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Semin Reprod Med 2017; 35(05): 442-447
DOI: 10.1055/s-0037-1604454
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Update on Gender-Affirming Treatment for the Transgender Woman

Cecile A. Unger
1   Center for Urogynecology and Pelvic Reconstructive Surgery, Cleveland Clinic, Cleveland, Ohio
2   Center for LGBT Care, Cleveland Clinic, Cleveland, Ohio
3   Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations
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Publication History

Publication Date:
26 October 2017 (online)

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Abstract

Transgender women often transition with cross-sex hormone therapy and some opt to further affirm themselves with breast augmentation, facial feminization procedures, and/or vaginoplasty surgery. When considering medical and surgical transition for the transgender woman, careful preoperative evaluation and individual assessment is imperative and the World Professional Association for Transgender Health (WPATH) Standards of Care provide the framework from which health care providers and surgeons may assess eligibility for affirming treatments. Vaginoplasty for the transgender woman may be performed by a variety of techniques, mainly penile inversion vaginoplasty or intestinal segment vaginoplasty. Surgical outcomes vary according to technique, and the unique risks, advantages, and disadvantages must be considered. Outcomes appear to be satisfactory following vaginoplasty surgery, but prospective, long-term data are still lacking. Providers should be aware of the peri- and postoperative management of the transgender women after genital surgery, as many women require ongoing care and management after surgery.

Keywords

male-to-female vaginoplasty - transgender woman - transgender surgery - gender affirmation surgery
 

