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

• Tổng quan tìm kiếm hai cơ sở dữ liệu y khoa cho các nghiên cứu từ năm 1995 trở đi và đưa vào 26 nghiên cứu về kết quả của phẫu thuật tạo âm đạo ở phụ nữ chuyển giới.
• Hầu hết các nghiên cứu là các báo cáo chất lượng thấp hoặc trung bình xem xét lại bệnh nhân trước đây của bác sĩ phẫu thuật, không có nhóm so sánh.
• Kết quả của phương pháp dùng da dương vật được báo cáo ở 1.461 người, và của phương pháp dùng ruột chỉ ở 102 người.
• Hẹp hoặc đóng lại của âm đạo mới là vấn đề phổ biến nhất ở cả hai phương pháp.
• Đời sống tình dục và mức độ hài lòng được mô tả là nhìn chung chấp nhận được, nhưng các nghiên cứu dùng nhiều bảng câu hỏi khác nhau, thường là những bảng chưa bao giờ được kiểm tra độ chính xác.
• Chỉ một trong 26 nghiên cứu báo cáo về chất lượng cuộc sống sau phẫu thuật.
• Các tác giả kết luận rằng các phương pháp tiêu chuẩn và các nghiên cứu theo dõi bệnh nhân theo thời gian là thiết yếu để đánh giá và so sánh kết quả phẫu thuật tạo âm đạo.

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.