Gynecological gender-affirming surgeries: what are the motivations and experiences? A qualitative study

Background: Although many transmasculine individuals undergo 1 or more gynecological surgeries (ie, hysterectomy, oophorectomy, tubectomy, or colpectomy), little has been published about motivation, subjective experiences, and the effect on dysphoria and quality of life.

Aim: The aim of this study was to acquire an in-depth understanding of patients' motivations and experienced outcomes of gynecological gender surgery.

Methods: In this qualitative study, in-depth semi-structured interviews were conducted. Nine participants were included who were: on the waiting list for their first gynecological surgery (n = 2), or who had either undergone gynecological surgery as part of their transitioning (ie, hysterectomy) and were on the waiting list for another gynecological procedure (ie, colpectomy, n = 2), or who had undergone gynecological surgery and did not wish to undergo any further surgeries (n = 5). In-depth semi-structured interviews were conducted. Topics discussed were motivation to opt for a specific surgery, expectations, and experiences. Thematic analysis was carried out to compose themes from the interview transcripts using the concepts of body image and gender affirmation as a theoretical lens.

Outcomes: The primary outcomes of this study were composed themes based on thematic analysis of the interview transcripts.

Results: Three subthemes were identified, displaying how gynecological surgeries could contribute to gender affirmation: body representation matching oneself; achieving functional congruence; and enabling further surgical transition.

Clinical implications: This study offers valuable insights for healthcare professionals in patient counseling and shared decision-making and provides a foundation for developing patient-reported outcome measures tailored to transmasculine individuals.

Strengths and limitations: To our knowledge, this is the first qualitative report to study the motivations for and outcomes of gynecological gender-affirming surgeries in such depth; however, the results cannot be directly applied to other settings without considering the local context, including factors such as legislation and insurance policies.

Conclusion: This study highlights how gynecological surgeries, unlike more visible gender-affirming procedures like chest surgeries, address internal conflicts related to the masculine identity by altering the body's functioning, thereby playing an important role in the process of gender affirmation.