  • References

  • 1 The World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. 2011 ; Available at: http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351&pk_association_webpage=3926 . Accessed January 30, 2017
    PubMedGoogle Scholar
  • 2 Unger CA. Care of the transgender patient: the role of the gynecologist. Am J Obstet Gynecol 2014; 210 (01) 16-26
    CrossrefPubMedGoogle Scholar
  • 3 Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA. , et al; Endocrine Society. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94 (09) 3132-3154
    CrossrefPubMedGoogle Scholar
  • 4 Giltay EJ, Gooren LJ. Effects of sex steroid deprivation/administration on hair growth and skin sebum production in transsexual males and females. J Clin Endocrinol Metab 2000; 85 (08) 2913-2921
    CrossrefPubMedGoogle Scholar
  • 5 Dittrich R, Binder H, Cupisti S, Hoffmann I, Beckmann MW, Mueller A. Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist. Exp Clin Endocrinol Diabetes 2005; 113 (10) 586-592
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Wilson R, Spiers A, Ewan J, Johnson P, Jenkins C, Carr S. Effects of high dose oestrogen therapy on circulating inflammatory markers. Maturitas 2009; 62 (03) 281-286
    CrossrefPubMedGoogle Scholar
  • 7 Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 2008; 93 (01) 19-25
    CrossrefPubMedGoogle Scholar
  • 8 Wierckx K, Gooren L, T'Sjoen G. Clinical review: breast development in trans women receiving cross-sex hormones. J Sex Med 2014; 11 (05) 1240-1247
    CrossrefPubMedGoogle Scholar
  • 9 Dahl M, Feldman J, Goldberg J. , et al. Physical aspects of transgender endocrine therapy. Int J Transgenderism 2006; 9 (3/4): 111-134
    CrossrefPubMedGoogle Scholar
  • 10 Moore E, Wisniewski A, Dobs A. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. J Clin Endocrinol Metab 2003; 88 (08) 3467-3473
    CrossrefPubMedGoogle Scholar
  • 11 Tangpricha V, Ducharme SH, Barber TW, Chipkin SR. Endocrinologic treatment of gender identity disorders. Endocr Pract 2003; 9 (01) 12-21
    CrossrefPubMedGoogle Scholar
  • 12 Gooren LJ. Clinical practice. Care of transsexual persons. N Engl J Med 2011; 364 (13) 1251-1257
    CrossrefPubMedGoogle Scholar
  • 13 Wallace P, Rasmussen S. Analysis of adulterated silicone: implications for health promotion. Int J Transgenderism 2010; 12: 167-175
    CrossrefPubMedGoogle Scholar
  • 14 Asscheman H, Gooren L. Hormone treatment in transsexuals. J Psychol Human Sex 1993; 5: 33-47
    PubMedGoogle Scholar
  • 15 Orentreich N, Durr NP. Proceedings: mammogenesis in transsexuals. J Invest Dermatol 1974; 63 (01) 142-146
    CrossrefPubMedGoogle Scholar
  • 16 Laub D. Discussion: augmentation mammaplasty in male-to-female transsexuals. Plast Reconstr Surg 1999; 104 (02) 550-551
    CrossrefPubMedGoogle Scholar
  • 17 Kanhai RC, Hage JJ, Asscheman H, Mulder JW. Augmentation mammaplasty in male-to-female transsexuals. Plast Reconstr Surg 1999; 104 (02) 542-549 , discussion 550–551
    CrossrefPubMedGoogle Scholar
  • 18 Marečková K, Weinbrand Z, Chakravarty MM. , et al. Testosterone-mediated sex differences in the face shape during adolescence: subjective impressions and objective features. Horm Behav 2011; 60 (05) 681-690
    CrossrefPubMedGoogle Scholar
  • 19 Whitehouse AJ, Gilani SZ, Shafait F. , et al. Prenatal testosterone exposure is related to sexually dimorphic facial morphology in adulthood. Proc Biol Sci 2015; 282 (1816): 20151351
    CrossrefPubMedGoogle Scholar
  • 20 Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med 2015; 12 (06) 1499-1512
    CrossrefPubMedGoogle Scholar
  • 21 Hage JJ, Karim RB. Abdominoplastic secondary full-thickness skin graft vaginoplasty for male-to-female transsexuals. Plast Reconstr Surg 1998; 101 (06) 1512-1515
    CrossrefPubMedGoogle Scholar
  • 22 Huang TT. Twenty years of experience in managing gender dysphoric patients: I. Surgical management of male transsexuals. Plast Reconstr Surg 1995; 96 (04) 921-930 , discussion 931–934
    CrossrefPubMedGoogle Scholar
  • 23 Siemssen PA, Matzen SH. Neovaginal construction in vaginal aplasia and sex-reassignment surgery. Scand J Plast Reconstr Surg Hand Surg 1997; 31 (01) 47-50
    CrossrefPubMedGoogle Scholar
  • 24 Bouman MB, van der Sluis WB, Buncamper ME, Özer M, Mullender MG, Meijerink WJ. Primary total laparoscopic sigmoid vaginoplasty in transgender women with penoscrotal hypoplasia: a prospective cohort study of surgical outcomes and follow-up of 42 patients. Plast Reconstr Surg 2016; 138 (04) 614e-623e
    CrossrefPubMedGoogle Scholar
  • 25 Wangjiraniran B, Selvaggi G, Chokrungvaranont P, Jindarak S, Khobunsongserm S, Tiewtranon P. Male-to-female vaginoplasty: Preecha's surgical technique. J Plast Surg Hand Surg 2015; 49 (03) 153-159
    CrossrefPubMedGoogle Scholar
  • 26 Selvaggi G, Ceulemans P, De Cuypere G. , et al. Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals. Plast Reconstr Surg 2005; 116 (06) 135e-145e
    CrossrefPubMedGoogle Scholar
  • 27 Perovic SV, Stanojevic DS, Djordjevic ML. Vaginoplasty in male transsexuals using penile skin and a urethral flap. BJU Int 2000; 86 (07) 843-850
    CrossrefPubMedGoogle Scholar
  • 28 Bizic M, Kojovic V, Duisin D. , et al. An overview of neovaginal reconstruction options in male to female transsexuals. Sci World J 2014; 2014: 638919
    PubMedGoogle Scholar
  • 29 Bouman MB, Buncamper ME, van der Sluis WB, Meijerink WJ. Total laparoscopic sigmoid vaginoplasty. Fertil Steril 2016; 106 (07) e22-e23
    PubMedGoogle Scholar
  • 30 Bouman MB, van Zeijl MC, Buncamper ME, Meijerink WJ, van Bodegraven AA, Mullender MG. Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function. J Sex Med 2014; 11 (07) 1835-1847
    CrossrefPubMedGoogle Scholar
  • 31 Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BP, Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals. J Sex Med 2015; 12 (07) 1626-1634
    CrossrefPubMedGoogle Scholar
  • 32 Sigurjónsson H, Möllermark C, Rinder J, Farnebo F, Lundgren TK. Long-term sensitivity and patient-reported functionality of the neoclitoris after gender reassignment surgery. J Sex Med 2017; 14 (02) 269-273
    CrossrefPubMedGoogle Scholar
  • 33 Pfäfflin F, Junge A. Sex Reassignment. Thirty Years of International Follow-up Studies After Sex Reassignment Surgery: A Comprehensive Review, 1961–1991. 1997 ; Available at: https://web.archive.org/web/20070503090247/http://www.symposion.com/ijt/pfaefflin/1000.htm . Accessed February 2, 2017
    PubMedGoogle Scholar
  • 34 Lawrence AA. Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Arch Sex Behav 2003; 32 (04) 299-315
    CrossrefPubMedGoogle Scholar
  • 35 Deutsch MB. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. 2016 ; Available at: http://transhealth.ucsf.edu/pdf/Transgender-PGACG-6-17-16.pdf . Accessed February 8, 2017
    PubMedGoogle Scholar
  • 36 Hoebeke P, Selvaggi G, Ceulemans P. , et al. Impact of sex reassignment surgery on lower urinary tract function. Eur Urol 2005; 47 (03) 398-402
    CrossrefPubMedGoogle Scholar