Methods: The video demonstrates our modified technique with lateral extension and fixation of the anterior mesh to the lateral vagina during laparoscopic sacrocolpopexy in a patient with severe uterine prolapse (grade III) and a large cystocele (grade III). Special emphasis is given to the topographical anatomy of the paravaginal space and the surgical technique of lateral fixation. Results: This modified new technique shows excellent perioperative results in more than 100 cases without any occurrences of lesions of the ureters. Our initial experience also shows very good anatomical results in all three compartments. Conclusions: Paravaginal dissection and exposure of the ureters to extend the mesh placement and fixation to the lateral border of the vagina in the anterior compartment during laparoscopic sacrocolpopexy seem to be feasible and safe, helping to significantly reduce the risk of anterior recurrences. Prospective data are needed to evaluate this interesting technique. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: As a consequence of the evolution of surgery in reconstructive techniques, cervicovaginal reconstruction has become an option for patients diagnosed with congenital cervical and vaginal atresia. This study was aimed at comparing long-term clinical and anatomical results in patients who had cervicovaginal reconstruction with either a small intestinal submucosa (SIS) graft or a split-thickness skin (STS) graft. Methods: This was a retrospective study of 34 patients who underwent cervicovaginal reconstruction using SIS or STS grafts between January 2012 and August 2017. The patients' postoperative resumption of menstruation, vaginal length, body image satisfaction, and sexual satisfaction were assessed. Quantitative and categorical variables were compared using Student's t test and Chi-squared test respectively. Results: The mean follow-up time was 81.29 ± 20.69 months. The SIS group had a shorter surgery time, an earlier return to work, and a higher cost (p < 0.05). All patients resumed menstruation, but 4 patients were diagnosed with cervical stricture. There was no significant difference in the length of the neovagina, and the satisfaction score of the sexual life of patients and their sexual partners was similar in both groups. Patients in the SIS group showed greater satisfaction with their bodies (p < 0.001). One patient in the SIS group got pregnant via assisted-reproduction techniques. Conclusions: Cervicovaginal reconstruction using SIS or STS grafts is an effective treatment for patients diagnosed with congenital cervical and vaginal atresia. The method of SIS graft is simpler, with less surgical injury and greater body satisfaction, but it is more expensive. [ABSTRACT FROM AUTHOR]

Background Contradictory findings on sexual health in women with Mayer-Rokitansky-Kuester-Hauser syndrome (MRKHS) after vaginal reconstruction point toward the need for more profound assessment of this subject, particularly as it is still unclear what constitutes sexual well-being, especially genital self-image or sexual self-esteem, in women with MRKHS and neovagina. Aim The aim of this qualitative study was to assess individual sexual health and sexual well-being in the context of MRKHS after vaginal reconstruction, with an emphasis on genital self-image, sexual self-esteem, sexual satisfaction, and coping with MRKHS. Methods Qualitative semistructured interviews were conducted with women with MRKHS after vaginal reconstruction (n = 10) with the Wharton-Sheares-George surgical method and a matched control group without MRKHS (n = 20). Women were surveyed about their previous and current sexual activities, perception of and attitudes toward their genitals, disclosure to others, coping with the diagnosis, and perception of surgery. Data were analyzed through qualitative content analysis and compared with the control group. Outcomes The primary outcomes of the study were major categories, such as sexual satisfaction, sexual self-esteem, genital self-image, and dealing with MRKHS, as well as subcategories related to the content analysis. Results Although half the women in the present study indicated that they were coping well with their condition and were satisfied with sexual intercourse, most felt insecure about their neovagina, were cognitively distracted during intercourse, and showed low levels of sexual self-esteem. Clinical Implications A better understanding of expectations and uncertainties regarding the neovagina might help professionals to support women with MRKHS after vaginal reconstruction to increase sexual well-being. Strengths and Limitations This is the first qualitative study focusing on individual aspects of sexual well-being, especially sexual self-esteem and genital self-image, in women with MRKHS and neovagina. The qualitative study indicates good interrater reliability and data saturation. The limitations of this study include the inherent lack of objectivity resulting from the method but also the fact that all the patients had a particular surgical technique, consequently resulting in limited generalizability of these findings. Conclusions Our data indicate that integrating the neovagina into the genital self-image is a prolonged process that is essential for sexual well-being and should thus be the focus of sexual counseling. [ABSTRACT FROM AUTHOR]

