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Transsexualism is the most extreme form of gender identity disorder and most transsexuals eventually pursue sex reassignment surgery (SRS). In transsexual women, this comprises removal of the male reproductive organs, creation of a neovagina and clitoris, and often implantation of breast prostheses. Studies have shown good sexual satisfaction after transition. However, long-term follow-up data on physical, mental and sexual functioning are lacking. To gather information on physical, mental, and sexual well-being, health-promoting behavior and satisfaction with gender-related body features of transsexual women who had undergone SRS. Fifty transsexual women who had undergone SRS >or=6 months earlier were recruited. Self-reported physical and mental health using the Dutch version of the Short-Form-36 (SF-36) Health Survey; sexual functioning using the Dutch version of the Female Sexual Function Index (FSFI). Satisfaction with gender-related bodily features as well as with perceived female appearance; importance of sex, relationship quality, necessity and advisability of gynecological exams, as well as health concerns and feelings of regret concerning transition were scored. Compared with reference populations, transsexual women scored good on physical and mental level (SF-36). Gender-related bodily features were shown to be of high value. Appreciation of their appearance as perceived by others, as well as their own satisfaction with their self-image as women obtained a good score (8 and 9, respectively). However, sexual functioning as assessed through FSFI was suboptimal when compared with biological women, especially the sublevels concerning arousal, lubrication, and pain. Superior scores concerning sexual function were obtained in those transsexual women who were in a relationship and in heterosexuals. Transsexual women function well on a physical, emotional, psychological and social level. With respect to sexuality, they suffer from specific difficulties, especially concerning arousal, lubrication, and pain.

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... 4 This limit leads to a suboptimal evaluation, especially in domains like lubrication and dyspareunia. 1 Generally, FSFI scores in MtF patients are similar to those observed in cis women with sexual dysfunction. 1 Therefore, we developed and preliminarily validated a new questionnaire, the operated Male-to-Female Sexual Function Index, to assess sexual function in patients who have undergone MtF gender affirming surgery. ...
... 1 Generally, FSFI scores in MtF patients are similar to those observed in cis women with sexual dysfunction. 1 Therefore, we developed and preliminarily validated a new questionnaire, the operated Male-to-Female Sexual Function Index, to assess sexual function in patients who have undergone MtF gender affirming surgery. ...
... Weyers et al evaluated body image using a visual analog scale and in that study transgender women were, on average, very satisfied with their genital appearance. 1 The oMtFp analyzed in that study appeared to experience specific difficulties, especially concerning arousal, lubrication and pain. 1,3 Also in our study lubrication seems to be an impactful problem for these patients. ...
Article
Purpose: No questionnaire is currently available to evaluate sexual function after male to female (MtF) gender affirming surgery. Such a limit leads to a suboptimal evaluation in post-operative sexual function in these patients. We aimed at developing and validating a new questionnaire, the operated Male to Female Sexual Function Index (oMtFSFI), for assessing sexual function in MtF patients after surgery. Material and methods: A panel of experts in gender dysphoria defined the main content areas to be assessed: genital self-image, desire, arousal, lubrication, orgasm, satisfaction, and sexual pain. After a pre-test on 10 patients, in the main study oMtFSFI was applied to 65 operated MtF patients (oMtFp), recruited in 7 Italian centres, and 57 women. The participants provided self-ratings on on-line oMtFSFI, FSFI, BDI-PC, and SF-36 questionnaires. oMtFp completed oMtFSFI twice, four weeks apart. Results: Principal component analysis performed on self-ratings provided by oMtFp on the oMtFSFI items yielded a 3-domain structure: Sexual Dissatisfaction, Sexual Pain and Genital self-image. The three domains were internally consistent and test-retest reliable. Convergent associations with FSFI scales emerged for Sexual Dissatisfaction and Sexual Pain, but not for Genital Self-image. MtF patients reported lower sexual function levels in comparison with cis-women. Conclusions: The present preliminary results supported reliability and psychometric validity of the oMtFSFI in the assessment of key sexual function domains in transgender women, further revealing that Genital self-image represents an assessment area to be taken into account in MtF patients, in addition to domains which are salient for cis-women as well.
... The Trans Curve (Fig. 1) presents a positive mental health pattern. Weyers et al. (2009) found that trans women score highly on mental health levels compared to general populations. Colizzi et al. (2013) found that when treated with hormone therapy trans people reported lower cortisol awakening responses, falling within the normal range for cortisol levels. ...
... In the literature studies found that transitioning can positively affect a person's life satisfaction through positive changes in appearance, attractiveness, body satisfaction, sex life, health-related quality of life, family and social relationships, partner relations, achievements in life, personal goals, self-confidence, identity, and spirituality Parola et al. 2010;Weyers et al. 2009;Imbimbo et al. 2009;Nelson et al. 2009;Kraemer et al. 2008;Gijs and Brewaeys 2007;Lobato et al. 2006;De Cuypere et al. 2006;Smith et al. 2005;Michel et al. 2002). Gorin-Lazard et al. (2012) noted that trans people's quality of health vector, independently of hormonal status, did not differ from the general population except for two subscales: physical (lower scores in trans people) and general health (lower scores in general populations). ...
... Moreover, van de Grift et al. (2017) estimated that the level of satisfaction with quality of life was similar between trans people who had surgically reassigned their gender and general reference values. Weyers et al. (2009) found that trans women scored highly on physical level, gender-related bodily features, appreciation of their appearance as perceived by others, and their own satisfaction with their self-image as women compared to the general population. However, the study found that sexual functioning was suboptimal when compared with general populations. ...
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For trans people (i.e., people whose gender is not the same as the sex they were assigned at birth), evidence suggests that transitioning (i.e., the steps a trans person may take to live in the gender with which they identify) positively affects extraversion, ability to cope with stress, optimism about the future, positivity towards life, self-reported health, social relations, self-esteem, body image, enjoyment of tasks, personal performance, job rewards, and relations with colleagues. These relationships are found to be enhanced by gender affirmation and support from family members, peers, schools and workplaces, stigma prevention programs, coping intervention strategies, socioeconomic conditions, antidiscrimination policies, and positive actions. Also important are legislation including the ability to change one’s sex on government identification documents without having to undergo sex reassignment surgery, accessible and affordable transitioning resources, hormone therapy, surgical treatments, high-quality surgical techniques, adequate preparation and mental health support before and during transitioning, and proper follow-up care. Societal marginalization, family rejection, violations of human and political rights in health care, employment, housing and legal systems, gendered spaces, and internalization of stigma can negatively affect trans people’s well-being and integration in societies. The present study highlights that although transitioning itself can bring well-being adjustments, a transphobic environment may result in adverse well-being outcomes. Policy makers can learn that policies to facilitate trans people’s transition and create cultures of inclusion in different settings, such as schools, workplaces, and health-care services, may help to improve societal well-being and allow the community to develop their potential and to minimize misery.
... 18 Despite the reported positive outcomes, trans women after HT and GAS experience specific sexual difficulties related to arousal, lubrication, and pain. 21 Furthermore, poor sexual functioning (eg, not being able to achieve orgasm) before GAS could predict poor sexual functioning after GAS. 22 The findings thus far suggest the potential for transgender persons to encounter sexual difficulties, but these have not yet been explored in detail in a large sample of both trans women and trans men. ...
... 18 One-fifth of trans women experienced arousal difficulties and more than one-quarter of trans women reported distress related to pain during or after sexual intercourse. Pain related with the neovagina has been reported previously, 21 although in our sample pain was also reported by trans women who had not received any medical treatment. To our knowledge, no studies have explored which sexual activities are most often related with pain. ...
... To our knowledge, no studies have explored which sexual activities are most often related with pain. 21 It could be hypothesized that trans women without medical treatment are more frequently having anal penetrative sex, resulting in pain during intercourse. ...
Article
Introduction: Studies about sexual functioning in trans persons have mainly focused on sexual functioning after genital gender-affirming surgery, have had small sample sizes, and have not explored the broad range of possible sexual dysfunctions. Measuring sexual functioning in trans persons during transitioning is important to determine the kind of care trans persons may need in order to regain their sexual health. Aim: The first aim of the present study was to explore the prevalence of sexual function disturbances and dysfunctions (with distress) in trans women and trans men 4 to 6 years after initial clinical entry. The second aim was to compare the prevalence of sexual dysfunctions among the various treatment trajectories and between trans persons with or without further genital treatment intentions. Methods: An online follow-up questionnaire was filled out by 518 trans persons (307 identifying predominantly feminine, 211 identifying predominantly masculine) as a part of the European Network for the Investigation of Gender Incongruence initiative. All participants had their initial clinical appointments in gender clinics in Ghent, Amsterdam, or Hamburg. Main outcome measure: The main outcome measures were the prevalence of sexual dysfunctions and medical treatment data, measured via self-report items. Results: The most frequent sexual dysfunctions experienced by trans women and trans men were difficulties initiating and seeking sexual contact (26% and 32%, respectively) and difficulties achieving an orgasm (29% and 15%, respectively). Compared with trans women after hormone treatment and non-genital surgery, trans women after vaginoplasty less often experienced arousal difficulties, sexual aversion, and low sexual desire. Compared with trans men without medical treatment, trans men after a phalloplasty experienced sexual aversion and low sexual desire less often. No significant differences were found between participants with or without further genital treatment intentions. Clinical implications: Clinicians should consider sexual counseling after medical treatments, paying particular attention to potential social and psychological barriers to the sexual health of their patients. Strengths & limitations: This study included all trans persons irrespective of treatment decisions, and focused on a broad range of potential sexual difficulties taking the distress criteria into account. Limitations include the cross-sectional design, the limited power for the comparison of treatment groups and the absence of validated questionnaires about sexual functioning for transgender persons. Conclusion: Sexual dysfunctions among trans men and women were very common among the various treatment groups and were unrelated to intentions to have further genital treatment. Although medical treatment may be helpful or even essential to developing good sexual health, a significant group of trans persons experienced sexual dysfunctions after genital surgery. Kerckhof ME, Kreukels BPC, Nieder TO, et al. Prevalence of Sexual Dysfunctions in Transgender Persons: Results from the ENIGI Follow-Up Study. J Sex Med 2019; XX:XXX-XXX.
... Previous research in adult transgender men (TM) as well as transgender women (TW) showed a highly heterogeneous distribution of sexual orientation/sexual identity [1][2][3][4][5][6][7][8][9][10][11][12][13][14], with changed preferences after gender-affirming surgery [2,5,6], after initiating gender-affirming hormonal therapy (HT) [5], and-in general-over the course of life [1]. The results on the causality of gender-affirming treatment-and the use of testosterone in particular-remain mixed [1,3,4]. ...
... Previous research in adult transgender men (TM) as well as transgender women (TW) showed a highly heterogeneous distribution of sexual orientation/sexual identity [1][2][3][4][5][6][7][8][9][10][11][12][13][14], with changed preferences after gender-affirming surgery [2,5,6], after initiating gender-affirming hormonal therapy (HT) [5], and-in general-over the course of life [1]. The results on the causality of gender-affirming treatment-and the use of testosterone in particular-remain mixed [1,3,4]. ...
... Previous studies are not always consistent in how these sexual identity labels are classified: relative to birth-assigned sex or to gender identity [3]. In addition, many recent papers on sexual orientation in cohorts of transgender people have methodological shortcomings due to their cross-sectional [3,4,11,12,[14][15][16][17] or retrospective design [1,2,7,8,13]. ...
Article
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Transgender people and their next-of-kin may request information on sexual orientation and preferred partners during hormonal affirming process. Although previous research on sexual orientation in transgender people is extensive, this literature may already be outdated and/or the methodology of studies assessing sexual orientation may fall short. This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence (ENIGI). Gender role and preferred partner in sexual fantasies, sexual orientation and gender of current sexual partner were assessed at baseline (initiation of HT) and every follow-up visit. Data from 469 transgender women (TW) and 433 transgender men (TM) were analyzed cross-sectionally and prospectively. At baseline, more than half reported having no partner (35% of TW, 47% of TM). After 12 months, more than half reported having a partner (59% of TW, 56% of TM), with no changes between one and three years of HT. The majority of TM preferred a female partner, TW preferred male and female partners. The sexual identity of their partner matched their sexual orientation in >80%. Sexual orientation did not change over time. We did not observe associations with serum levels of sex steroids or gender-affirming surgery (chest or genital surgery). Sexual orientation did not change during hormonal transition and was not associated with sex steroids or surgery. Also, preferences matched the partner’s sexual identity. We do not assume that changing serum levels of sex steroids is directly associated with changes in partner choice. The number of people with a current partner increased, possibly due to the indirect effects of gender-affirming care.
