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A longitudinal study of motivations before and psychosexual outcomes after genital gender confirming surgery in transmen

van de Grift, TC1; Pigot, GLS2; Boudhan, S1; Elfering, L1; Kreukels, BPC1; Gijs, LACL1; Buncamper, ME1; Özer, M1; van der Sluis, W1; Meuleman, EJH1; Bouman, MB1; Mullender, MG1

1: VU University Medical Center, Netherlands; 2: VU University Medical Center, NetherlandsVU University Medical Center, Netherlands

Objectives: Genital dissatisfaction is an important reason for transmen to undergo genital gender confirming surgery (GCS: phalloplasty or metoidioplasty). Little is known, however, on the motives to choose for specific techniques, how transmen benefit postoperatively and whether psychosexual outcomes improve. We aimed to evaluate these motivations and psychosexual outcomes regarding GCS.

Material and Methods: A longitudinal study was conducted in 21 transmen at least one year after GCS. Participants were recruited via their surgeon. Data were collected when they applied for surgery and at least one year after surgery. Data collection included semi-structured questionnaires on motivations for surgery, postoperative experiences, and standardized measures on psychological symptoms, body image, self-esteem, sexuality and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records.

Results: Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one’s identity (100%), enabling sexual intercourse (78%), and voiding standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with partner), and used their genitals more frequently during sex compared to before surgery (31 to 78%).

Conclusion: Counseling and decision-making around GCS in transmen should be a highly personalized and interdisciplinary practice. The present study provides input for preoperative decision-making; (1) main motives for surgery include identity confirmation, voiding and sexuality, (2) surgery can result in more sexual activity and genital involvement during sex, while some distress may remain, but (3) complications and voiding symptoms are prevalent.


Work supported by industry: no.

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