Background An increasing number of nonbinary patients are receiving gender-affirming procedures due to improved access to care. However, the preferred treatments for nonbinary patients are underdescribed. The purpose of this study was to investigate the goals and treatments of nonbinary patients. Methods A retrospective study of patients who self-identified as nonbinary from our institutional Gender Health Program was conducted. Patient demographics, clinical characteristics, surgical goals, and operative variables were analyzed. Results Of the 375 patients with gender dysphoria, 67 (18%) were nonbinary. Over half of the nonbinary patients were assigned male at birth (n = 57, 85%) and nearly half preferred the gender pronoun they/them/theirs (n = 33, 49%). A total of 44 patients (66%) received hormone therapy for an average of 2.5 ± 3.6 years, primarily estrogen (n = 39). Most patients (n = 46, 69%) received or are interested in gender-affirming surgery, of which, almost half were previously on hormone therapy (n = 32, 48%). The most common surgeries completed or desired were facial feminization surgery (n = 15, 22%), vaginoplasty (n = 15, 22%), mastectomy (n = 11, 16%), and orchiectomy (n = 9, 13%). Nonbinary patients who were assigned male at birth (NB-AMAB) were more often treated with hormones compared to nonbinary patients assigned female at birth (NB-AFAB) (72% vs. 30%, p = 0.010). Conversely, patients who were AFAB were more likely to complete or desire surgical intervention than those who were AMAB (100% vs. 63.0%, p < 0.021). Conclusion Majority of nonbinary patients were assigned male at birth. NB-AFAB patients all underwent surgical treatment, whereas NB-AMAB patients were predominantly treated with hormone therapy. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The passage of the Affordable Care Act improved access to gender-affirming care but positioned insurers as the primary gatekeepers of treatment. Insurers have developed criteria for coverage approval that result in barriers to care for some individuals. In this study, the author sought to understand the experiences of individuals seeking insurance coverage for gender-affirming top surgery. This report summarizes the role of navigators in facilitating access to coverage. METHODS: This study is based on semistructured, in-depth interviews with 30 transgender and gender diverse people assigned female at birth. The participants were diverse in age, race and ethnicity, geographic location, type of insurance coverage, and care setting. Thematic analysis was used to examine key influences on the coverage-seeking process. RESULTS: Participants identified navigation as a key domain. Analysis centered on 3 themes: navigators improving access to care; the contribution of lesbian, gay, bisexual, transgender, queer plus (LGBTQ+) health centers in facilitating access; and the role of informal navigators in furthering the inequitable distribution of care. Participants reported that navigators improved the likelihood of insurance coverage for gender-affirming surgeries and reduced health care inequities based on sociodemographic characteristics. CONCLUSION: Nonstandardized criteria among insurers promote inequitable access to health care because approval relies on consumer ability to navigate complex systems and adequate economic resources to fulfill criteria. Improved access to navigators would reduce barriers to gender-affirming care. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the long‐term outcomes of laparascopic sigmoid cervicovaginoplasty in patients with congenital cervicovaginal atresia with a functioning uterus. Methods: In this case series study, seven patients with cervicovaginal atresia with a functioning uterus underwent laparoscopic sigmoid cervicovaginoplasty surgery between 2016 and 2020. Mean follow‐up duration was 25.9 months (2–48 months). All of the patients had regular menstrual cycles. The average length of the vagina was 8.9 cm (7.6–10.5 cm). In one patient, proximal stenosis of neovagina was observed 12 months after surgery. Results: The mean age and body mass index of the patients were 18 years (12–27 years) and 19.7 (17.6–22.4), respectively. The average time period between the initiation of disease symptoms and the operation was 52.28 months (2–156 months). There were no postoperative short‐term complications. We did not perform hysterectomy in our patients. None of our patients complained of signs of low anterior resection syndrome. Two patients had sexual activities without dyspareunia, postcoital bleeding, or malodorous vaginal discharge. Conclusion: Sigmoid cervicovaginoplasty is a safe and effective procedure with satisfactory long‐term outcomes. This surgery eliminates the psychological burden of hysterectomy in these patients. Through preserving the uterus, patients may have a chance of possible future pregnancy if abdominal cerclage is performed. Synopsis: Laparoscopic sigmoid cervicovaginoplasty has satisfactory long‐term outcomes for patients with congenital cervicovaginal atresia and functioning uterus. [ABSTRACT FROM AUTHOR]