... The World Health Organization considers sexual satisfaction/health an important determinant of quality of life (WHOQOL Group, 1994), indicating the importance of research on sexuality in transgender individuals. Although some studies indicate that sexual dysfunctions occur in a relatively large proportion of the transgender population (Kerckhof et al., 2019;Weyers et al., 2009), it was found that gender affirming treatment has a positive influence (Constantino et al., 2013). However, most of the research on sexuality in this population has typically applied a rather medical/functional approach, by focusing on neo-vaginal depth (Hess et al., 2018), frequency of masturbation and orgasm (Wierckx et al., 2011), and sexual functioning (Weyers et al., 2009). ...
... Although some studies indicate that sexual dysfunctions occur in a relatively large proportion of the transgender population (Kerckhof et al., 2019;Weyers et al., 2009), it was found that gender affirming treatment has a positive influence (Constantino et al., 2013). However, most of the research on sexuality in this population has typically applied a rather medical/functional approach, by focusing on neo-vaginal depth (Hess et al., 2018), frequency of masturbation and orgasm (Wierckx et al., 2011), and sexual functioning (Weyers et al., 2009). Such a functional approach tends to ignore the biopsychosocial nature of sexual responses, which are determined by a myriad of biological, psychological, relational and sociocultural factors. ...
... In both transgender groups, fear of sexual contacts was frequently reported, which fits with the current finding that transgender individuals report more sexual anxiety as part of their self-concept. Another study investigating sexual function in transgender women who had undergone gender affirming surgery also found that this group shows elevated rates of sexual dysfunctions (Weyers et al., 2009), such as problems with arousal. This coincides with our finding of lower scores on sexual attitudes -arousal in the transgender sample. ...
Article
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Sexual responding in transgender people has typically been investigated from a medical and functional perspective. Aligning with the biopsychosocial model, it is however equally important to consider psychological aspects of sexuality in this population. We propose that the Sexual Self-Concept (SSC) theory offers a valuable framework to understand (sexual) wellbeing in transgender people, while Self-Concept Discrepancy (SCD) theory could offer an explanation of the mechanisms underlying negative SSCs related to gender dysphoria. We investigated differences in SSC (consisting of sexual esteem, sexual attitudes, and sexual self-efficacy) in 197 binary transgender and 205 cisgender individuals using an online survey and explored the mediating role of actual/ideal self-discrepancies in explaining the relation between gender dysphoria and SSC. Transgender and cisgender individuals differed significantly in seven out of eight components related to sexual esteem and sexual attitudes. Actual/ideal self-discrepancies mediated the relationship between gender dysphoria and the SSC in transgender individuals for the sexual esteem components related to body perception, conduct, and attractiveness, as well as for sexual anxiety. We found no relation between gender dysphoria and the other SSC components in this group. We conclude that SSC discrepancies could be a valuable treatment target to improve transgender individuals' sexual esteem and sexual attitudes.
... Among transgender individuals, satisfaction with primary sex characteristics is particularly low before GAT compared to other body parts (Becker et al., 2016;van de Grift, Cohen-Kettenis, Elaut, et al., 2016) and seems to be particularly related to sexual satisfaction (de Cuypere et al., 2005;Weyers et al., 2009). Moreover, sexual satisfaction and positive perception of primary sex characteristics were positively correlated in a small sample of transmen and women after genderaffirming surgery (GAS) (de Cuypere et al., 2005). ...
... Improvement of satisfaction with body characteristics not modified by GAT has been shown as well (van de Grift et al., 2017). In addition, transwomen with higher sexual functioning report more satisfaction with their appearance after GAS (Weyers et al., 2009). These findings are in line with research in the general population indicating that individuals with better body image show better sexual well-being (Gillen & Markey, 2019) and that a better body image may be associated with stronger sexual desire (Dosch, Ghisletta & van der Linden, 2016). ...
... Whereas body image has been discussed to be of central importance for sexual satisfaction and functioning, the present study did not confirm indirect effects of body image (measured via the dimension of attractiveness and self-confidence) on the associations between GAHT/GAS and sexual desire. The reason for this result may be that previous research focused more on sexual functioning (Weyers et al., 2009) and sexual excitement (de Cuypere et al., 2005), whereas the present study focused on sexual desire as an outcome. It is important to mention that these bio-psychological constructs are overlapping but not to be equitable. ...
Article
It has been posited that gender-affirming treatment (GAT) can have an influence on body image and sexual desire in trans people. This study aims to examine associations between GAT and sexual desire as well as whether body image mediates the influences of gender-affirming hormone therapy (GAHT) or gender-affirming surgery (GAS) on sexual desire. A total of 210 individuals diagnosed with gender dysphoria (n = 105 of each gender) were assessed via self-assessment questionnaires in a cross-sectional study. Associations between GAT and sexual desire were investigated via multivariate analyses of variance. Mediation analyses were conducted to clarify associations between GAHT/GAS, body image, and sexual desire. GAHT was associated with increased sexual desire only in transmen. GAS had no significant effect on sexual desire in transmen and transwomen. Body image did not mediate the influence of GAHT or GAS on sexual desire in both groups. GAHT and GAS had significant direct effects on body image in both genders, whereas body image showed no significant direct effect on sexual desire. The results indicate that effects of GAT on sexual desire seem to be attributable to other factors than body image, such as the hormonal influence of testosterone in transmen.
... Une majorité des femmes trans ne regrette pas ce choix, même si la satisfaction obtenue quant aux résultats en est limitée. Pour Weyers et al. [27], la perception de leur état de santé par les femmes trans interrogées est meilleure après l'opération et 96 % d'entre elles affirment ne pas regretter celle-ci. Il n'y aurait aucune différence significative entre la santé perç ue des femmes trans ayant bénéficié d'une telle opération et les femmes cisgenres de la population générale. ...
... Les expériences sexuelles postopératoires sont fondamentales en vue d'une meilleure réappropriation, une érotisation du corps qui dépend en majorité du bon fonctionnement d'un néovagin [26]. En ce qui concerne l'apparence, l'étude menée par Weyers et al. [27] met en évidence une corrélation positive entre une satisfaction sexuelle globale et la perception que les autres ont de leur apparence féminine (notamment des modifications corporelles apportées par les traitements). Les femmes trans hétérosexuelles ont un niveau de fonctionnement sexuel (évalué à l'aide du Female Sexual Function Index dans lequel sont examinés le désir sexuel, l'excitation, la lubrification, l'orgasme, et la satisfaction sexuelle) [33] similaire à celui des femmes cisgenres sans aucune plainte exprimée, contrairement aux femmes trans homosexuelles (les termes hétérosexuelles et homosexuelles sont repris de l'article). ...
... L'autre moitié a changé de partenaire après l'opération. Weyers et al. [27] ajoutent à cette analyse le biais de l'orientation sexuelle. Selon ces chercheurs, les femmes trans strictement hétérosexuelles et homosexuelles ont autant de probabilité d'être en relation avec un partenaire stable, alors que celles qui sont bisexuelles sont moins fréquemment engagées dans une relation amoureuse plus stable. ...
Article
Résumé Objectifs Comprendre la place et les évolutions des prises en charge médicales et psychologiques de la vie sexuelle des femmes trans, dans le cadre des parcours de transition/affirmation de genre. Méthode Une revue narrative de la littérature médicale, psychiatrique et psychologique. Après sélection, 19 articles ont été retenus et analysés de façon inductive à l’aide de la théorie ancrée et des méthodes classiques d’analyse de contenu thématique. Résultats La majorité des articles recensés et analysés font le constat d’une relative absence de recherches sur le thème de la vie sexuelle. Les traitements chirurgicaux de réassignation sexuelle augmentent significativement la qualité de la vie sexuelle des femmes trans sauf dans le cadre de la pose d’un « néovagin ». Les changements d’orientation sexuelle ne sont pas toujours liés aux éléments du traitement entrepris par les personnes mais apparaissent liés à d’autres facteurs psychosociaux. Discussion Les catégories d’orientation sexuelle sont fluides autant que les pratiques sexuelles et le genre. Elles évoluent selon le moment de vie des personnes interrogées dans une parole singulière. Conclusions Après avoir longtemps été considérée comme un élément central du diagnostic de « transsexualisme », la question de la sexualité et notamment de l’orientation sexuelle des personnes apparaît actuellement peu prise en compte dans les parcours de soin. Cette absence est critiquée fortement par les auteurs des principales revues de la littérature déjà publiées. On suggère une meilleure prise en compte de la vie sexuelle comme élément clinique de l’histoire singulière des femmes trans. On observe par ailleurs que la pratique des opérations chirurgicales sur les organes génitaux n’occupe pas la place centrale qu’elle occupait encore récemment et que la question de la sexualité se pose indépendamment des modifications anatomiques génitales.
... 53 FSFI was the most commonly used validated questionnaire (17 studies). [31][32][33]35,36,39,41,[46][47][48][49][52][53][54][55][56]73 ...
... and are concerning for bias to this effect, as shown inWeyers et al. (2009) in which FSFI scores are considerably higher in the heterosexual cohort when compared to the members of the LGBTQ+communities.56 Vedovo et al. (2020) published a recent, somewhat validated questionnaire for TGD patients after vaginoplasty that is adapted from the FSFI.53 ...
... and are concerning for bias to this effect, as shown inWeyers et al. (2009) in which FSFI scores are considerably higher in the heterosexual cohort when compared to the members of the LGBTQ+communities.56 Vedovo et al. (2020) published a recent, somewhat validated questionnaire for TGD patients after vaginoplasty that is adapted from the FSFI.53 ...
Article
Background: Vaginoplasty is a gender affirming procedure for transgender and gender diverse (TGD) patients who experience gender incongruence. This procedure reduces mental health concerns and enhances patients' quality of life. A systematic review investigating the sexual health outcomes of vaginoplasty has not been performed. Objectives: To investigate sexual health after gender-affirming vaginoplasty for TGD patients. Data Sources MEDLINE/PubMed, Embase, Scopus and PsycINFO databases were searched, unrestricted by dates or study design. Methods: We included primary literature that incorporated TGD patients, reported sexual health outcomes after vaginoplasty intervention and were available in English. Outcomes included at least one of these sexual health parameters: sexual desire, arousal, sensation, activity, secretions, satisfaction, pleasure, orgasm, interferences or aids. Results: Our search yielded 140 studies with 12 different vaginoplasty surgical techniques and 6,953 patients. The majority of these studies were cross-section or retrospective cohort observational studies (66%). 17.4 - 100% (median 79.7%) of patients (n = 2,384) were able to orgasm postoperatively regardless of revision or primary vaginoplasty techniques. Female Sexual Function Index was the most used standardized questionnaire (17 studies, ranging from 16.9 - 28.6). 64 - 98% (median 81%) of patients were satisfied with their general sexual satisfaction. The most common interference of sexual activity was dyspareunia. Conclusions: The heterogenous methods of measuring sexual outcomes reflects the difficulty in comparing single-center surgical outcomes, encouraging the need for a standardized and validated metric for reporting sexual health after vaginoplasty for TGD patients. The most common sexual health parameter reported is sexual activity while therapeutic aids and pleasure were the least reported parameters. Future studies are needed to improve and expand methods of measuring sexual health, including prospective studies, validated questionnaires and inclusive metrics.
... Es handelt sich bei allen inkludierten Artikeln um nicht randomisierte Studien mit dem Evidenzgrad Level III (e2). Bei Studien, die sowohl über die Lebensqualität von Transfrauen als auch Männern (17)(18)(19)(20)(21) Studien, die den SF-36 zur Beantwortung der Frage nach der postoperativen Lebensqualität nutzten (18,20,(22)(23)(24)(25), beobachteten nach GaOP eine Verbesserung der "sozialen Funktionsfähigkeit", der "körperlichen" und "emotionalen Rollenfunktion", der "allgemeinen Gesundheitswahrnehmung", der "Vitalität" und des "psychischen Wohlbefindens" (p = 0,025 bis p > 0,05). In zwei dieser Studien (22,24) unterschied sich das "psychische Wohlbefinden" von Transfrauen nach Ga-OP nicht signifikant von dem der Normstichprobe. ...
... Bei Studien, die sowohl über die Lebensqualität von Transfrauen als auch Männern (17)(18)(19)(20)(21) Studien, die den SF-36 zur Beantwortung der Frage nach der postoperativen Lebensqualität nutzten (18,20,(22)(23)(24)(25), beobachteten nach GaOP eine Verbesserung der "sozialen Funktionsfähigkeit", der "körperlichen" und "emotionalen Rollenfunktion", der "allgemeinen Gesundheitswahrnehmung", der "Vitalität" und des "psychischen Wohlbefindens" (p = 0,025 bis p > 0,05). In zwei dieser Studien (22,24) unterschied sich das "psychische Wohlbefinden" von Transfrauen nach Ga-OP nicht signifikant von dem der Normstichprobe. Dadurch wird das formal nicht signifikante Ergebnis erklärt. ...
