Transgender Post-reassignment Urogynecologic Measures and Perceptions

The intent of this mixed methods study for transgender women after gender confirmation
surgery is to characterize and subsequently create a validated screening questionnaire for
postoperative urologic and pelvic floor symptoms. For individuals who seek gender-confirming
treatment, about 13% undergo genital surgery for cosmetic purposes with or without
gonadectomy, and this number is increasing. Patient satisfaction following surgery is high,
particularly regarding sexual and cosmetic outcomes; however, unexpected negative functional
outcomes such as bowel and bladder dysfunction and pelvic organ prolapse impact overall
patient satisfaction. The available information suggests that 16-33% of patients experience
incontinence postoperatively, with stress predominance, 32-47% experience abnormal voiding,
and 24-66% experience overactive bladder symptoms. Outside of the typically assessed voiding
symptoms, unique complaints of MTF postoperative patients include obstructive voiding
symptoms due to urethral stenosis, persistent perimeatal erectile tissue, prostatic
hypertrophy, and irritation from neovaginal tissue. Additionally, may of these patients
develop symptomatic neovaginal prolapse, requiring re-suspension. We suggest that further
clarification regarding MTF postoperative urologic and pelvic floor complaints can be
achieved via a mixed methods approach. By using focus group interviews to create specific
evaluative questions for this unique population, we can then prospectively assess patients
undergoing surgery via a national multicenter sampling strategy. The goal of the study is to
better understand the unique symptoms these women experience and create a validated, reliable
screening questionnaire to monitor patients after surgery.