Introduction: We analyzed the frequency, presentation and pitfalls in the diagnosis and surgical management of a large group of normomenstruating adolescents with obstructive reproductive tract anomalies. Material and methods: Retrospective analysis of prospectively collected data. Of the 143 outpatients referred for severe dysmenorrhea and persistent pelvic pain, 42 (29.3%) young women with obstructive Müllerian anomalies and regular menstrual flow were identified. These patients were divided into four groups: (1) patients with duplicate uterine cavities, obstructed hemivagina and ipsilateral renal agenesis (n = 34); (2) patients with unicornuate uterus and noncommunicating cavitated rudimentary horn (n = 5); (3) patients with accessory cavitated uterine mass (n = 2); (4) patients with partially obstructed transverse vaginal septum (n = 1). All 42 patients were conservatively treated via laparoscopy and 35/42 patients had also vaginal surgery. Results: Of the four groups, patients in groups 2 and 3 (n = 7) were conservatively managed by laparoscopy alone; for patients in groups 1 and 4 (n = 35), laparoscopy and the vaginal approach were used. Patients of group 1 were treated by resecting the obstructed vaginal septum with drainage of retained collections. In patients in group 2, surgery consisted of the removal of the rudimentary horn. Patients of group 3 were treated by the removal of myometrial neoformations. In the patient in group 4, treatment consisted of removal of the septum. All surgical procedures were successful and no major complications were recorded. Follow‐up reports highlighted the disappearance of obstruction and clear improvement in pain symptoms. Conclusions: Unilateral obstructive anomalies of the female genital tract are difficult to identify. Early diagnosis allows the preservation of reproductive activity and avoids potential complications. [ABSTRACT FROM AUTHOR]