... Ainsworth & Spiegel (22) konnten darlegen, dass Transfrauen ohne chirurgische Interventionen im indirekten Vergleich mit Cisfrauen aus der SF-36-Normstichprobe ein signifikant niedrigeres "psychisches Wohlbefinden" aufwiesen (39,5 vs. 48,9; p < 0,05). Lindqvist et al. (23) und Weyers et al. (24) stellten eine Zunahme der "empfundenen Gesundheit" im ersten postoperativen Jahr fest (p < 0,05 beziehungsweise < 0,009), die danach wieder abnahm, jedoch nicht auf den Ausgangswert zurückfiel (p < 0,0001). Außerdem kamen die Studien zu dem Schluss, dass die "körperlichen Schmerzen" postoperativ zunahmen und die "körperliche Funktionsfähigkeit" abnahm, wobei die postoperativen Beobachtungszeiträume zwischen 3 Monaten (18) und 5 Jahren (23) schwankten. ...
Article
Background: The prevalence of persons who are born with primary and secondary male sexual characteristics but feel that they are female (trans women) is ca. 5.48 per 100 000 males in Germany. In this article, we provide a detailed overview of the currently available data on quality of life after male-to-female sex reassignment surgery. Methods: This review is based on publications retrieved by a systematic literature search that was carried out in the PubMed, EMBASE, Web of Science, and PsycINFO databases in March 2017. Results: The 13 articles (11 quantitative and 2 mixed quantitative/qualitative studies) that were found to be suitable for inclusion in this review contained information on 1101 study participants. The number of trans women in each study ranged from 3 to 247. Their mean age was 39.9 years (range: 18-76). Seven different questionnaires were used to assess postoperative quality of life. The findings of the studies permit the conclusion that sex reassignment surgery beneficially affects emotional well- being, sexuality, and quality of life in general. In other categories (e.g., "freedom from pain", "fitness", and "energy"), some of the studies revealed worsening after the operation. All of the studies were judged to be at moderate to high risk of bias. The drop-out rates, insofar as they were given, ranged from 12% to 77% (median: 56%). Conclusion: Current studies indicate that quality of life improves after sex reassign- ment surgery. The available studies are heterogeneous in design. In the future, prospective studies with standardized methods of assessing quality of life and with longer follow-up times would be desirable.
... Out of 16 studies, two were conducted in the USA (24,44), three in Belgium (40,41,43), two in Iran (22,29), one in Switzerland (13), one in the UK (37), one in Croatia (38), one in Yugoslavia (25), one in France (42), one in Brazil (35), one in the Netherlands (39), one in Germany (10), and one in Italy (36). Six studies had a cross sectional design (22,24,29,40,41,43), four were case-control studies (10,13,36,37), four were cohorts (25,35,39,44), and two had a mixed-methods design (quantitative data were assessed) (38,42). ...
... Out of 16 studies, two were conducted in the USA (24,44), three in Belgium (40,41,43), two in Iran (22,29), one in Switzerland (13), one in the UK (37), one in Croatia (38), one in Yugoslavia (25), one in France (42), one in Brazil (35), one in the Netherlands (39), one in Germany (10), and one in Italy (36). Six studies had a cross sectional design (22,24,29,40,41,43), four were case-control studies (10,13,36,37), four were cohorts (25,35,39,44), and two had a mixed-methods design (quantitative data were assessed) (38,42). ...
... The mean age of the subjects ranged 20.5 to 37.3 years in FtM transsexuals and 21 to 56.9 years in MtF transsexuals. QoL was measured using the short-form health survey (SF-36) in eight studies (24,29,37,38,(40)(41)(42)(43), WHOQOL-BREF questionnaire in three studies (35,36,39), King's health questionnaire in one study (13), self-structured instruments in two studies (22,25), a standardized selfassessment tool for QoL in one study (10), and a 21-point Likert scale in one study (44). Out of 15 studies evaluating the QoL, nine examined both FtM and MtF transsexuals (13,22,25,(36)(37)(38)(39)(40)45), two focused on FtM transsexuals (24,41), and four examined MtF transsexuals (29,35,43,44). ...
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Background: Gender identity disorder (GID) or gender dysphoria is a disorder in which an individual identifies him/herself with the opposite sex. GID following sex reassignment surgery is usually associated with severe distress and several limitations in the personal and social aspects of life as a transgender. Objectives: The aim of this systematic review and meta-analysis was to evaluate quality of life after sex reassignment surgery in transgender individuals. Data sources: A search was conducted in English databases, including PubMed, Scopus, PsycINFO, Science Direct, and Google Scholar, as well as Iranian databases including Iran Medex, MagIran, and SID. In addition, the reference lists of the included articles were reviewed without any time limitations. The final literature search was performed on June 12, 2017. Study selection: All relevant cross-sectional and observational studies were evaluated in this review. The keywords included: “sex”, “gender”, “reassignment surgery”, “reassignment operation”, “sex change”, “sex reversal”, “transpersonal”, “sexual transition", “gender dysphoria”, “transsexual”, “transgender”, “gender identity”, “male-to-female transsexual”, “female-to-male transsexual”, “quality of life”, “QOL”, “quality adjusted”, and “wellbeing”. Data extraction: After screening 941 articles, sixteen studies were reviewed systematically, six of which were included in the meta-analysis. Comprehensive Meta-Analysis Software Version 2 was used for all meta-analyses. Results: Quality of life improved after sex reassignment surgery in some dimensions, including bodily pain, emotional role, and mental health in male-to-female (MtF) transsexuals and physical function and physical role in female-to-male (FtM) transsexuals. Physical role, vitality, and social function in MtF transsexuals were not significantly different from the general population. On the other hand, bodily pain, general health, social function, vitality, mental health, and emotional role in FtM transsexuals, as well as physical function and general health in MtF transsexuals, were lower than the general population. Conclusion: Based on the findings, sex reassignment surgery could improve some dimensions of quality of life, including bodily pain, emotional role, and mental health in MtF transsexuals and physical function and physical role in FtM transsexuals. Nevertheless, further research is necessary in this area. Keywords: Gender dysphoria; Quality of life; Sex reassignment surgery; Systematic review; Meta-analysis
... Therefore, transsexual individuals with similar problems may have different opinions about their quality of life and report it differently [14]. Various studies have been done on the quality of life of transsexual individuals [15][16][17][18]. Changing gender is a complex phenomenon that remarkably affects the individuals' health and social performance and also their identities [19]. ...
... However, the mean total score of quality of life in transsexual women was slightly higher than that of nontranssexual women [17]. In a study by Weyers et al., the mean total score of quality of life was 73.3 ± 25.11 in transsexual women [18]. One study showed that the life quality score depended on gender, and the mean score of quality of life in women was lower than that of men (35). ...
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Background: Several reports have demonstrated varying results on the quality of life (QoL) of the transgender population. Therefore, the aim of this study was to conduct a systematic review and meta-analysis about the quality of life (QoL) of individuals during the post transsexual surgery period. Methods: We searched major biomedical electronic databases, including Scopus, Google Scholar, Psychological Information Database (PsycInfo), Web of Science, PubMed, Excerpta Medica dataBASE (EMBASE), and ProQuest, for all relevant literature published in English up to December 2019. The included papers required to be cross sectional studies that reported quality of life in people with transsexuality post surgery. After selecting eligible studies, 2 authors extracted data of each study independently and resolved any inconsistency by consensus with the third reviewer. The risk of bias was assessed by 2 independent research experts by the Newcastle-Ottawa Scale (NOS). Results: In this study, out of 497 articles extracted from the initial investigation, 8 articles with 1099 patients were ultimately selected for meta-analysis. The pooled mean of quality of life in transsexual individuals was obtained to be 70.45 (95%CI 55.87-85.03) and 59.17 (95%CI 48.59-69.74), based on World Health Organization Quality of Life (WHOQoL-BREF) and The 36-item short form of the Medical Outcomes Study questionnaire (SF36), respectively. Also, the results of the subgroup analysis for the weighted mean quality of life in male to female and female to male showed that the mean quality of life in female to male was 57.54 (95%CI 42.24-72.84) and it was 62.47 (95%CI 45.94-79.00) in male to female, based on SF36 questionnaire. Moreover, the weighted mean quality of life in female to male was 69.99 (95%CI 43.76, 96.23) and it was 70.65 (95%CI 53.11, 88.19) in male to female, based on WHOQoL-BREF questionnaire. Conclusion: The results of this systematic review may support the approaches to transsexuality that facilitates sex reassignment. In this review, the means of quality of life after surgery were not compared to the means of quality of life before surgery or even before hormonal therapy which was due to inadequate number of primary studies.
... 8 Quantitative data from adult studies on sexuality after hormones and/or gender-affirming surgery reveal mixed results, with either an increase in sexual satisfaction and activity (eg, more arousal, desire, increase in masturbation), or a decrease (eg, arousal difficulties). [20][21][22][23][24][25][26][27][28][29][30][31] The authors of a qualitative study in transgender adults describing the subjective experience of sexuality during gender transition reported ambivalent outcomes as well. 32 Thus far, there has been no investigation of sexual development during and after early affirming medical treatment in transgender adolescents. ...
... 8,25,27,31 The increase in sexual activity of our group seems to be even more exponential than that in studies of adults after treatment, in which a variety of outcomes on sexual and romantic activity are found, ranging from an increase in sexual activity to no change or even a decrease. [24][25][26][27][28][29][30]34 These findings might suggest that early GAT, including puberty suppression, makes sexual development easier for transgender youth compared with adults. This might be due to the fact that adolescents and adults treated with GnRH analogues are described as having fewer problems passing in their experienced gender, 40,41 which makes it easier to form a romantic relationship or find a sexual partner. ...
Article
Objectives: Early gender-affirmative treatment (GAT) of adolescents may consist of puberty suppression, use of affirming hormones, and gender-affirmative surgeries. This treatment can potentially influence sexual development. In the current study, we describe sexual and romantic development during and after treatment. Methods: The participants were 113 transgender adolescents treated with puberty suppression, affirmative hormones, and affirmative surgery who were assessed as young adults (38 transwomen and 75 transmen; mean age 20.79 years, SD 1.36) during and after their GAT. A questionnaire on sexual experiences, romantic experiences, and subjective sexual experiences was administered and compared to the experiences of a same-aged sample from a Dutch general population study (N = 4020). Results: One year post surgery, young transgender adults reported a significant increase in experiences with all types of sexual activities: masturbation increased from 56.4% to 81.7%, petting while undressed increased from 57.1% to 78.7%, and sexual intercourse increased from 16.2% to 37.6% post surgery compared to presurgery. Young transmen and transwomen were almost equally experienced. In comparison with the general population, young transgender adults were less experienced with all types of sexual activities. Conclusions: Early GAT (including puberty suppression, affirmative hormones, and surgeries) may provide young transgender adults with the opportunity to increase their romantic and sexual experiences.
... Although sexual orientation, desire, and behavior have often been addressed in the context of gender incongruence in trans women and play a key role in the theory of autogynephilia, only a few studies have systematically compared gynephilic and androphilic trans women with regard to sexual desire or the quality of sexual experience. 31,32 These studies have reported that androphilic trans women in the later stages of GA show higher levels of sexual desire and better sexual functioning than gynephilic trans women. ...
... This observation is in line with other empirical studies, which indicate that gynephilic trans women are just as likely to be involved in a relationship as androphilic trans women. 13,32 A limitation of our study-with regard to dyadic sexual desire-is that the SDI cannot distinguish between a primary erotic and secondary erotic interest in another person. As stated earlier, Blanchard 20 suggested that in some gynephilic trans women, a new "secondary erotic interest in men" (p.323) may arise to validate their own femininity. ...
