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

• Gjennomgangen søkte i to medisinske databaser etter studier fra 1995 og utover og inkluderte 26 studier om resultatene av vaginoplastikk hos transkvinner.
• De fleste studiene var rapporter av lav eller middels kvalitet som så tilbake på en kirurgs tidligere pasienter, uten sammenligningsgruppe.
• Resultater for penishudmetoden ble rapportert for 1 461 personer, og for tarmmetoden for bare 102.
• Innsnevring eller lukking av den nye vaginaen var det vanligste problemet med begge metodene.
• Seksualliv og tilfredshet ble beskrevet som samlet sett akseptable, men studiene brukte mange ulike spørreskjemaer, ofte slike som aldri var testet for nøyaktighet.
• Bare én av de 26 studiene rapporterte om livskvalitet etter operasjonen.
• Forfatterne konkluderte med at standardiserte metoder og studier som følger pasienter fremover i tid er avgjørende for å vurdere og sammenligne resultatene av vaginoplastikk.

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.