Our understanding of prostate cancer in transgender women (TW) is still in its infancy. There are no formal guidelines on how to perform prostate-specific antigen (PSA) screening or what is considered an elevated PSA level in TW. Future work should aim to establish guidance on PSA screening risks and benefits in TW. Approximately 0.4–1.3% of the worldwide population is transgender. Although the exact prevalence is unknown, there is an increase in open identification as transgender. Among transgender women (TW), the prostate is retained even after gender-affirmation surgery, thus necessitating ongoing screening for prostate cancer (CaP). However, little is known about CaP screening in this population. To assess our current understanding of CaP incidence and prostate-specific antigen (PSA) screening in TW. We performed a nonsystematic narrative review of all PubMed publications through June 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Given the limited primary research on this subject, case reports were also included. Studies were reviewed to understand PSA screening practices and reports of CaP in this population, as applicable. There is no consensus regarding PSA screening in TW from any of the major societies, and TW are largely absent from guidelines. Case report data suggest that TW with CaP may have more aggressive disease, and these cancers may have been pre-existing prior to present before gender-affirming hormone therapy (GAHT) or be castrate-resistant. We are in the infancy of our understanding of PSA screening in TW. Important avenues for future research include understanding the risks/benefits of PSA screening in TW, how best to mitigate potential negative psychological effects of PSA screening in TW, establishing baseline PSA values for those on GAHT (and determining what values should be considered "elevated"), establishing when to initiate PSA screening for those on GAHT, and establishing the accuracy of biomarkers for those undergoing GAHT. We examined patterns of prostate cancer screening for transgender women. Little is known about prostate cancer incidence or screening in this population. Additional research is needed to establish guidelines for screening in this population. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to assess blood loss during facial feminization surgeries and to evaluate blood transfusion requirements. Data from the medical records of all male-to-female transgender patients (transwomen) treated with gender affirming hormones and undergoing facial feminization surgeries were analysed. The total blood loss was calculated based on the haemoglobin balanced method. Twenty transwomen (average age of 25.9 years) were enrolled. Group 1 included 10 transwomen who underwent cranioplasty, genioplasty, and mandibular angles refining, group 2 included six transwomen who underwent cranioplasty and genioplasty, and group 3 included four transwomen who underwent mandibular angles refining and genioplasty. The median calculated blood loss for groups 1, 2, and 3 was 1159.7 ml, 828.5 ml, and 546.2 ml, respectively. The group differences in surgical time, intraoperative fluid amounts, and calculated blood loss volumes were significant. None of the patients required an intraoperative blood transfusion and the hormonal treatment had no effect on the amount of calculated blood loss. Hence, blood loss during facial feminization surgeries is well controlled and does not lead to life-threatening events, precluding the possibility of providing generalized recommendations for preoperative blood transfusion preparations. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Anterior bilateral sacrospinous ligament fixation (ABSSLF) was first described in 2000 but only evaluated in a limited number of studies. However, due to the FDA's ban on transvaginal mesh, interest in this technique has re-emerged. The SSLF procedure is known for its inherent high risk for anterior compartment failure; hence, in our center we started performing a preemptive concomitant anterior repair with the intention to reduce such risk. The aim of this study was to review the feasibility and clinical outcomes of this innovative technique. Methods: We performed a retrospective cohort study of all the women who had an ABSSLF and a concomitant anterior native tissue repair between May 2019 and July 2020 in a tertiary hospital in France. Our primary endpoint was surgical feasibility, while as secondary endpoints we wanted to explore the perioperative morbidities and clinical outcomes associated with this technique. Results: A total of 50 women were operated on in the studied period. The median follow-up time was 10 [8.5] months. It was feasible to perform the combined ABSSLF and concomitant anterior native tissue repair in all cases. The most frequent perioperative complications reported were urinary tract infection (14%) and difficulty in resuming voiding (16%). Anatomical and functional results were improved. The rate of anterior compartment recurrence was 37%. Conclusions: ABSSLF with a concomitant anterior native tissue repair is feasible and relatively safe for treating anterior and apical pelvic prolapse. However, anterior compartment failure rate is still a limitation. Further larger studies with long-term anatomical and functional results comparing this technique to alternative transvaginal surgical approaches are needed. [ABSTRACT FROM AUTHOR]

Infants with genital development considered atypical for assigned female sex may undergo feminizing genitoplasty (clitoroplasty and/or vaginoplasty) in early life. We sought to identify factors associated with parent/caregiver decisions regarding genitoplasty for their children with genital virilization. Longitudinal, observational study Twelve pediatric centers in the United States with multidisciplinary differences/disorders of sex development clinics, 2015-2020 Children under 2 years old with genital appearance atypical for female sex of rearing and their parents/caregivers Data on the child's diagnosis and anatomic characteristics before surgery were extracted from the medical record. Parents/caregivers completed questionnaires on psychosocial distress, experience of uncertainty, cosmetic appearance of their child's genitalia, and demographic characteristics. Urologists rated cosmetic appearance. For 58 patients from the study cohort with genital virilization being raised as girls or gender-neutral, we compared these data across 3 groups based on the child's subsequent surgical intervention: (i) no surgery (n = 5), (ii) vaginoplasty without clitoroplasty (V-only) (n = 15), and (iii) vaginoplasty and clitoroplasty (V+C) (n = 38). Fathers' and urologists' ratings of genital appearance were more favorable in the no-surgery group than in the V-only and V+C groups. Clitorophallic length was greater in the V+C group compared with the V-only group, with substantial overlap between groups. Mothers' depressive and anxious symptoms were lower in the no-surgery group compared with the V-only and V+C groups. Surgical decisions were associated with fathers' and urologists' ratings of genital appearance, the child's anatomic characteristics, and mothers' depressive and anxious symptoms. Further research on surgical decision-making is needed to inform counseling practices. [ABSTRACT FROM AUTHOR]

