Gender dysphoria is when a person’s gender identity does not match their assigned sex at birth. Some people with gender dysphoria choose to transition to align with their gender identity, which may sometimes include surgery like vaginoplasty (the surgical creation of a neovagina). There are different techniques for this surgery, but it is still not clear how they affect sexual satisfaction.

Currently, surveys that are designed for cisgender women are used to measure sexual satisfaction in transgender women after vaginoplasty. However, it is important to evaluate how effective these surveys are at accurately measuring sexual satisfaction in this population, considering the unique experiences and anatomy of transgender women.

The authors of a recent study set out to do just that. The researchers collected and reviewed all English language surveys that are validated to assess sexual function and satisfaction in cisgender women from North America to see if they could be relevant for transgender women after vaginoplasty. They found 13 surveys that might be applicable.

Then, with the input of 3 expert gender-affirming surgeons, they categorized questions from the surveys as either relevant or irrelevant for this group of individuals. Lastly, the surveys were assessed for additional questions that are crucial for individuals post-vaginoplasty but may apply to other populations as well, such as those related to pain, scarring, restoration of sensation, and cosmetic genital appearance.

Ultimately, the study found that some questions in the surveys were relevant to transgender women after vaginoplasty, such as those about arousal, satisfaction, and pain during vaginal penetration.

Nevertheless, many questions were not applicable, like those about endogenous lubrication. The authors of this study suggest that future surveys should include questions about genital self-image, restoration of sensation, prostate stimulation, holistic well-being, societal acceptance, and expectation fulfillment for a more accurate assessment of this population’s sexual satisfaction.

These findings clearly indicate that many aspects of the surveys that were analyzed are not applicable to transgender women after vaginoplasty. Furthermore, essential aspects of this population’s sexual function are not addressed in surveys that are designed for cisgender women.

The existing surveys designed to measure female sexual function, like the Female Sexual Function Index (FSFI), do not fully capture transgender women’s experiences after surgery. That’s why there is a need for a specific survey designed for transgender women who have undergone this type of gender-affirming surgery, similar to surveys designed for other specific populations.

The authors concluded that collaboration with transgender women who have experienced vaginoplasty is essential for creating a comprehensive and respectful survey that addresses their unique needs and experiences.

References:

• Fraiman, E., Goldblatt, C., Loria, M., Mishra, K., & Pope, R. (2023). One survey fits all? Evaluating the relevance of sexual function measures designed for cis women in trans women postvaginoplasty. The Journal of Sexual Medicine, 20(8), 1133-1138. https://doi.org/10.1093/jsxmed/qdad088