Article
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Background One of the most prominent etiological theories of gender incongruence in trans women proposes a paraphilic erotic target location error (ie, autogynephilia) as a causal factor in gynephilic (ie, exclusively gynephilic and bisexual) trans women. We hypothesized that a paraphilic erotic target location should manifest itself in various aspects of sexual behavior, solitary and dyadic sexual desire, and psychosexual experience. Aim To compare sexual behavior, sexual desire, and psychosexual experience of exclusively gynephilic and bisexual trans women with that of androphilic trans women to explore whether their sexuality differs substantially. Methods Trans women diagnosed with gender dysphoria (Diagnostic and Statistical Manual of Mental Disorders–5) were recruited at 4 transgender healthcare centers in Germany. The present study analyzed items on sexual behavior, desire, and experience of a self-report questionnaire, collected as part of a cross-sectional multicenter study. Main Outcomes Multiple aspects of sexuality were examined using self-constructed items. Sexual desire was measured using the Sexual Desire Inventory and psychosexual experience using the Multidimensional Sexuality Questionnaire. Results Significantly more exclusively gynephilic than androphilic trans women reported a history of sexual arousal in relation to cross-dressing. However, little evidence was found that gynephilic and androphilic sexual desire, behavior, and psychosexual experience differ profoundly. Interestingly, a statistically non-significant trend indicated that gynephilic trans women who had not yet undergone gender affirming surgery showed the highest levels of sexual desire (solitary and dyadic), whereas the opposite was the case for androphilic trans women. Clinical Translation Data of this study indicate that sexual orientation does not appear to be a good predicator for sexual behavior, desire, and psychosexual experience in trans women. Strengths and Limitations We investigated sexual desire and experience using standardized and evaluated measures such as the Sexual Desire Inventory and Multidimensional Sexuality Questionnaire. Future studies with a larger sample size should investigate how different gender affirming medical intervention might have diverging influences on sexual behavior, desire, and experience. Conclusion Ultimately, this study found little evidence for the hypothesis that sexual behavior, sexual desire, and psychosexual experience differ substantially in gynephilic (exclusively gynephilic and bisexual) and androphilic trans women.
... Almost all studies conducted non-validated questionnaires to assess regret due to the lack of standardized questionnaires available in this topic. 15,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Most of the questions evaluating regret used options such as, "yes," "sometimes," "no" or "all the time," "sometimes," "never," or "most certainly," "very likely," "maybe," "rather not," or "definitely not." 14,18,19,23,[27][28][29][30][31][32][33][34][35][36][37][38] Other studies used semi-structured interviews. ...
... 15,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Most of the questions evaluating regret used options such as, "yes," "sometimes," "no" or "all the time," "sometimes," "never," or "most certainly," "very likely," "maybe," "rather not," or "definitely not." 14,18,19,23,[27][28][29][30][31][32][33][34][35][36][37][38] Other studies used semi-structured interviews. 34,37,[39][40][41][42][43] However, in both circumstances, some studies provided further specific information on reasons for regret. ...
Article
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Background: There is an unknown percentage of transgender and gender non-confirming individuals who undergo gender-affirmation surgeries (GAS) that experiences regret. Regret could lead to physical and mental morbidity and questions the appropriateness of these procedures in selected patients. The aim of this study was to evaluate the prevalence of regret in transgender individuals who underwent GAS and evaluate associated factors. Methods: A systematic review of several databases was conducted. Random-effects meta-analysis, meta-regression, and subgroup and sensitivity analyses were performed. Results: A total of 27 studies, pooling 7928 transgender patients who underwent any type of GAS, were included. The pooled prevalence of regret after GAS was 1% (95% CI <1%-2%). Overall, 33% underwent transmasculine procedures and 67% transfemenine procedures. The prevalence of regret among patients undergoing transmasculine and transfemenine surgeries was <1% (IC <1%-<1%) and 1% (CI <1%-2%), respectively. A total of 77 patients regretted having had GAS. Twenty-eight had minor and 34 had major regret based on Pfäfflin's regret classification. The majority had clear regret based on Kuiper and Cohen-Kettenis classification. Conclusions: Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population.
... 79,87,90,95,98,99,101,102,117,118,120,126 Subjective arousal and desire were similarly experienced by a majority (79,1%) of postsurgical women. 79,90,108,123,135,142 Twenty-four studies discussed whether participants could attain orgasm. 79,87,88,90,91,95,96,[98][99][100][101]104,[106][107][108][109]113,120,121,123,125,126,128,134 A majority (about 70%) could achieve orgasm, 79,87,88,90,91,95,98−101,104,106 −109,113,117,120,121,123,125,126,128,134,143 whereas less than 10% could not or had not, 79,88,90,95,99,100,107,109,120,125,143 10% had not tried 79,90,99,125 , and another 10% chose 'not applicable.' 107 Five studies applied the Female Sexual Function Index (FSFI) and reported a mean orgasm domain score ranging between 2.82 −3.9 (scores CIS women without sexual problems 5.1 SD1.1). ...
... 100,120 Whether GAS brings about a change in sexual activities remains unclear, this data and associations between presurgical and postsurgical sexual a 142 ctivity were not provided. 92,96,107,109,128,147 Overall sexual satisfaction or satisfaction with sex life (77%), 79,84,90,92,94,107,108,113,119,135,142,143 satisfaction during sex, 80,120,123 and satisfaction with orgasmic function was present in a majority of postsurgical individuals. 87,91 Some studies reported on sexual dysfunction, where sexual wellbeing was mostly defined as a lack of sexual dysfunction. ...
Article
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Introduction Much has been published on the surgical and functional results following Gender Affirming Surgery (‘GAS’) in trans individuals. Comprehensive results regarding sexual wellbeing following GAS, however, are generally lacking. Aim To review the impact of various GAS on sexual wellbeing in treatment seeking trans individuals, and provide a comprehensive list of clinical recommendations regarding the various surgical options of GAS on behalf of the European Society for Sexual Medicine. Methods The Medline, Cochrane Library and Embase databases were reviewed on the results of sexual wellbeing after GAS. Main Outcomes Measure The task force established consensus statements regarding the somatic and general requirements before GAS and of GAS: orchiectomy-only, vaginoplasty, breast augmentation, vocal feminization surgery, facial feminization surgery, mastectomy, removal of the female sexual organs, metaidoioplasty, and phalloplasty. Outcomes pertaining to sexual wellbeing- sexual satisfaction, sexual relationship, sexual response, sexual activity, enacted sexual script, sexuality, sexual function, genital function, quality of sex life and sexual pleasure- are provided for each statement separately. Results The present position paper provides clinicians with statements and recommendations for clinical practice, regarding GAS and their effects on sexual wellbeing in trans individuals. These data, are limited and may not be sufficient to make evidence-based recommendations for every surgical option. Findings regarding sexual wellbeing following GAS were mainly positive. There was no data on sexual wellbeing following orchiectomy-only, vocal feminization surgery, facial feminization surgery or the removal of the female sexual organs. The choice for GAS is dependent on patient preference, anatomy and health status, and the surgeon's skills. Trans individuals may benefit from studies focusing exclusively on the effects of GAS on sexual wellbeing. Conclusion The available evidence suggests positive results regarding sexual wellbeing following GAS. We advise more studies that underline the evidence regarding sexual wellbeing following GAS. This position statement may aid both clinicians and patients in decision-making process regarding the choice for GAS. Müjde Özer, Sahaand Poor Toulabi, Alessandra D. Fisher, et al. ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”. Sex Med 2021;XX:XXXXXX.
... It is known that in Europian countries such as France and Germany, for the assessment of individuals with gender dysphoria, chromosome analysis is done in addition to physical examination, endocrinological investigation and Hughes, 2008.) imaging methods (Inoubli et al. 2014, Weyers et al. 2009). It was reported that the practical contribution of chromosome analysis which is done routinely in these countries was not known (Auer et al. 2013). ...
Article
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Objective: Gender dysphoria refers to the experienced discomfort related to the incongruence between gender identity and the sex assigned at birth. Current treatment approach for this clinical condition is gender affirmation procedures. International guidelines about gender affirmation do not recommend routine genetic evaluation. In Turkey, provision of health insurance for medical expenses incurred by these procedures requires genetic consultation which frequently involves chromosome analysis (karyotyping). However, the contribution of routine chromosome analysis to the assessment and management of gender dysphoria is not established. This study aims to assess the results of chromosome analysis and its effect on the management of gender dysphoria. Method: The completed chromosome analysis results and observational records of 217 individuals among a total of 281 evaluated for gender affirmation in the psychiatry polyclinic were investigated retrospectively. Results: The chromosome analysis results of 213 (98.2 %) of the 217 individuals investigated were congruent with the sex assigned at birth. Variations were found in the karyotypes of 4 individuals with female sex assigned at birth, only 1 of whom had been diagnosed with a disorder of sex development. In the other cases, however, chromosome analysis did not affect the diagnosis or the clinical intervention. Conclusion: Finding that routine chromosome analysis during the assessment for gender affirmation process rarely affected the clinical diagnosis and the treatment was consistent with the reports of previous studies and supported the recommendation that chromosome analysis should be carried out only in cases where history, physical examination and the required imaging investigations suggested a disorder sex development.
... However they function well on a physical, emotional, psychological and social level. 28 Another study found rates of hypoactives sexual desire are similar to those found in the general female population. They also had moderate to high rates of orgasmic functioning. ...
Article
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Introduction: Mak nyahs are locally known male-to-female transgenders in Malaysia. In Western countries, medicalization of transgenderism allows strictly selected patients to undergo sex reassignment surgery. However, a standardized treatment system is not yet available in Malaysia. A number of mak nyahs underwent sex reassignment surgery at their own will. This study aimed to explore mak nyahs’ knowledge and perception on sex reassignment surgery. Materials and Methods: A qualitative research was carried out from 13thJuly 2016 till 31st August 2016 among 8 adult mak nyahs in Kuantan, Pahang. Snowball sampling was used. Participants who gave verbal consent were interviewed individually and in focus groups. Data obtained was transcribed and used as the primary data source. Results: All informants were Malays and Muslims. They generally had some knowledge about the standard procedures and risks in sex reassignment surgery. All informants expressed their desire to have the surgery, but chose not to. Reasons discouraging them from having the surgery were: i) religion, ii) forbiddance from family, iii) fear of regret, iv) death from surgery, and v) the lack of necessity. Factors driving them to have the surgery: i) more income from sex work, ii) pressure from sex clients, iii) securing a stable relationship, iv) self-satisfaction, and v) hope for a better future. Conclusion: Religion seemed to be the main reason refraining them from undertaking the surgery. Counselling mak nyahs should include the advantages and disadvantages of sexual reassignment surgery. Islamic religious preaching is very important to help reduce high risk behaviours, as well as teaching mak nyahs to cope with challenges in adult life. Further research is necessary to show association between religious knowledge and successful rehabilitation of the mak nyahs’ community.
... Gender-affirming hormone therapy (GAHT) is often an important aspect of transition-related care, improving quality of life (QOL) and mental health of trans people. [8][9][10][11][12][13][14][15][16][17] GAHT should be accessible to, but not required of, all trans people. In this narrative review, we aim to provide readers with a comprehensive summary of health considerations related to TW, defined here as people assigned male at birth (AMAB) but who have female gender identity or expression. ...
Article
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Transgender (trans) women (TW) were assigned male at birth but have a female gender identity or gender expression. The literature on management and health outcomes of TW has grown recently with more publication of research. This has coincided with increasing awareness of gender diversity as communities around the world identify and address health disparities among trans people. In this narrative review, we aim to comprehensively summarize health considerations for TW and identify TW-related research areas that will provide answers to remaining unknowns surrounding TW’s health. We cover up-to-date information on: (1) feminizing gender-affirming hormone therapy (GAHT); (2) benefits associated with GAHT, particularly quality of life, mental health, breast development and bone health; (3) potential risks associated with GAHT, including cardiovascular disease and infertility; and (4) other health considerations like HIV/AIDS, breast cancer, other tumours, voice therapy, dermatology, the brain and cognition, and aging. Although equally deserving of mention, feminizing gender-affirming surgery, paediatric and adolescent populations, and gender nonbinary individuals are beyond the scope of this review. While much of the data we discuss come from Europe, the creation of a United States transgender cohort has already contributed important retrospective data that are also summarized here. Much remains to be determined regarding health considerations for TW. Patients and providers will benefit from larger and longer prospective studies involving TW, particularly regarding the effects of aging, race and ethnicity, type of hormonal treatment (e.g. different oestrogens, anti-androgens) and routes of administration (e.g. oral, parenteral, transdermal) on all the topics we address.
... This is in line with research reporting good physical QOL in trans women. 5,6 As all study participants had received GAS at least 4 months ago, consequences of surgery as pain or physical limitations that could influence physical QOL should be minimal. ...