Background: Vaginoplasty is among female genital cosmetic surgery methods, which has increasingly gained popularity among women seeking a solution to enhance their sexual functioning. The objective of this study was to evaluate the postoperative self-esteem, sexual satisfaction, coping with stress, and defense mechanisms in married Turkish women who underwent vaginoplasty surgery. Methods: A total of 106 women who underwent vaginoplasty and 106 healthy control subjects were evaluated. Study data were collected through face-to-face interviews using "Personal Information Form," "Coopersmith Self-Esteem Inventory," "Sexual Satisfaction Scale," "Coping Responses Inventory," and "Defense Style Questionnaire" and compared between the two groups. Results: The mean Coopersmith Self-Esteem Inventory score was significantly higher in the vaginoplasty group compared to the controls (p < 0.001). The mean ego-focused sub-dimension score of the Sexual Satisfaction Scale was significantly higher in the control group (p = 0.005), while the mean logistic analysis sub-dimension score of the Coping Responses Inventory was significantly higher in the vaginoplasty group (p = 0.002). There was a statistically significant positive correlation between self-esteem and mature defenses in both the vaginoplasty and control groups (p = 0.028, p = 0.020, respectively). The correlation between the self-esteem and immature defenses was significantly negative in both groups (for both p < 0.001). Conclusions: The main results of this study indicate a higher self-esteem and sexual satisfaction in women undergoing vaginoplasty. In addition, the use of mature defense mechanisms was also higher among these women compared to healthy control subjects. These results show the importance of both preoperative and postoperative psychiatric evaluations in women undergoing cosmetic genital surgeries. Level of evidence: Level II, Risk/Prognostic. [ABSTRACT FROM AUTHOR]

Genital gender affirming surgery is an effective treatment for gender dysphoria in transgender individuals. Optimization of medical and mental health conditions, including coordination with a patient's entire care team, is essential. Feminizing procedures include vaginoplasty (creation of female genitalia with a vaginal canal) and vulvoplasty (creation of female genitalia with a short or absent vaginal canal). Masculinizing procedures include metoidioplasty (construction of male genitals via local tissue rearrangement) and phalloplasty (creation of a phallus from extra-genital tissue). We aim to provide an overview of genital gender affirming surgery for providers who are interested in learning more about genital gender affirming surgery. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the outcomes following vaginoplasty by pudendal thigh flap. Study Design: Retrospective longitudinal study. Place and Duration of the Study: Plastic surgery Department, Shifa International Hospital, Islamabad Pakistan, from Jan 2010 to Dec 2021. Methodology: Vaginal reconstruction was done using bilateral pudendal thigh flap in 20 patients with vaginal defects during eleven years, 2010-2021. Results: All patients were adults with an age range from 18 to 41 years. Five were married, and 15 were unmarried patients at the time of surgery. Out of the 20 patients, 10(50%) were diagnosed with Mayer Rokitansky Kuster Hauser syndrome, 9(45%) with isolated vaginal atresia and 1(5%) with s/p resection angiosarcoma. The mean vaginal length was 9.0±0.46cm, one year post-operatively. Two patients (10%) developed necrosis of the distal part of the unilateral flap followed by infection, which was managed conservatively, and the other was managed with the McIndoe technique. One patient developed a cutaneous fistula which was excised. All flaps survived completely in the rest of the 19(95%) patients. Conclusion: Vaginoplasty using pudendal thigh flap was a safe and reliable method for vaginal reconstruction and showed adequate functional and aesthetic results. [ABSTRACT FROM AUTHOR]

