Sexual Function Outcomes Following Gender-Affirming Vaginoplasty: a Literature Review

Purpose of ReviewGender-affirming vaginoplasty is associated with a high degree of patient satisfaction; however, transgender and gender diverse individuals may face significant challenges regarding sexual dysfunction postoperatively. Sexual function is complex and multifaceted, and data regarding postoperative sexual function can help guide patient counseling and decision-making.Recent FindingsWhile much of the literature on outcomes of gender-affirming vaginoplasty has focused on capacity to achieve orgasm, numerous parameters of sexual function may impact patient satisfaction and quality of life. Patients may experience decrease in sexual desire and arousal following gender-affirming vaginoplasty; however, the impact of dysphoria vs additional psychosocial factors impacting sexuality vs organic sexual dysfunction remains unclear. Correlation of clitoral function with patient satisfaction is complex and not easily determined. Preoperative anorgasmia may predict postoperative anorgasmia; however, preoperative anorgasmia related to gender dysphoria and incongruence may resolve postoperatively.SummaryWhile progress has been made in the literature surrounding gender-affirming vaginoplasty, existing limitations may make it difficult to appropriately counsel patients regarding surgical outcomes related to sexual health. Heterogeneity in study methodology and quality limits the ability to make specific recommendations regarding differences in technique, and there remains a significant need for high-quality, validated patient-reported outcome measures regarding sexual function post-gender-affirming vaginoplasty.