Surgical Experience and Outcome Evaluation of Genital Gender Affirmation Surgery for Transgender Female in China: A Case Series

Background: Gender-affirming surgery (GAS) for transgender females developed relatively late and limited in China due to some reasons. To introduce GAS surgical experiences for Chinese transgender females is necessary.

Aims: To report surgical choices and experience including clitoral/urethral reconstruction, vaginoplasty, and vulvoplasty, and their outcomes.

Methods: A single-center, retrospective case series was conducted among transgender females who underwent GAS between September 2018 and March 2023. Surgical outcomes were evaluated including short-term and long-term complications. Scar-Q Scale, Female Sexual Function Index (FSFI), Amsterdam Hyperactive Pelvic Floor Scale-Women (AHPFS-W), and Female Genital Self-Imaging Scale (FGSIS) were carried out for outcome evaluation.

Results: Thirteen transgender females underwent GAS. Among them, 7 patients underwent sigmoid colon vaginoplasty, 3 patients underwent zero-depth vaginoplasty (ZDV), and 3 patients underwent vaginoplasty using skin flap (penile or scrotum). Postoperative follow-up showed that for sigmoid colon neo-vagina, vaginal length can reach 10-15 cm, with a width of about 2 fingers. For skin flap neo-vagina, the long-term vaginal length can maintain at around 8-10 cm, with a width of about 2 fingers. AHPFS-W outcome shows that patients undergoing sigmoid colon vaginoplasty and ZDV have relatively better pelvic floor muscle function. Patients undergoing skin flap vaginoplasty scored higher on the FGSIS, indicating a higher level of self-acceptance toward reconstructed genitalia.

Discussion: Factors like anatomical characteristics, sexual customs and cultural backgrounds may alter the choice of GAS techniques for Chinese transgender females. The GAS surgical experience specialized to Chinese transgender females is necessary to share.

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