Purpose: Penile inversion vaginoplasty uses genital skin to construct the neovaginal canal. When genital skin is insufficient, extragenital tissue is needed. The purpose of this study is to evaluate which demographic factors and intraoperative anatomical measurements are associated with skin availability and the need for extragenital tissue. Materials and Methods: This was a prospective cohort study of patients undergoing penile inversion vaginoplasty from May 2016 through January 2021. Preoperative variables included patient demographics, orchiectomy and circumcision status, and stretched penile and scrotal skin lengths. Outcomes included measurements of available scrotal skin surface area and need for extragenital skin graft. Results: A total of 235 patients were included. Patients with prior orchiectomy and shorter stretched scrotal and penile lengths had less scrotal skin available (P < .002) and were more likely to require extragenital skin grafts (P < .001). Patients with prior orchiectomy had 3 times greater odds of needing additional skin grafts. Length of time exposed to gender-affirming hormones did not predict scrotal skin availability (P = .8). Conclusions: Factors associated with need for extragenital skin grafting with penile inversion vaginoplasty were prior orchiectomy and stretched penile skin length <8 cm. Scrotal skin length >10 cm was associated with low risk for needing additional graft. Considering these factors can help with preoperative planning and patient counseling. [ABSTRACT FROM AUTHOR]

Historically, outcome measures for gender-affirming genital surgery have focused on medical and surgical outcomes, with limited attention to patients' reports of post-surgical sexual function and sexual satisfaction. The aim of this scoping review was to assess the published literature on patients' sexual function and sexual satisfaction following gender affirming genital surgery, identifying gaps in the evidence base and potential areas of focus for future research efforts. Our sample included English-language studies published in the past 20 years addressing measures of sexual health, sexual function, and/or sexual well-being for individuals who underwent gender affirming genital surgery. Systematic reviews, meta-analyses, and other forms of reviews were excluded. The final sample consisted of ten articles. All studies addressed sexual function through assessment of ability to orgasm. Overall, transgender women who underwent vaginoplasty and were sexually active post-operatively described improved sexual function after surgery. In one study, transgender men showed moderate improvement of sexual function while another indicated reduced sexual function compared to transgender men treated with hormones only. Prospective research is needed to improve understanding of patients' values, goals and expectations for sexual function and sexual satisfaction following surgery, and to inform the development of validated outcomes measures. [ABSTRACT FROM AUTHOR]

Abstract Transgender and non-binary (TGNB) individuals often experience gender dysphoria. TGNB individuals with gender dysphoria may undergo genital gender-affirming surgery including vaginoplasty, phalloplasty, or metoidioplasty so that their genitourinary anatomy is congruent with their experienced gender. Given decreasing social stigma and increasing coverage from private and public payers, there has been a rapid increase in genital gender-affirming surgery in the past few years. As the incidence of genital gender-affirming surgery increases, a concurrent increase in the development and utilization of patient reported outcome measurement tools is critical. To date, there is no systematic way to assess and measure patients’ perspectives on their surgeries nor is there a validated measure to capture patient reported outcomes for TGNB individuals undergoing genital gender-affirming surgery. Without a systematic way to assess and measure patients’ perspectives on their care, there may be fragmentation of care. This fragmentation may result in challenges to ensure patients’ goals are at the forefront of shared- decision making. As we aim to increase access to surgical care for TGNB individuals, it is important to ensure this care is patient-centered and high-quality. The development of patient-reported outcomes for patients undergoing genital gender-affirming surgery is the first step in ensuring high quality patient-centered care. Herein, we discuss the critical need for development of validated patient reported outcome measures for transgender and non-binary patients undergoing genital reconstruction. We also propose a model of patient-engaged patient reported outcome measure development.

A mismatch between the birth sex of a person and psychological recognition of self (gender) leads to a gender expression, which is at variance with the societal norms, and thus gives rise to gender incongruence (GI). In the past few years, there has been a significant change in demographics, understanding of etiology, management, laws and legislations in the field of GI. The authors, who have been performing gender affirmative surgeries (GAS) since the past 27 years, present their experience in gender affirmation together with the current state of knowledge. Recent studies report a significant rise in prevalence of GI, which is similar to the experience of author and other large volume Gender identity clinics in India and worldwide. This article endeavors to provide the medical professional with the current state of knowledge in the field of GI, so that they are better equipped to optimally manage these patients.