Summary

Surgeons from the Amsterdam gender clinic reviewed studies published from 1995 onwards on ways to surgically create a vagina in trans women. They found 26 studies. Almost all looked back at patients of a single surgical team, covering 1,461 operations using penile skin and 102 using a piece of bowel. Narrowing of the new vagina was the most common problem with both methods. Sex life and satisfaction were judged generally acceptable, but every study measured them differently, and only one measured quality of life. The authors concluded that the penile skin method is the best studied, the bowel method does not seem worse, and better-planned studies that follow patients forward with standard measures are essential. In plain terms, the review shows how weak the evidence was: it cannot reliably say how often problems or dissatisfaction happen, or which method is better.

Key findings

• Η ανασκόπηση αναζήτησε σε δύο ιατρικές βάσεις δεδομένων μελέτες από το 1995 και μετά και περιέλαβε 26 μελέτες για τα αποτελέσματα της κολποπλαστικής σε τρανς γυναίκες.
• Οι περισσότερες μελέτες ήταν αναφορές χαμηλής ή μέτριας ποιότητας που κοιτούσαν πίσω τους παλαιότερους ασθενείς ενός χειρουργού, χωρίς ομάδα σύγκρισης.
• Τα αποτελέσματα για τη μέθοδο με δέρμα πέους αναφέρθηκαν σε 1.461 άτομα και για τη μέθοδο με έντερο σε μόνο 102.
• Η στένωση ή το κλείσιμο του νέου κόλπου ήταν το συχνότερο πρόβλημα και στις δύο μεθόδους.
• Η σεξουαλική ζωή και η ικανοποίηση περιγράφηκαν ως συνολικά αποδεκτές, αλλά οι μελέτες χρησιμοποίησαν πολλά διαφορετικά ερωτηματολόγια, συχνά ερωτηματολόγια που δεν είχαν δοκιμαστεί ποτέ ως προς την ακρίβεια.
• Μόνο μία από τις 26 μελέτες ανέφερε την ποιότητα ζωής μετά την επέμβαση.
• Οι συγγραφείς κατέληξαν ότι τυποποιημένες μέθοδοι και μελέτες που παρακολουθούν τους ασθενείς προς τα εμπρός στον χρόνο είναι ουσιώδεις για να κριθούν και να συγκριθούν τα αποτελέσματα της κολποπλαστικής.

Abstract

INTRODUCTION: Gender reassignment surgery is the keystone of the treatment of transgender patients. For male-to-female transgenders, this involves the creation of a neovagina. Many surgical methods for vaginoplasty have been opted. The penile skin inversion technique is the method of choice for most gender surgeons. However, the optimal surgical technique for vaginoplasty in transgender women has not yet been identified, as outcomes of the different techniques have never been compared.

AIM: With this systematic review, we aim to give a detailed overview of the published outcomes of all currently available techniques for vaginoplasty in male-to-female transgenders.

METHODS: A PubMed and EMBASE search for relevant publications (1995-present), which provided data on the outcome of techniques for vaginoplasty in male-to-female transgender patients.

MAIN OUTCOME MEASURES: Main outcome measures are complications, neovaginal depth and width, sexual function, patient satisfaction, and improvement in quality of life (QoL).

RESULTS: Twenty-six studies satisfied the inclusion criteria. The majority of these studies were retrospective case series of low to intermediate quality. Outcome of the penile skin inversion technique was reported in 1,461 patients, bowel vaginoplasty in 102 patients. Neovaginal stenosis was the most frequent complication in both techniques. Sexual function and patient satisfaction were overall acceptable, but many different outcome measures were used. QoL was only reported in one study. Comparison between techniques was difficult due to the lack of standardization.

CONCLUSIONS: The penile skin inversion technique is the most researched surgical procedure. Outcome of bowel vaginoplasty has been reported less frequently but does not seem to be inferior. The available literature is heterogeneous in patient groups, surgical procedure, outcome measurement tools, and follow-up. Standardized protocols and prospective study designs are mandatory for correct interpretation and comparability of data.

Conclusion

The penile skin inversion technique is the most researched surgical procedure. Outcome of bowel vaginoplasty has been reported less frequently but does not seem to be inferior. The available literature is heterogeneous in patient groups, surgical procedure, outcome measurement tools, and follow-up. Standardized protocols and prospective study designs are mandatory for correct interpretation and comparability of data.