Ramirez, Johanna L.

Background: Penile inversion vaginoplasty (PIV) is a common gender-affirming procedure for transgender women, but validated, transgender-specific patient-reported outcomes remain limited. This study evaluated long-term outcomes after PIV using the Post-Affirming Surgery Form and Function Individual Reporting Measure (AFFIRM), a validated instrument assessing appearance, urologic, and gynecologic domains. Methods: We conducted a single-institution retrospective cohort with a cross-sectional, anonymous AFFIRM survey distributed in 2024. Demographics, perioperative outcomes, and complications were obtained by chart review. AFFIRM domain scores, reported on a 0–200 scale with lower scores indicating better outcomes, were analyzed descriptively. Results: Of 193 eligible patients who underwent PIV between 2017 and 2023, surveys were delivered to 186 patients, and 47.8% responded. Median age at surgery was 34.3 years (interquartile range 26.1–49.1), with a median follow-up time of 50.0 months. Most respondents reported high satisfaction with genital appearance, and 90% strongly agreed their anatomy aligned with gender identity. Clitoral sensation was reported by 93%, most commonly as pleasurable. Urologic symptoms were generally minimally bothersome; although 59% reported a misdirected urine stream, mean bother score was low (1.64 ± 1.77). Vaginal dryness and dyspareunia were reported by 43% and 44%, respectively, with 27% describing symptoms as bothersome. Major complications occurred in 13.9% and revision surgery in 34.2%, most commonly for stenosis or depth concerns (13.5%). Conclusions: AFFIRM captured meaningful, transgender-specific, long-term outcomes after PIV, complementing traditional surgical metrics and identifying opportunities to improve preoperative counseling, surgical refinement, and postoperative management of vaginal dryness and urinary symptoms.

Abstract Background Medical chaperones are authorized individuals present during physical examinations involving the genitals, breasts/chest, or anal areas. The use of medical chaperones may provide an opportunity to improve transgender and gender diverse (TGD) patients’ experiences with sensitive examinations. Aim To examine TGD adult patients’ preferences and comfort for having a medical chaperone and whether TGD-specific characteristics, social anxiety symptoms, and feelings of medical mistrust are associated with preference for having a medical chaperone present during a sensitive physical examination. Methods This study used a cross-sectional survey that randomly sampled adult patients from a gender clinic in the Midwest region of the U.S. A total of 420 surveys were mailed. Sixty-two surveys were returned undeliverable, 358 reached recipients; 151 were returned (42.1% response rate). The survey included items related to demographics, gender-related anatomical dysphoria, social anxiety symptoms, feelings of medical mistrust, and preference and comfort towards medical chaperones. Results Among 149 respondents, 74 (49.7%) reported comfort for the idea of having a medical chaperone present during a sensitive physical examination, 50 (33.6%) reported neutral comfort, and 25 (16.8%) reported discomfort. Among 147 respondents, 89 (60.5%) endorsed a preference for a female medical chaperone. We found no associations between gender-related anatomical dysphoria or social anxiety symptoms and comfort for having a medical chaperone, or the gender preference for a medical chaperone. Medical mistrust was associated with lower comfort with having a medical chaperone present during a sensitive physical examination. Clinical Implications Routinely offering medical chaperones, especially female chaperones, is like to be generally acceptable to most TGD patients. These findings may inform clinic policies on providing medical chaperones during sensitive examinations. Strengths and Limitations This study is the first to examine TGD preferences for medical chaperones. Findings are limited by a single site, homogeneous sample, cross-sectional design, and reliance on hypothetical rather than observed examinations. Conclusion TGD adults report comfort with the concept of having a medical chaperone during sensitive examinations and most would prefer the chaperone to be female. Preference for having a medical chaperone present during a sensitive physical exam is not likely influenced by gender dysphoria or social anxiety.