Puberty suppression (PS) with gonadotropin-releasing hormone agonists (GnRHa) has become a key part of gender-affirming medical treatment (GAMT) for transgender adolescents. This treatment helps delay unwanted sexual characteristics, like facial hair or a deep voice for transfeminine individuals, and it gives them more time to explore their gender identity before undertaking further medical steps. (One such step could be a gender-affirming surgery like a vaginoplasty).

The timing of PS can potentially affect sexual function later in life, especially since it impacts genital development during a critical window in adolescence. For example, some studies suggest that individuals who undergo PS early in puberty might have smaller genitalia, which can affect the success of vaginoplasty.

Therefore, a new study aimed to understand how the timing of PS influences sexual function after vaginoplasty in transfeminine individuals. Additionally, the authors of the study sought to determine if individuals who did not experience orgasm before surgery could achieve it afterwards.

The researchers focused on 37 transfeminine participants who began GAMT before the age of 18, were diagnosed with gender dysphoria, and had received PS either early or late. Of the 37 participants, 43% received PS during early puberty, and 57% in late puberty. Those who started early PS mainly hamed intestinal vaginoplasty, while the late group mostly had penile inversion vaginoplasty. The investigators surveyed the participants about their sexual and romantic experiences before and after surgery, specifically focusing on sexual desire, arousal, and orgasm.

The participants’ data was compared based on when they started puberty suppression, and statistical tests were used to assess both groups. Overall, most participants (91%) experienced sexual desire after surgery, with no significant differences between early and late PS groups. However, sexual arousal and orgasm experiences were different before surgery. Before surgery, 50% of early PS individuals experienced arousal, compared to 86% in the late group. Similarly, 19% of the early group experienced orgasm, while 58% in the late group did. Post-surgery, arousal and orgasm rates were similar across both groups, with 89% experiencing arousal and 78% experiencing orgasm.

Sexual difficulties, such as pain during intercourse, were reported by 52% of participants, but no significant differences were found between those who had early versus late PS treatment. Some individuals reported feeling shame or discomfort about their bodies post-surgery.

Interestingly, experiencing orgasm before surgery did not predict the ability to achieve orgasm after surgery, as 75% of those who did not orgasm pre-surgery were able to do so post-surgery. These findings suggest that timing of PS and surgical techniques have minimal impact on post-surgical sexual outcomes.

The results of this study show that both the early and late PS groups were able to experience sexual desire, arousal, and orgasm after surgery, with no significant differences between the groups. While sexual difficulties were common in both groups, they were similar to those observed in cisgender women and other transfeminine individuals without PS.

This study challenges concerns about the impact of testosterone exposure during puberty on sexual functioning. It also highlights the importance of tailored sexological counseling to support transfeminine individuals before and after surgery to improve their sexual satisfaction. Though the study provides valuable insights, more research is needed with larger sample sizes to confirm these findings and explore other aspects of sexual wellbeing, such as pleasure and satisfaction. The results also emphasize the need for healthcare providers to offer personalized guidance on sexual function after vaginoplasty.

References:

• van der Meulen, I. S., Bungener, S. L., van der Miesen, A. I. R., Hannema, S. E., Kreukels, B. P. C., Steensma, T. D., Bouman, M.-B., & de Vries, A. L. C. (2025). Timing of puberty suppression in transgender adolescents and sexual functioning after vaginoplasty. The Journal of Sexual Medicine, 22(1), 196–204. https://doi.org/10.1093/jsxmed/qdae152