Article
Introduction: Psychosocial resources like social support or intrapersonal coping skills play an important role in resilience and quality of life (QOL), yet research systematically investigating the availability of different resources and QOL in transgender (trans) women is missing. Aim: The present study aimed to systematically investigate the existence of different psychosocial resources and QOL in trans women following gender-affirming surgery (GAS). Methods: Using a cross-sectional design, 557 trans women who had received GAS at the local urological department were invited to study participation. Criteria for study inclusion were 18 years and older, diagnosis of transsexualism according to the International Classification of Disease, completion of all sessions of GAS, and given written informed consent to study participation. Main outcome measures: Psychosocial resources were assessed using the Essen Resource Inventory (ERI), the Sense of Coherence Scale, and the Social Support Scale. QOL was assessed with the Short Form Health Survey. Data from trans women were compared to normative data of healthy non-trans women as reported in the respective test manuals. Results: In total, 158 trans women responded and participated in this study. They had received GAS 4 months to 21 years ago. The total sample was divided into 3 subgroups depending on the time interval since the participants' last GAS procedure (group 1: GAS 0.3-3 years ago (n = 48); group 2: GAS 3.1-10 years ago (n = 62); and group 3: GAS 10.1-21 years ago (n = 41)). Trans women retrospectively indicated their available resources 3 years ago (ERI 3-years) and in the last 4 weeks (ERI 4-weeks). Trans women who had received GAS within the last 3 years (group 1) showed an increase in resources when comparing ERI 3-year scores (presurgery) with ERI 4-week scores (postsurgery). No differences emerged for group 2 and group 3. Compared to normative data from non-trans women, trans women scored significantly lower on the ERI but not in measures of Social Support Scale or Sense of Coherence Scale. Compared to non-trans women, mental QOL was significantly impaired in trans women, whereas no differences in physical QOL emerged. Clinical implications: As this study hints towards reduced psychosocial resources in trans women, the offering of specialized counseling can have high beneficial potential to support the development of resources, thereby enhancing QOL. Strength & limitations: Data of a large sample of trans women is provided who were investigated up to 21 years after GAS. The study is limited by its cross-sectional design and the response rate of 42%. Conclusion: This study indicates that psychosocial resources improve around the time of GAS and seem to be improved and sustained in later years following GAS. Still, compared to non-trans women, trans women have a lower availability of resources and a lower mental QOL. Breidenstein A, Hess J, Hadaschik B, et al. Psychosocial Resources and Quality of Life in Transgender Women following Gender-Affirming Surgery. J Sex Med 2019;16:1672-1680.
... The satisfaction rate is much higher than that reported by other studies involving a lesser volume of patients. 5,7,13,[56][57][58][59][60] There are some limitations of the study. First, even though the plastic surgeon was the same for all patients, the general surgeon involved varied. ...
Article
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Background:. Current male-to-female (MtF) sex-reassignment-surgery techniques have not been fully successful to achieve the ideal objectives. The ordeal of multiple procedures, associated complications, and suboptimal results leads to high rate of dissatisfaction. We have tried to overcome functional inadequacy and address the esthetic issues for outer genitalia and vagina with our innovative “true shape sigma-lead SRS: Kaushik’s technique,” which has now become the technique of choice for MtF genital SRS for our patients. Methods:. Between April 2007 and April 2017, authors performed 386 sigma-lead SRS in MtF transsexuals. Results were analyzed based on complications, resurgeries, and esthetic/functional outcomes. Corrective SRS using rectosigmoid constituted 145 cases and is not a part of this study. Results:. Maximum follow-up was 7 years (average 34 months). Seventy-eight (20.2%) patients had complications, majority being minor (97.4%). Forty-four (11.4%) required resurgeries, 10 (2.6%) were corrective for introital stricture and mucosal prolapse, whereas 34 (8.8%) opted for optional minor esthetic enhancement. The overall satisfaction rate for cosmetic and functional outcomes was 4.7 out of 5. In addition to review of the literature, innovations in the technique have been explained. Conclusions:. Kaushik’s sigma-lead MtF SRS technique is a step short to become the gold standard of genital SRS because it has proven to be safe and reliable. It allows faster healing, minimal dilation, and nearly natural cosmetic results in the form of clitoris/clitoral hood, labia minora, labia majora along with self-lubricating, fully deep, and sensate neovagina with orgasmic capabilities. This is perhaps the largest reported series of rectosigmoid use in transsexuals carried out for primary vaginoplasty.
... A insatisfação com os procedimentos transexualizadores realizados esteve associada ao menor bem-estar psicológico. Estudos mostram que os procedimentos transexualizadores têm impacto positivo na saúde mental das mulheres transgênero 48,49 . No entanto, os resultados positivos observados no bem-estar psicológico das mulheres transgênero não são diretos, mas mediados: as transformações físicas diminuem o estresse associado a não ser reconhecida como mulher e, consequentemente, diminui a chance de constrangimentos e violências 49,50 . ...
Article
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Resumo: O objetivo do trabalho foi estimar fatores associados ao bem-estar psicológico de travestis e mulheres transexuais. Estudo transversal com 602 travestis e pessoas transexuais em sete municípios do Estado de São Paulo, Brasil entre 2014 e 2015. Foi realizada seleção amostral com abordagem consecutiva e técnica bola de neve. A variável dependente foi bem-estar psicológico (WHOQOL-BREF) e as independentes foram: características sociodemográficas, modificações corporais, condições de saúde, violência e encarceramento. A análise de variância múltipla foi usada para identificar os fatores associados. A maioria tinha cor da pele preta ou parda e entre 25 e 39 anos de idade, até o Ensino Médio completo, renda individual de até dois salários mínimos e trabalhava, sendo 42,3% profissionais do sexo. Cerca de um quarto já foi presa. Em torno de um quarto fazia tratamento para HIV. O escore médio observado foi de 63,2 (IC95%: 61,8-64,6). Na análise múltipla, estiveram associados ao menor bem-estar psicológico: não ter endereço fixo, ter menor escolaridade, estar insatisfeita com as relações pessoais, suporte de amigos ou procedimentos transexualizadores realizados e ter sofrido violência verbal ou sexual. Enquanto piores condições de vida e de exposição à violência prejudicam o bem-estar psicológico de travestis e mulheres transexuais, a possibilidade de realizar transformações corporais desejadas e o respeito ao nome social interferem positivamente na avaliação que fazem de suas vidas.
... 27 The number of our participants is intermediate compared with similar studies. 16,28,29 This may be owing to rather strict inclusion criteria and the surgical technique used. All surgeries have been performed by the same team of surgeons and nurses. ...
Article
Background: There are few studies evaluating depression, self-esteem, and mental health after gender confirming treatment of transgender women. Most of these studies include different surgical techniques and nonvalidated questionnaires. With our survey, we are aiming to assess psychopathologies and mental health as well as sexuality among a group of patients treated by the same surgeon performing our self-developed combined surgical technique. This vaginoplasty approach is characterized by constructing the vaginal cavity with parts of the penile and scrotal skin as well as the longitudinally incised urethra. Materials and methods: Forty-seven transgender women who underwent gender confirming treatment between 2007 and 2013 were included in a retrospective study. The assessment of our study group was performed by means of self-developed indication-specific questionnaires and 3 standardized questionnaires that can be compared with norm data. Results: Preoperative psychotherapy was mostly considered as helpful by the patients, yet postoperatively, only a third of our study participants were still under therapeutic treatment. Furthermore, we could show a change in sexual preference toward a more bisexual orientation. Gender confirming treatment satisfied the expectations for most of the patients and, in their opinion, should have been performed earlier. Results of the standardized Patient Health Questionnaire 4, a short depression screening questionnaire, did not significantly differ from healthy norm data. The Freiburg Personality Inventory, Revised, revealed normal emotionality and sane self-assessment within our study group. High self-esteem and significantly higher scores than norm data were found for the Rosenberg Self-esteem Scale. Conclusions: Gender confirming treatment with the combined technique is an important part of a multi-structured treatment of transgenders and does have effects on psychological well-being. It seems to decrease psychopathologies and implicates several ameliorations for transgender women. Findings need to be verified in prospective studies including preoperative evaluations.
... Wynika z nich, że tylko 10% badanych osób transpłciowych zmagało się z problemami natury psychicznej i myślami samobójczymi [3]. Dodatkowo Weyers i współpracownicy wykazali, że kobiety transpłciowe funkcjonują tak samo dobrze jak kobiety biologiczne [4]. Dane te mogą wskazywać na dobre funkcjonowanie osób transpłciowych i skłaniają do refleksji nad zagadnieniem poczucia jakości życia tychże osób. ...
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Badanie pilotażowe miało na celu weryfikację doniesień naukowych mówiących o dobrym funkcjonowaniu osób transpłciowych. Na tej podstawie starano się porównać poczucie jakości życia mężczyzn transpłciowych z cispłciowymi mężczyznami heteroseksualnymi, homoseksualnymi i biseksualnymi a także zweryfikować role terapii hormonalnej i operacyjnej korekty płci jako potencjalnych predyktorów poczucia jakości życia mężczyzn transpłciowych. Cispłciowi mężczyźni heteroseksualni wykazywali się istotnie wyższym poczuciem jakości życia w stosunku do członków społeczności LGBTQ (mężczyzn transpłciowych, cispłciowych mężczyzn homoseksualnych i biseksualnych). Orientacja seksualna mężczyzn transpłciowych nie różnicowała ich wyników poczucia jakości życia. Role operacyjnej korekty płci i terapii hormonalnej jako potencjalnych predyktorów poczucia jakości życia okazały się być niemożliwe do zweryfikowania, z uwagi na małą liczbę odpowiedzi. Powyższe predyktory wymagają ponownej weryfikacji. Wartymi zbadania mogą być również postrzegane i otrzymywane wsparcie społeczne, odczuwany stres czy stosowane przez osoby transpłciowe strategie copingu, które to są istotnie związane z poczuciem jakości życia każdego człowieka.
... Options include social, psychological, and medical aspects (including gender-affirming hormone therapy and surgery). As genderaffirming hormonal and surgical care has been shown to reduce or even resolve feelings of gender dysphoria in transgender people (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), genderaffirming care should be easily accessible (13). ...
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Objective: To study the considerations and concerns of transgender people regarding fertility preservation and parental desire in a large, nonclinical sample. Gender-affirming care can reduce fertility. Previous research on fertility in transgender people (mainly focused on people visiting health care professionals) shows low fertility preservation use. Design: A web-based survey on fertility and parenthood. Setting: Not applicable. Patient(s): Transgender people assigned female at birth (AFAB) were selected for this analysis (n = 172 or 40.4% of the total sample) of which 116 (67.4%) self-identified as transgender men (TM) and 56 (32.6%) as gender nonbinary (GNB) people. Intervention(s): Not applicable. Main outcome measure(s): Data on parental desire and fertility preservation were assessed in a large, nonclinical sample of AFAB transgender people. Result(s): Sixty-seven (39.0%) respondents had a current/future parental desire. Parental desire rates did not differ between TM and GNB persons. Barriers for fulfilling the parental desire (multiple response) included assumed difficulties in the adoption procedure (41.3%), fear of discrimination against the child (38.0%) or being discriminated against as a transgender parent (32.6%), and the cost for using personal genetic material (32.6%). Nine percent had cryopreserved reproductive cells or tissue. Conclusion(s): Even though parental desire rates in this cohort are in line with earlier research, fertility preservation use was lower in the current study. These numbers reflect the barriers transgender people face when considering fertility options, including cost and the need to postpone hormone therapy. In addition, GNB persons have different needs for gender-affirming treatment and subsequently for fertility preservation.
... It shows that only 10% of transgender study participants struggled with psychological problems and suicidal thoughts [3]. In addition, Weyers and colleagues have shown that transgender women function just as well as biological women [4]. These data may indicate the good functioning of transgender people and encourage reflection on the issue of their subjective well-being. ...
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This pilot study was aimed at verifying scientific reports on the good functioning of transgender people. On this basis, it was attempted to compare the subjective well-being of transgender men with heterosexual, homosexual and bisexual cisgender men. This study tried to verify the role of hormone therapy and surgical gender correction (sex reassignment surgery) as potential predictors of the subjective well-being of transgender men. Cisgender heterosexual men showed significantly higher subjective well-being in relation to members of the LGBTQ community (transgender men, homosexual and bisexual cisgender men). Sexual orientation of transgender men did not differentiate their subjective well-being. The roles of the operational gender correction and hormone therapy as potential predictors of the subjective well-being proved to be impossible to verify due to the small number of responses. The above predictors need to be verified again. Social support, perceived stress, and coping strategies used by transgender people, which are significantly related to the subjective well-being of every human being, may also be worth examining.
... [17] Similarly, in another study by Weir et al. (2009), the lowest score of quality of life in female transsexuals was related to the aspect of vitality. [19] These results are not consistent with the finding of the present study. In regard to "determining and comparing the quality of life of transsexual people undergoing hormone therapy in both control and intervention groups after the intervention," the results showed that although after the intervention the highest quality of life in both groups was related to the aspect of physical performance and there was an increase in the quality of life in both groups (88.83 intervention group and 84.43 control group), this increase was not statistically significant (P = 0.119). ...
