Gender Identity Disorder of Adult, Voiding Disorders, Sexual Dysfunction
Conditions
Keywords
Transgender women, Male-to-female, Gender confirmation surgery, Voiding disorder, Vaginal dysfunction
Brief summary
The intent of this mixed methods study for transgender women after gender confirmation surgery is to characterize and subsequently create a validated screening questionnaire for postoperative urologic and pelvic floor symptoms. For individuals who seek gender-confirming treatment, about 13% undergo genital surgery for cosmetic purposes with or without gonadectomy, and this number is increasing. Patient satisfaction following surgery is high, particularly regarding sexual and cosmetic outcomes; however, unexpected negative functional outcomes such as bowel and bladder dysfunction and pelvic organ prolapse impact overall patient satisfaction. The available information suggests that 16-33% of patients experience incontinence postoperatively, with stress predominance, 32-47% experience abnormal voiding, and 24-66% experience overactive bladder symptoms. Outside of the typically assessed voiding symptoms, unique complaints of MTF postoperative patients include obstructive voiding symptoms due to urethral stenosis, persistent perimeatal erectile tissue, prostatic hypertrophy, and irritation from neovaginal tissue. Additionally, may of these patients develop symptomatic neovaginal prolapse, requiring re-suspension. We suggest that further clarification regarding MTF postoperative urologic and pelvic floor complaints can be achieved via a mixed methods approach. By using focus group interviews to create specific evaluative questions for this unique population, we can then prospectively assess patients undergoing surgery via a national multicenter sampling strategy. The goal of the study is to better understand the unique symptoms these women experience and create a validated, reliable screening questionnaire to monitor patients after surgery.
Interventions
Focus group participants will be asked about their postoperative urogynecologic experience. Confidentiality will be enforced and participants will be made aware that they may opt out of answering any questions.
DIAGNOSTIC_TESTQuestionnaire packet
Participants will be asked to complete a questionnaire packet comprised of three previously validated questionnaires and one newly created focused questionnaire. They will be asked to complete the new questionnaire again 2 weeks later. We estimate about 10 minutes will be required to complete the packet.
Sponsors
Icahn School of Medicine at Mount Sinai
The Cleveland Clinic
Boston Medical Center
Weill Medical College of Cornell University
Study design
Observational model
OTHER
Time perspective
OTHER
Eligibility
Sex/Gender
MALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Stage 1 -- Male-to-female transgender women who are at least 4 weeks postoperative following genital surgery for gender confirmation * Stage 2 -- Male-to-female transgender women who are scheduled to undergo surgery or are within 4 weeks postoperative * Both stages -- Minimum age 18 years old * Both stages -- English fluency * Both stages -- Reliable contact information and/or permanent residence
Exclusion criteria
* Preexisting pelvic pathology, including abnormal anatomy or baseline voiding dysfunction * Urinary or intestinal problems prior to surgery lasting greater than 6 weeks
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Stage 1: Focus groups | 3 months | Characterization of genital, urologic, bowel, and sexual symptoms following male-to-female gender confirmation surgery |
| Stage 2: Questionnaire testing | 12 months | Validity and reliability testing of new questionnaire |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Frequency and severity of symptoms | 15 months | Frequency and severity of symptoms |
| Relationship between surgical technique and symptoms | 15 months | Relationship between surgical technique and symptoms |
| Effect of hormonal therapy usage and symptoms | 15 months | Effect of hormonal therapy usage and symptoms |
| Length of time since surgery and development of symptoms | 15 months | Length of time since surgery and development of symptoms |
Countries
United States
Contacts
Primary ContactSarah Huber, MD
Outcome results
None listed