Gender-affirming vaginoplasty lacks universally-adopted guidelines for perioperative management. The Standards of Care developed by the World Professional Association for Transgender Health recommend surgeons provide an extensive consultation with the patient; explaining the surgery itself as well as informing the patient on pre- and post-operative expectations. With the copious amount of information to know about this process, patients may also turn to friends, support groups, the internet, etc. to find the details for themselves. We believe it would be useful to develop an inclusive guidebook outlining the entire vaginoplasty journey. 

With this study, we sought to determine what information patients seek throughout their process of gender-affirming vaginoplasty. We hope to use the results from this study to inform the development of patient resources.

This study consisted of an anonymous survey emailed to 30 patients who underwent gender-affirming vaginoplasty between September 2018 and September 2020 with our team. The survey was composed of Likert-scale items that explored the importance of various topics. Patients were also asked from whom and how did they receive information regarding perioperative considerations and where they would have preferred to get it from. Descriptive statistics were used to analyse these responses. Free-text boxes allowed patients to comment on any additional topics that may be missing, provide advice for future patients, and offer suggestions for alternative methods of education/information delivery. A thematic analysis was performed on the qualitative portion of the survey.

Seventeen individuals completed the questionnaire (56.6% response rate). All topics received an average rating of moderately important or higher (≧ 3 out of 5 on the Likert scale). The topics which got the lowest scores were Fertility Preservation and Preventative Cancer Screening. Of the 30 pre-operative topics queried, participants preferred to receive information in written form for 29 of them (97%), and from the surgeon (rather than other health care providers, friends, or the internet) for 27 topics (90%). A document outlining the expected five-day hospital course and one with post-discharge instructions were rated as very or extremely helpful by 85% and 77% of participants, respectively. Thematic analysis revealed five main themes; recovery process, satisfaction, trust in healthcare providers, information delivery, and neovaginal dilation and depth.

Individuals undergoing gender-affirming vaginoplasty have extensive informational needs. Participants recognized the importance of all topics inquired about, however neovaginal dilation and pelvic floor physiotherapy were particularly hot topics as seen in the thematic analysis. Previous research has shown that patient forget much of the information relayed during a medical encounter. To this point, participants in this study reported that the written resources received were extremely helpful. Participants also generally preferred to receive information directly from the surgical team, which may reflect a known variability in surgeon preferences as well as trust in the surgical team. The importance of cultural competence and being able to build a trustworthy relationship with their healthcare providers were prominent findings of this study, underscoring the challenges that transgender patients face in interacting with the health care system.

Individuals undergoing gender-affirming vaginoplasty have extensive informational needs and these are likely best addressed by their surgical team with a combination of written resources and verbal discussion with the patient. We hope these findings will contribute to creating patient-centered resources for transgender women undergoing vaginoplasty.

Continence 2S2 (2022) 100387
DOI: 10.1016/j.cont.2022.100387