González, César A.

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.