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Introduction: Gender identity disorder is a complex psychological problem and people with this disorder are at risk of many problems, including reduced quality of life. Empowerment intervention is one of the methods that can be used to improve the quality of life of people. The present study aimed to investigate the effect of empowerment model-based training on the quality of life of transgender people undergoing hormone therapy. Methods: The present study is a randomized clinical trial that was conducted in 2012 on 81 transgender people at Tehran Welfare Center. The study samples were randomly assigned into two groups of intervention and control. The intervention group received training based on the empowerment model (threat perception, problem-solving, educational participation, and evaluation) and the control group received routine treatment. Results: According to the findings, after the intervention, a statistically significant difference was found between the two groups in terms of the mean level of overt anxiety (P = 0.045) and aspects of emotional health (P = 0.030), the general perception of health (P = 0.007), mental health (P = 0.008), and overall quality of life (P = 0.005). Also, although there was a statistically significant difference in the aspect emotional well-being in the intervention group before and after the intervention (P = 0.034), this difference was not significant between the two groups (P = 0.274). Conclusion: The results showed that the empowerment-based training program had a significant relationship with the improvement in aspects of emotional health, the overall perception of health, mental health, emotional well-being and overall quality of life.
... Ondanks de globaal positieve effecten van genderbevestigende interventies op seksueel functioneren, blijkt een grote variabiliteit in de individuele ervaringen (Klein & Gorzalka, 2009). Sommige trans vrouwen rapporteren moeilijkheden bij opwinding, lubricatie en pijn (Weyers et al., 2009). Trans mannen die preoperatief reeds problemen ervaren met seksueel functioneren, hebben een grotere kans om ook na chirurgie minder tevreden te zijn (Garcia, Christopher, De Luca, Spilotros, & Ralph, 2014). ...
Article
Samenvatting Hoewel transgender personen steeds zichtbaarder worden in onze maatschappij en in de zorgverlening, blijkt er bitter weinig onderzoek uitgevoerd naar hun seksualiteitsbeleving. Oudere, vaak kleinschalige studies hebben het seksueel functioneren na een medische transitie vaak verengd tot het al dan niet kunnen beleven van een orgasme. Het doel van de huidige studie is om de prevalentie van een breed spectrum aan seksuele functiestoornissen en disfuncties (met last) in kaart te brengen bij een multicenter cohorte van transgender personen tijdens/na hun transitie. De pre-valentie wordt eveneens gerapporteerd naargelang de verschillende mogelijke medische trajecten die deelnemers (hebben) doorlopen. 518 transgender personen (307 die zich vooral vrouwelijk, 211 die zich vooral mannelijk identificeren) hebben een online follow-up vragenlijst ingevuld in het kader van het European Network for the Investigation of Gender Incon-gruence Initiative (ENIGI). Alle participanten hadden hun eerste afspraak vier à zes jaar voor het onderzoek in een genderteam in Gent, Amsterdam of Hamburg. Zowel trans vrouwen als trans mannen ervaren het vaakst 'last van problemen bij het initiëren van seks' (26% en 32%) en 'last van problemen met het bereiken van een orgasme' (29% en 15%). Trans vrouwen ervaren na vaginoplas-tiek minder vaak opwindingsproblemen, seksuele aversie en een laag seksueel verlangen, in vergelijking met trans vrouwen die enkel hormonale therapie innemen. Vergeleken met trans mannen die geen medische stappen zetten, ervaren trans mannen na een falloplastiek minder vaak problemen met seksuele aversie maar vaker pijn na het vrijen. Seksuele disfuncties bij transgender personen vier tot zes jaar na hun eerste contact met transgenderzorg zijn frequent. Medische stappen kunnen helpen en zelfs essentieel zijn voor de ontwikkeling van een gezonde seksualiteit. Toch blijkt een significante groep van transgender personen (nog) last te hebben van seksuele disfuncties na genitale chirurgie. Seksuologische nazorg in deze groep verdient dus zeker aandacht.
... Cependant, les données de suivi à long terme sur l'amélioration sexuelle et si les femmes transsexuelles éprouvent des sentiments de regret plus tard manquent généralement. » (Weyers, 2009.) Enfin, une autre piste explicative du regret pourrait venir de la stérilisation imposée (non conservation des gamètes, hormonothérapie stérilisante. . . ...
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Il semble y avoir de plus en plus de demandes de soin par des enfants et adolescents trans et non binaires. Pour saisir les enjeux, besoins et solutions actuellement validées par la recherche, nous avons mené une revue de la littérature scientifique de 2010 à 2017. Il en ressort que les enfants et adolescents trans sont parmi les jeunes les plus à risque de suicide, discrimination, violence par les pairs, échec scolaire, dépression, anxiété et troubles alimentaires. Que le milieu de vie est le facteur le plus déterminant pour leur bien-être et que la violence, l’isolement et le secret sont des facteurs délétères sur santé psychique, que ce sont ces expériences négatives qui seraient responsables des difficultés psychiques et relationnelles largement documentés chez les personnes trans de tout âge. Les structures de soin adaptées offrant un accompagnement respectueux et acceptant la différence de genre sont nécessaires et plébiscitées. Trois axes sont identifiés : les traitements hormonaux de retard de puberté voir de puberté croisée ; l’accompagnement des familles et la lutte contre le harcèlement scolaire. Mots clé : transgenre, non-binaires, enfants, adolescent, vulnérabilité, anti-oppressif Keywords : trangender, non-binary, children, youth, vulnerability, anti-oppressive
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Purpose of review Analyze the utilization of patient-centered outcomes research (PCOR) methods in the literature containing patient-reported outcome measures (PROMs) for gender affirming surgery (GAS). Recent findings Multiple recent systematic reviews have demonstrated that the majority of PROMs used to assess GAS are either ad hoc measures never intended for validation or are neither specific to nor validated for the population or intervention being studied. This review builds on prior works with inclusion of articles related to facial and vocal GAS and presentation of PCOR recommendations and best practices based on review findings. Summary A systematic review of records in PubMed and Scopus using search terms related to GAS and PROMs yielded 652 total articles of which 158 were included in the final analysis. Just over half of included articles utilized validated PROMs, though only 38% of those articles utilized a PROM that had been validated in the TGNB population. Thirteen (8.2%) studies detailed the involvement of patients in PROM development as subjects, and only 4 (2.5%) utilized PCOR methods that engaged TGNB individuals as research stakeholders. Utilization of PCOR methods in research evaluating outcomes of GAS is exceedingly rare despite increasing use of PROMs over time. To collect data that are both accurate and meaningful to the TGNB population, PCOR methods must be adopted within this field.
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Background: While the importance of sexual pleasure for physical and mental health becomes increasingly evident, research on sexual pleasure in transgender persons is lacking. Recently, the first version of the Amsterdam Sexual Pleasure Index (ASPI Vol. 0.1) was validated in cisgender persons. This questionnaire aims to assess the tendency to experience sexual pleasure independent of gender, sexual orientation or anatomy. Aim: The aims of this study were threefold. First, to perform exploratory scale validation analyses of the ASPI in transgender persons. Secondly, to compare transgender sexual pleasure scores to reference data in cisgender persons. Finally, to identify factors that are associated with sexual pleasure. Methods: In a follow-up study conducted within the European Network for the Investigation of Gender Incongruence (ENIGI), online questionnaires were distributed to persons who had a first clinical contact at gender clinics in Amsterdam, Ghent or Hamburg four to six years earlier. Internal consistency of the ASPI was assessed by calculating McDonald's omega (ω t). ASPI scores were compared to scores from the cisgender population using a one sample t-test, and linear regressions were conducted to study associations with clinical characteristics, psychological wellbeing, body satisfaction and self-reported happiness. Results: In total, 325 persons filled out the ASPI. The ASPI showed excellent internal consistency (ω t , all: 0.97; transfeminine: 0.97, transmasculine: 0.97). Compared to data from cisgender persons, transgender participants had significantly lower total ASPI scores (i.e., lower sexual pleasure; transgender vs. cisgender, mean(SD): 4.13(0.94) vs. 4.71(0.61)). Lower age, current happiness and genital body satisfaction were associated with a higher tendency to experience sexual pleasure. Conclusion & discussion: The ASPI can be used to assess the tendency to experience sexual pleasure and associated factors in transgender persons. Future studies are needed to understand interplaying biopsychosocial factors that promote sexual pleasure and hence transgender sexual health and wellbeing.
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The aim of the present study was to investigate experiences that tell about coping and resilience in the lives of 19 Finnish transgender adults, aged 21–62 years (M = 35.20, SD = 12.10). The study was explorative in nature, using semistructured interviews. Results indicated, with data analyzed according to principles of grounded theory, the following three central sources of support: social relations, experiences of having a congruent gender and body identity and meaningful leisure time. On an overall level, the results indicated that transgender persons make use of a number of coping mechanisms, some general and some with elements specifically connected to transitioning to live in the desired gender. The results of this study are of importance for understanding how to support transgender persons both with their universal, and specific, needs.
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Introduction: Rising numbers of trans women are undergoing genital surgeries, such as vulvoplasty or vulvovaginoplasty, to create a neovagina. Medical professionals who adhere to the World Professional Association for Transgender Health (WPATH) Standards of Care, Version 7, and who recommend or perform these procedures, are expected to balance best practices with patient preferences, specifically the decision to create or omit the vaginal canal. Due to a paucity of literature on gender-confirming vulvoplasty (GCV) in trans women, there has been no documentation of factors that prompt practitioners to reject or recommend the procedure. Aim: The aim of the study was to provide descriptive data of WPATH-affiliated medical professionals' knowledge, experiences, and attitudes toward GCV; surgical risks, benefits, and any considerations when referring transgender women 18-21 years of age for this procedure. Methods: Purposive sampling of all physicians, surgeons, nurse practitioners, physician assistants, and registered nurses listed in the WPATH membership directory was initiated via invitational e-mails. The 32-item survey focused on demographics, medical practices, surgical techniques, and reasons for recommending or rejecting the procedure. Data analysis included frequencies and Pearson's χ2 test. Main outcome measures: Key outcome measures included frequency of cases performed; reasons for recommending, rejecting, or performing GCV; and differences in attitudes toward the procedure among various medical professionals. Results: N = 198 (20.7%) of 956 solicited professionals completed the survey. Surgeons (n = 61) comprised 30.8% of the total sample. 46 surgeons (76.7%) reported having performed vulvovaginoplasty, and 25 (41.7%) had performed GCV. "Patient request" was the most common reason for recommending or performing GCV. Surgeons were more likely to either agree and perform (30.4%), or reject (32.1%) GCV in a patient aged 18-21 than other practitioners, who were more likely to be "unsure" (68.5%). These differences were statistically significant (χ2 = 16.467 [2]; n = 193; P < .001). Clinical implications: The data identify a lack of standardized terminology and surgical techniques concerning GCV. Strength & limitations: This is the first exploratory study to assess medical practitioner experiences and attitudes toward a seldom documented procedure. A larger, more inclusive sample would increase the statistical strength and representative aspect of the study. Conclusion: The study shows divergence in attitudes and knowledge among medical practitioners who recommend or perform GCV, and uncertainty when the patient is 18-21 years old. The study contributes to an expanded description and specific indications of performing GCV in the updated WPATH SOC Version 8. Milrod C, Monto M, Karasic DH. Recommending or Rejecting "the Dimple": Medical Professionals' Experiences and Attitudes Toward Gender-Confirming Vulvoplasty in Transgender Women. J Sex Med 2019;XX:XXX-XXX.
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Transgender people may choose to affirm their gender identity with gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS). The effects of GAHT and GAS on sexual health in transgender people have not been well elucidated. This systematic review aimed to appraise the current scientific literature regarding sexual desire, arousal, orgasm, pain, and satisfaction in transmen and transwomen before, during, and after gender transition. Overall, sexual dysfunction is common in both transmen and transwomen. GAHT and GAS may help to improve sexual satisfaction. More studies that focus on sexual health in the transgender population are urgently needed.
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Despite the increased visibility and knowledge in the area of transgender health, the sexual health and experiences of transgender women undergoing Gender-Affirming Hormone Therapy (GAHT) are still under-researched; often, the effects of GAHT on trans women’s sexuality are broadly miscategorised as ‘erectile dysfunction’. This study aimed to provide an exploration of trans women’s negotiation of the psycho- and physiosexual shifts which result from GAHT. Twelve participants (including one pilot) took part in hour-long semi-structured interviews, with two providing a secondary interview for further data triangulation. These interviews were manually transcribed, coded, and final themes were identified and titled from participants’ own words. The interviewer also maintained a journal that was used to provide further depth, reflection, and insight to the emerging themes. The final analysis identified four themes: overall experiences, physiological changes, psychological changes, and shifts in experiences of orgasm. Most participants had positive and/or affirming experiences of sexuality while medically transitioning. One important, and significantly under-researched, experience described by participants was the development of new erogenous zones; for many, their source of sexual pleasure and climax had shifted partially if not entirely away from their genitals and towards nipples, legs, backs, or other body parts. These findings highlight the dearth of medical knowledge in the area of sexual function and pleasure for trans women undergoing GAHT and provide an impetus for a systematic reimagining of how clinical practitioners might negotiate their treatment of a transgender client.
