Complications of the Neovagina in Male-to-Female Transgender Surgery: A Systematic Review and Meta-analysis with Discussion of Management

Abstract

Introduction

Gender-affirmation surgery is often the final gender-confirming medical intervention sought by those patients suffering from gender dysphoria. In the male-to-female transgendered patient, the creation of aesthetic and functional external female genitalia with a functional vaginal channel is of the utmost importance. The aim of this review and meta-analysis is to evaluate the epidemiology, presentation, management and outcomes of neovaginal complications in the male-to-female transgender reassignment surgery patients.

Materials and Methods

PUBMED was searched a in accordance with PRISMA guidelines for relevant articles (n=125). Ineligible articles were excluded and articles meeting all inclusion criteria went on to review and analysis (n=13).

Results

Ultimately, studies reported on 1684 patients with an overall complication rate of 32.5% and a reoperation rate of 21.7% for non-aesthetic reasons. The most common complication was stenosis of the neo-meatus (14.4%). Wound infection was associated with an increased risk of all tissue-healing complications. Use of sacrospinous ligament fixation (SSL) was associated with a significantly decreased risk of prolapse of the neovagina.

Conclusions

Gender-affirmation surgery is important in the treatment of gender dysphoric patients, but there is a high complication rate in the reported literature. Variability in technique and complication reporting standards makes it difficult to assess the accurately the current state of male-to-female gender reassignment surgery. Further research and implementation of standards is necessary to improve patient outcomes. This article is protected by copyright. All rights reserved.

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