Gender-Affirming Vaginoplasty Improves Quality of Life in Transfeminine Individuals

OBJECTIVE: To longitudinally evaluate patient-reported outcomes following gender-affirming vaginoplasty across multiple physical and psychosocial health domains. SUMMARY BACKGROUND DATA: Vaginoplasty is a frequently accessed genital gender-affirming surgery by transfeminine individuals. Few studies have prospectively examined patient-reported outcomes following this procedure. METHODS: A prospective, longitudinal patient-reported outcome survey study of patients undergoing gender-affirming vaginoplasty was conducted from September 2018 to February 2023 at a single institution. The primary outcomes of this study were fifteen validated patient-reported outcome measure scales across various health domains completed at three survey timepoints: preoperatively, 3-months postoperatively, and 12-months postoperatively. Individuals who completed the surveys at all three timepoints were included for final analysis. RESULTS: Response rate was 55% with 48 total participants. There was significant postoperative improvement in mental health outcomes as measured by the Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scales. The Gender Congruence and Life Satisfaction Scale (GCLS) scores as well as the BODY-Q Body Image, Social Function, and Satisfaction with Decision scales all significantly improved postoperatively compared to preoperatively. Patient-Reported Outcomes Measurement Information System (PROMIS) Pain scales demonstrated worsened pain at 3-months postoperatively but returned to preoperative levels at 12-months postoperatively. PROMIS Sexual Function scales also improved postoperatively compared to preoperatively. Minor complications did not worsen 12-month patient-reported outcomes. Major complications and mental health diagnoses were associated with worse patient-reported outcomes across a variety of scales. CONCLUSIONS: Following gender-affirming vaginoplasty, transfeminine individuals report significant improvement across a wide variety of validated patient-reported outcome measures assessing physical and psychosocial health domains.