Impact of vaginoplasty on sexual health and satisfaction in transgender women.

Background: Demand for gender-affirming surgery (GAS) is rising. The main objective of this surgery is the creation of a perineo-genital complex that appears and functions as femininely as possible, with a sensitive clitoris and a vagina capable of receptive intercourse. Penile skin inversion is currently regarded as the gold standard technique. Although previous research indicates positive subjective outcomes following GAS procedures in transgender women, comprehensive data concerning their sexual satisfaction and health remains limited.

Aims: The aim of this study was to evaluate the impact of vaginoplasty on sexual health and satisfaction in transgender women using the penile inversion technique.

Methods: We performed a retrospective study on 56 patients who underwent primary penile skin inversion vaginoplasty. The survey was made of two validated questionnaires in cis-women (Female Genital Self-Image Scale and Female Sexual Function Index) and one custom questionnaire, which explored various aspects of sexual health and satisfaction.

Outcomes: Improvement in overall sexual life and satisfaction.

Results: Mean FGSIS score was 22.8 and mean FSFI score was 22.1. Sexual health after vaginoplasty was significantly improved. Around 70% (n = 39) of patients rated their post-operative self-confidence >7/10. Furthermore, 82% of our patients reported orgasm after vaginoplasty. Clitoral stimulation emerged as the primary method for achieving sexual arousal post-surgery. Upon asking: "Would you decide to have vaginoplasty again today? ", 93% patients answered "agreed or totally agreed".

Clinical implication: Using patient-reported data, these findings highlight the importance of vaginoplasty within multidisciplinary gender transition processes and its efficacy in perceived sexual health.

Limitations: Limitations of this study include reliance on patient-reported outcomes prone to recall bias and the use of non-validated questionnaires.

Conclusion: This study underscores the positive impacts of penile inversion vaginoplasty on sexual health, satisfaction, and functional outcomes, supported by patient-reported data; further studies will be necessary to provide questionnaires validated in transwomen.