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Résumé Objectifs Cet article vise à discuter de la notion de « regret » dans la clinique de changement de genre. Méthode Pour ce faire, l’article propose un état des lieux de la littérature existante ainsi que de nombreuses traductions. Résultats Il en résulte que la notion de regret s’entend comme un argument central dans les parcours « trans », notamment en matière de « principe de précaution ». Discussion À l’aune de ces résultats, l’article propose une redéfinition du regret, comme résultant des déceptions relatives aux techniques opératoires et des suivis hospitaliers inadéquats, plus qu’aux transitions elles-mêmes. Conclusion Au total, c’est la suspicion portée sur les corps « trans » et sur les transitions qui est ici débattue.
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Introduction: Transfeminine genital reconstructive surgery is an important part of gender affirmation for many transgender women. Sexual health post-vaginoplasty is an important aspect of quality of life that can have a significant impact on overall well-being. Objectives: The objective of this review is to provide a summary of the literature on the sexual outcomes of transgender females post-vaginoplasty and identify treatment strategies for those experiencing sexual dysfunction. Methods: A literature review was conducted with a focus on sexual health outcomes in transgender females post-vaginoplasty as well as treatment options for sexual dysfunction. Results: Penile inversion vaginoplasty with or without free skin grafts or local tissue flaps and intestinal vaginoplasty are the options available to patients interested in transfeminine genital reconstructive surgery with a neovagina. Sexual satisfaction post-vaginoplasty is high regardless of the vaginoplasty technique, however up to 29% of patients may be diagnosed with a sexual dysfunction due to associated distress with a sexual function disturbance. Hormone treatment, pelvic floor physical therapy, sex therapy, and sex surrogacy are treatment options for patients with sexual dysfunctions. Conclusion: Patient reported outcome measures appropriately validated for this patient population are necessary to better understand sexual function outcomes, sexual dysfunction and treatment options for post-vaginoplasty patients. Schardein JN, Nikolavsky D. Sexual Functioning of Transgender Females Post-Vaginoplasty: Evaluation, Outcomes and Treatment Strategies for Sexual Dysfunction. Sex Med Rev 2021;XX:XXX-XXX.
Article
Objective: The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in the transgender population versus no use of cross-sex hormones. Introduction: Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic. Inclusion criteria: Studies were considered that included participants who were trans women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where the hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery among those who used hormones were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety. Methods: A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and grey literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the Joanna Briggs Institute protocols, standardized critical appraisal and data extraction tools. Results: Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred. Conclusions: Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but had not yet begun taking cross-sex hormones. However, because the certainty of this evidence was very low to low, recommendations for hormone use to improve quality of life, depression and anxiety could not be made. High-quality research on this issue is needed, as is the development of a quality-of-life tool specific to the transgender population.
Article
Background Few studies have investigated how physical, mental and sexual function are associated with each other in operated transgender women (oTW). Aim To provide information on the physical, mental and sexual health of oTW in comparison with a group of cisgender women (cisW). Methods An age-matched control study was carried out, recruiting 125 oTW in 7 national referral centers and 80 volunteer women. Beck Depression Inventory Primary Care (BDI-PC), General Health Survey (SF-36), Female Sexual Function Index (FSFI) and operated Male to Female Sexual Function Index (oMtFSI) questionnaires were web-based administered. Data included: age, area of origin, educational level, sexual orientation, years since surgery and hormone therapy. Outcomes T-test was applied to inspect mean score differences between oTW and cisW, in mental, sexual and physical health; simple correlations and multiple regression analysis revealed how mental, sexual and physical health were concurrently associated in the two groups Results Response rate 60% (52% oTW, 71% cisW). oTW mean age 38.5 years (SD = 9.3), cisW 37.7 years (SD = 11.5). Both cisW and oTW reported average values in the range of mental, physical and sexual health. Statistical comparisons revealed no significant group differences in mental and physical health. oTW who referred a worse sexual function also reported worse overall mental well-being and higher levels of depressive symptoms. FSFI scores were negatively associated with years since surgery, but not with age. Multiple regression analysis showed that FSFI Pain accounted for a significant unique variance proportion of risk of depression in oTW. FSFI Sexual Pain was the strongest estimator of inter-individual differences in BDI-PC among oTW (P < .01). Clinical Implications No significant differences in the levels of depressive symptoms, physical and mental well- being were found in oTW and cis-W. The relation between depressive symptoms and sexual function in oTW is stronger than in cisW, and sexual pain substantially predicts risk of depression in oTW. Strengths & Limitations The evaluation of outcomes using validated questionnaires and the relatively large sample size. The convenience control group reported mental, physical and sexual health levels within the range of Italian normative data. Since this is a cross-sectional study, we must be careful in drawing conclusions from our results. Conclusions Sexual pain and lubrication difficulties are the main causes of worse sexual function in oTW, highlighting the importance of perioperative counseling to make surgical expectations realistic and to educate to a proper neovagina management. Vedovo F, Di Blas L, Aretusi F, et al. Physical, Mental and Sexual Health Among Transgender Women. A comparative Study Among Operated Transgender and Cisgender Women in a National Tertiary Referral Network. J Sex Med Rev 2021;xx:xxx–xxx.
Article
Background: To optimize neovaginal dimensions, several modifications of the traditional penile inversion vaginoplasty are described. Options for neovaginal lining include skin grafts, scrotal flaps, urethral flaps, and peritoneum. Implications of these techniques on outcomes remain limited. Methods: A systematic review of recent literature was performed to assess evidence on various vaginal lining options as adjunct techniques in penile inversion vaginoplasty. Study characteristics, neovaginal depth, donor-site morbidity, lubrication, and complications were analyzed in conjunction with expert opinion. Results: Eight case series and one cohort study representing 1622 patients used additional skin grafts when performing penile inversion vaginoplasty. Neovaginal stenosis ranged from 1.2 to 12 percent, and neovaginal necrosis ranged from 0 to 22.8 percent. Patient satisfaction with lubrication was low in select studies. Three studies used scrotal flaps to line the posterior vaginal canal. Average neovaginal depth was 12 cm in one study, and neovaginal stenosis ranged from 0 to 6.3 percent. In one study of 24 patients, urethral flaps were used to line the neovagina. Neovaginal depth was 11 cm and complication rates were comparable to other series. Two studies used robotically assisted peritoneal flaps with or without skin grafts in 49 patients. Average neovaginal depth was approximately 14 cm, and complication rates were low. Conclusions: Skin grafts, scrotal flaps, urethral flaps, and peritoneal flaps may be used to augment neovaginal canal dimensions with minimal donor-site morbidity. Further direct comparative data on complications, neovaginal depth, and lubrication are needed to assess indications in addition to advantages and disadvantages of the various lining options.
Article
Despite the population of transgender individuals in the United States doubling from 2011 to 2016, this population is one of the most understudied in counseling and related disciplines. Of the available research, the associations between gender congruence, defined as an individual’s body matching their gender identity, and well-being have been examined, particularly demonstrating positive associations between gender congruence and overall life satisfaction. However, a dearth of research remains on the possible associations between gender congruence and indices of relationship well-being—particularly sexual satisfaction—and possible moderating effects of the internal negative feelings regarding one’s identity (internalized transphobia). To address these gaps in the literature, this study gathered self-report data from 165 binary transgender men. While there was not an effect of gender congruence on sexual satisfaction, internalized transphobia was found to moderate this association; individuals who reported high internalized transphobia and high gender congruence reported the highest sexual satisfaction. Results of this study highlight the existing literature on the negative associations between internalized transphobia and well-being for transgender individuals. Implications for counselors are discussed, including advocacy efforts and implementation of techniques to facilitate growth and resilience to help transgender clients navigate the negative effects of internalized transphobia.
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While there is a sizeable literature on sexual satisfaction among male–female mixed-sex couples, research examining other types of relationships (e.g., same-sex) is limited. The current study aimed to broaden our understanding of sexual satisfaction across the diverse relationships of sexual and gender minority individuals assigned female at birth (SGM-AFAB) and inform models of sexual satisfaction for this population. We examined: (1) differences in sexual satisfaction and characteristics of sexual activity (frequency of sex, frequency of orgasm, duration of sex) by relationship type (same-sex, mixed-sex, gender-diverse) among SGM-AFAB; (2) a model of sexual satisfaction and its correlates; and (3) differences in this model by relationship type. Results indicated cisgender women in relationships with cisgender women (same-sex) reported higher duration of sex, frequency of orgasm, and sexual satisfaction compared to cisgender women in relationships with cisgender men (mixed-sex). There were few differences in characteristics of sexual activity between SGM-AFAB in gender-diverse relationships (involving one or more gender minority partners) and those in same- or mixed-sex relationships. Results indicated similarities across relationship types in a model of sexual satisfaction and its correlates. For all relationship types, more frequent and longer duration of sexual activity predicted higher orgasm frequency, more frequent orgasm predicted higher sexual satisfaction, and higher sexual satisfaction predicted better relationship functioning. Only the association between orgasm frequency and sexual satisfaction varied by relationship type. As one of the first studies examining sexual satisfaction among SGM-AFAB in mixed-sex and gender-diverse relationships, findings substantially further our understanding of sexual satisfaction in this population.
Article
Many psychological studies focus on trans identity development in young individuals and on the stressors they often face, including the risk of chronic rejection or stigma internalization, but leave out the particularities of transitioning as an adult, particularly as a transwoman (TW). This study remedies this gap by conducting qualitative interviews on a sample of six transgender women above the age of 35, living in the United Kingdom, analyzed using interpretative phenomenological analysis (IPA). While transgender research typically shows that young individuals under the age of thirty go through a period of dissonance, followed by exploration and finally transition, adults may find that they experience a rather different sequence of self-discovery (Fraser, 2009). The current research found that older transwomen generally grow up feeling different, but that their lack of exposure to other trans individuals prevented them from voicing their identity until later life. The anticipation of negative reactions delayed their decision to transition and may have led them to reluctantly marry, have children and engage in over compensatory behavior in an effort to conceal their identity. The participants began openly exploring their identity with the spread of trans information on the internet, during which they sought new relationships that could bolster their need for coherence, often leading them to neglect individuals and environments that may have be non-verifying for some time. After a short period of open exploration, the respondents came out to the majority of their ecosystem, forcing them to redefine their relationships and their place in society. Physically transitioning appeared to improve most of the participants’ mental wellbeing, helped them find a sense of authenticity and coherence, although this was generally mitigated by the consistency of support offered by family and friends.
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Introduction Feminizing gender-affirming surgery (GAS) has been an increasingly used procedure in the United States and worldwide for transgender women with gender dysphoria. Studies on patient-reported quality of life outcomes in those undergoing GAS remain limited. Objective To provide recent insights from the literature on sexual metrics in the evaluation of the transgender women. Methods We queried PubMed to identify studies assessing sexual function metrics in those undergoing feminizing GAS. Results There is no single validated method to establish preoperative and postoperative sexual function. Assessment currently remains institutionally dependent. Evaluation can involve questionnaires including but not limited to the International Index of Erectile Function, the Female Sexual Function Index, and the Male to Female Sexual Function Index. Conclusion In this literature review, we discuss considerations for the evaluation of sexual function for patients considering feminizing GAS with vaginoplasty. Although we describe some of the major tools currently used in evaluating sexual function in this patient population, a need for a validated method remains. Syed JS, Honig S. Sexual Metrics in Transgender Women: Transitioning From International Index of Erectile Function to Female Sexual Function Index. Sex Med Rev 2020;XX:XXX–XXX.
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Although mastectomy could lead to a decrease in sexual performance among patients, only a handful of studies focused on the psychological and sexual behavioral aspects after the surgery. Research on post-mastectomy sexuality has focused mainly on female subjects but barely on lesbian, gay, bisexual, transgender, queer (LGBTQ), and male patients. This narrative review aimed to explore the importance of sexuality after mastectomy from a LGBTQ perspective. Each sexual minority group has been addressed individually. In general, sexual and gender minority breast cancer (BC) patients undergoing bilateral mastectomy expect a complex treatment plan in terms of physical and emotional outcomes. Bilateral mastectomy or top surgery for masculinization reasons was reported to be the most popular procedure among transmen, which resulted in a significant improvement in the quality of life. Heterosexual and lesbian female patients are willing to undergo mastectomy after repeated lumpectomies or to avoid radiation, despite potential post-operative somatic and quality-of-life complications. Transwomen would seek gender-affirming surgery to improve physical satisfaction and psychological well-being. There is not enough evidence for non-oncological reasons and consequences of mastectomy in gay men and cisgender heterosexual men. Establishing the awareness of the sexuality impact of mastectomy will allow the implementation of tailored perioperative psychological care.
