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

• 검토는 의학 데이터베이스 두 곳에서 1995년 이후 연구를 검색했고 트랜스 여성의 질성형술 결과에 대한 연구 26건을 포함했습니다.
• 대부분의 연구는 외과의의 과거 환자를 되돌아본 낮거나 중간 품질의 보고였고 비교 집단이 없었습니다.
• 음경 피부 방법의 결과는 1,461명에 대해, 장 방법의 결과는 102명에 대해서만 보고되었습니다.
• 새로 만든 질이 좁아지거나 막히는 것이 두 방법 모두에서 가장 흔한 문제였습니다.
• 성생활과 만족도는 전반적으로 받아들일 만하다고 설명되었지만, 연구마다 정확성이 검증된 적 없는 경우가 많은 다양한 설문지를 사용했습니다.
• 26건 중 수술 후 삶의 질을 보고한 연구는 한 건뿐이었습니다.
• 저자들은 질성형술의 결과를 판단하고 비교하려면 표준화된 방법과 환자를 시간 순으로 추적하는 연구가 필수적이라고 결론지었습니다.

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.