Gender-Affirming Vaginectomy with Concurrent Hysterectomy Compared to Staged Vaginectomy After Hysterectomy: A Cohort Study Analysis of 30-Day Perioperative Outcomes.

Abstract

Introduction: To evaluate and compare 30-day perioperative outcomes of those undergoing gender-affirming vaginectomy with a hysterectomy and those with vaginectomy alone.

Methods: This was a retrospective cohort study of patients who underwent gender-affirming transvaginal vaginectomy with or without concurrent minimally invasive hysterectomy at an academic institution from 2020 to 2023 by surgeons in the division of Urogynecology and Reconstructive Pelvic Surgery. The primary outcome was a composite of clinically significant surgical complications within 30 days of the procedure, including Emergency Department (ED) visits, readmissions, re-operations, and surgical and urinary tract infections.

Results: Sixty-eight patients underwent gender-affirming transvaginal vaginectomy during the study period. Thirty-one patients had vaginectomy at the time of concurrent hysterectomy, while 37 patients had staged vaginectomy following hysterectomy. The median age was 32.8 years (27.6-38.8), and the mean body mass index (BMI) was 28.5 (SD 0.7). All concurrent hysterectomies were performed laparoscopically. Most demographic characteristics were similar between the two groups, except that the staged vaginectomy group had a longer duration of hormone therapy and higher parity. No significant differences were observed in the 30-day perioperative complications between those who underwent combined procedure transvaginal vaginectomy with or without minimally invasive hysterectomy. The only notable differences were an increase in the median estimated blood loss and a longer operative time in the concurrent hysterectomy and vaginectomy group. However, no patients in the cohort required a blood transfusion, and there was no difference in the total length of hospital stay.

Conclusions: Concurrently performing hysterectomy and vaginectomy adds no significant clinical morbidity to those undergoing vaginectomy as an interval procedure following hysterectomy.