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Common and uncommon complications after M to F gender affirming genital surgery with vaginoplasty

Garcia, M1

1: Cedars-Sinai Medical Center, United States

Objectives: Transgender people today represent approximately 0.6% of the adult population (1.4 million people). Genital gender affirming surgery (vaginoplasty) for transgender women has been a covered benefit by MediCare, MediCal, and in an increasing number of U.S. states, commercial health insurance plans due to state laws that bar exclusion of provision by insurance plans. There is not yet an accepted “gold standard” vaginoplasty technique, or, approach to preventing or managing complications. Because many patients present to general urologists for management of short and long-term complications after surgery, how to manage such complications is relevant to general urologists and reconstructive urologists not specialized in gender affirming surgery. We present here a review of common and uncommon complications after surgery, and how we propose such complications arise. We review management approaches.

Materials and Methods: Outcomes and complications from vaginoplasties performed over a 2-year period by a single-surgeon are reviewed. In addition, post-operative complications among patients who underwent vaginoplasty elsewhere but who presented to our institutions for management, are reviewed. 
Complications managed at our tertiary care centers included the less common: recto-vaginal fistula and perineal fistula), neovaginal stenosis that was salvageable by dilation, stenosis not salvageable by dilation, urethral stricture, and loss viability of a portion of the clitoris. More common complications include granulation tissue and bleeding from the vulva, vaginal pain, and dehiscence of the posterior commissure. A moderate number of patients presented with recurrent urinary and neovaginal infections. The proposed etiology, mechanism of injury, and management primary and alternative approaches for each is discussed. How to counsel patients and surgeons to avoid such complications is discussed.

Conclusions: Knowledge about how to manage post-operative complications after M to F genital gender affirming surgery with vaginoplasty is relevant to general and reconstructive urologists not specialized in transgender surgery, as such patients are often referred to the only available urologists in a health-care setting. Management of most such complications is straightforward, and effective.


Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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