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Sexual function is an important part of most women’s lives. Female sexual dysfunction (FSD), defined as a sexual problem that causes clinically significant distress, is common, but under-identified and undertreated. Clinicians should ask about sexual concerns in routine visits. Assessment of FSD should include a comprehensive history and physical examination utilizing a biopsychosocial approach. Providers should explore psychological, emotional, interpersonal, and sociocultural contributing factors. Medications should be reviewed as possible contributors. Antidepressants are a common cause of FSD. Treatment of FSD should focus on the underlying diagnosis. Given its complexity, FSD is best treated utilizing a multidisciplinary approach, including a medical provider, pelvic floor physical therapist, and sex therapist. General recommendations for all patients with FSD include increasing exposure to sexual stimuli such as erotic literature, scheduling sex, decreasing stressors, and improving overall general health through adequate sleep, exercise, and a healthy diet.
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Chronic disease is a growing concern for research, policy and clinical care. While the global burden of HIV for transgender populations has been comprehensively covered in recent systematic reviews, the same is not true for the burden of other chronic disease. The objective of this study was to review the literature on non-HIV chronic disease burden for transgender populations worldwide. A systematic review was conducted of Medline, Embase, CINAHL, PsycINFO and LGBT Life bibliographic databases for peer-reviewed scientific studies with non-HIV chronic disease prevalence data for transgender populations published any date up to February 15, 2019 without restriction on country or study design. A total of 93 studies and 665 datapoints were included in this review, comprising 48 distinct chronic disease outcomes in seven groups (cancer, cerebro/cardiovascular conditions, chronic liver and kidney disease, mental health and substance use conditions, metabolic and endocrine disorders, musculoskeletal and brain disorders, respiratory conditions, and unspecified and other conditions). The empirical literature on chronic disease among global transgender populations focuses on mental health morbidity, demonstrating an evidence gap on chronic physical health morbidity, particularly beyond that of sexual health. This review identified important gaps including in age-related conditions, inflammation-related disease and studies designed explicitly to investigate chronic disease burden among transgender populations. There is a need for high quality evidence in this area, including longitudinal population-based studies with appropriate comparison groups, and consistent measurement of both transgender status and chronic conditions.
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Introduction: Transgender people who chose to proceed with gender affirming hormonal and/or surgical therapy, may face reduced options for fulfilling their parental desire in the future. The ideas and concerns of adult transgender people regarding fertility preservation and parental desire have never been reported in a large, non-clinical sample of assigned male at birth (AMAB) transgender people. Methods: A web-based survey on fertility and parenthood in (binary and non-binary) transgender people was conducted in Belgium. AMAB people were selected for this analysis. Results: We included 254 AMAB persons, of which 196 (77.2%) self-identified as transgender women (TW), 14 (5.5%) as cross-dressers and 44 (17.3%) as gender non-binary (GNB) people. Fifty-five (21.6%) respondents had a current/future parental desire, parental desire was already fulfilled in 81 (31.9%) and not present in 57 people (22.4%) (other: 19.2%). TW were more likely to express a parental desire, compared to GNB people and cross-dressers (P = 0.004). In total, 196 AMAB people previously sought medical assistance, of which 30 (15.3%) considered the loss of fertility due to the transitioning process undesirable. The majority (68.2%) did not want fertility preservation (FP). Fourteen people (9.8%) had proceeded with FP. The main reasons not to proceed with FP included not feeling the need (70; 68.0%), not desiring a genetic link with (future) child(ren) (20; 19.4%) and having to postpone hormone treatment (15; 14.6%). TW were more likely to have a parental desire and to have cryopreserved or to consider cryopreserving gametes, compared to GNB people. Conclusion: Parental desire and FP use were lower in the current non-clinical sample than in previous research on clinical samples. This can possibly be explained by the barriers transgender people face when considering fertility options, including postponing hormone therapy. Also, GNB persons have different needs for gender affirming treatment and FP.
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Introduction: Several steps in the transitioning process may affect sexual desire in transgender people. This is often underexposed by those providing gender-affirming care. Aim: To prospectively assess sexual desire during the first 3 years of hormonal therapy (HT) in transgender people. Methods: This prospective cohort study was part of the European Network for the Investigation of Gender Incongruence. At baseline, different psychological questionnaires were administered. Sex steroids were measured at each follow-up visit. Data were analyzed cross-sectionally and prospectively. Main outcome measure: Prospective analysis of total, dyadic (with another person), and solitary (with oneself) sexual desire in 766 participants (401 transgender women [TW], 364 transgender men [TM]) was carried out using the Sexual Desire Inventory (SDI) questionnaire during a 3-year follow-up period, starting at the initiation of HT. Other factors associated with prospective changes were assessed. Results: In TW, total, dyadic, and solitary SDI scores decreased during the first 3 months of HT. However, after 36 months, total and dyadic SDI scores were higher than baseline scores. Solitary scores after 36 months were comparable with baseline scores. In TM, total, dyadic, and solitary SDI scores increased over the first 3 months, remaining stable thereafter. However, total and dyadic SDI scores after 36 months were comparable with baseline scores, whereas solitary scores remained higher than baseline. Factors associated with a prospective increase in SDI scores included having undergone gonadectomy, no longer experiencing menstrual bleeding or higher gender dysphoria levels at baseline (in TM only). Clinical implications: This study offers clear data on the time course of sexual desire after starting HT and thereby helps to inform people who want to start HT. Transgender people can be informed that changes in sexual desire after initiating HT are temporary. Over a longer period of time, the current research does not suggest induction of hypoactive sexual disorder in TW or long-term increased sexual desire in TM. Strength & limitations: Strengths include the prospective design of this large multicentric study, the well-defined cohort, controlling for HT, sex steroids, and other factors. Limitations include performing a data lock, the absence of an objective measure of sexual desire, and the timing of laboratory measurements. Conclusion: Gender-affirming HT only induces short-term changes in sexual desire in transgender people. Over a longer period of time, a net increase in dyadic sexual desire in TW receiving feminizing HT and sexual desire scores comparable with baseline in TM receiving virilizing HT, were observed. Defreyne J, Elaut E, Kreukels B, et al. Sexual Desire Changes in Transgender Individuals Upon Initiation of Hormone Treatment: Results From the Longitudinal European Network for the Investigation of Gender Incongruence Study. J Sex Med 2020;XX:XXX-XXX.
Article
Background: Following gender-affirming penile inversion vaginoplasty or vulvoplasty, patients may seek vulvar revision procedures for a variety of common aesthetic and functional concerns. These indications for revision and accompanying techniques are not well-described in the literature. Methods: Patients who underwent vulvar revision surgery at the authors' institution were identified, and patient demographics, surgical indications, operative details, and complications were described. Common complaints requiring external genital revision were sorted into four categories: clitoral, labial, introital, and urethral. Results: Thirty-five patients with a history of vaginoplasty underwent vulvar revision between May of 2017 and December of 2019. The mean age at surgical correction was 38.9 years. Ten patients (28.6 percent) had undergone prior secondary procedures (range, 1 to 3). Mean follow-up after revision surgery was 10.7 ± 8.7 months (range, 0 to 30.6 months). The majority of patients underwent concurrent revisions in multiple "categories". Labial aesthetic concerns were most common (n = 27, 77.1 percent), followed by clitoral (n = 20, 57.1 percent), urologic (n = 17, 48.6 percent), and introital complaints (n = 12, 34.3 percent). Twelve patients (34.3 percent) had canal stenosis requiring concurrent robot-assisted canal revision with peritoneal flaps. Complications included labial abscess (n = 1) and deep vein thrombosis (n = 1). Three patients (8.6 percent) underwent subsequent external genital revisions. Management approaches and surgical techniques for each of these common revision categories are provided. Conclusion: As more individuals seek vaginoplasty and vulvoplasty, surgeons must be prepared to address a range of common aesthetic and functional complaints requiring vulvar revision. Clinical question/level of evidence: Therapeutic, IV.
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Background: To establish the benefit of sex reassignment surgery (SRS) for persons with a gender identity disorder, follow-up studies comprising large numbers of operated transsexuals are still needed. Aims: The authors wanted to assess how the transsexuals who had been treated by the Ghent multidisciplinary gender team since 1985, were functioning psychologically, socially and professionally after a longer period. They also explored some prognostic factors with a view to refining the procedure. Method: From 107 Dutch-speaking transsexuals who had undergone SRS between 1986 and 2001, 62 (35 male-to-females and 27 female-to-males) completed various questionnaires and were personally interviewed by researchers, who had not been involved in the subjects' initial assessment or treatment. Results: On the GAF (DSM-IV) scale the female-to-male transsexuals scored significantly higher than the male-to-females (85.2 versus 76.2). While no difference in psychological functioning (SCL-90) was observed between the study group and a normal population, subjects with a pre-existing psychopathology were found to have retained more psychological symptoms. The subjects proclaimed an overall positive change in their family and social life. None of them showed any regrets about the SRS. A homosexual orientation, a younger age when applying for SRS, and an attractive physical appearance were positive prognostic factors. Conclusion: While sex reassignment treatment is an effective therapy for transsexuals, also in the long term, the postoperative transsexual remains a fragile person in some respects.
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The purpose of this study was to examine body image and relationship satisfaction in male and female college students. A total of 101 males and 187 females, primarily Caucasian and middle class, completed a questionnaire designed to measure satisfaction with specific body parts, overall body characteristics, and relationship status. These variables were examined in light of gender and body size differences. Results indicated that women, especially those under or above average weight, were more dissatisfied with their appearance than were men, whereas men were more dissatisfied with their relationships and sex lives than were women. In addition, those body parts with which each gender was most dissatisfied were consistent with the body parts emphasized through ideal images. These results are discussed in relation to gender role dynamics and societal pressures.
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This paper explores the relationship between marital status and mortality for both men and women. It is shown that, controlling for age, the married have lower mortality rates than the single, the widowed, or the divorced and that the differences between the married and unmarried statuses are much greater for men than for women. It is argued that these relationships can, at least in part, be attributed to the characteristics of the marital statuses in our society, for: (1) precisely the same pattern is found in studies of psychlogical wellbeing and mental illness; (2) the evidence from specific types of mortality indicates that this pattern is characteristic primarily of types of mortality in which one's psychological state may greatly affect one's life chances; (3) a role explanation can account for the way the pattern varies with changes in age; and (4) it appears that the alternative explanation, namely, that the relationship are due to selective process, does not account for most of the variation in r...
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This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
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The Female Sexual Functioning Index (FSFI; Rosen et al., 2000) is a self-report measure of sexual functioning that has been validated on a clinically diagnosed sample of women with female sexual arousal disorder. The present investigation extended the validation of the FSFI to include women with a primary clinical diagnosis of female orgasmic disorder (FOD; n = 71) or hypoactive sexual desire disorder (HSDD; n = 44). Internal consistency and divergent validity of the FSFI were within the acceptable range for these populations of women. Significant differences between women with FOD and controls and between women with HSDD and controls were noted for each of the FSFI domain and total scores.
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The Female Sexual Function Index (FSFI) is a brief multidimensional scale for assessing sexual function in women. The scale has received initial psychometric evaluation, including studies of reliability, convergent validity, and discriminant validity (Meston, 2003; Rosen et al., 2000). The present study was designed to crossvalidate the FSFI in several samples of women with mixed sexual dysfunctions (N = 568) and to develop diagnostic cut-off scores for potential classification of women's sexual dysfunction. Some of these samples were drawn from our previous validation studies (N = 414), and some were added for purposes of the present study (N = 154). The combined data set consisted of multiple samples of women with sexual dysfunction diagnoses (N = 307), including female sexual arousal disorder (FSAD), hypoactive sexual desire disorder (HSDD), female sexual orgasm disorder (FSOD), dyspareunia/vaginismus (pain), and multiple sexual dysfunctions, in addition to a large sample of nondysfunctional controls (n = 261). We conducted analyses on the individual and combined samples, including replicating the original factor structure using principal components analysis with varimax rotation. We assessed Cronbach's alpha (internal reliability) and interdomain correlations and tested discriminant validity by means of a MANOVA (multivariate analysis of variance; dysfunction diagnosis x FSFI domain), with Bonferroni-corrected post hoc comparisons. We developed diagnostic cut off scores by means of standard receiver operating characteristics-curves and the CART (Classification and Regression Trees) procedure. Principal components analysis replicated the original five-factor structure, including desire/arousal, lubrication, orgasm, pain, and satisfaction. We found the internal reliability for the total FSFI and six domain scores to be good to excellent, with Cronbach alpha's >0.9 for the combined sample and above 0.8 for the sexually dysfunctional and nondysfunctional samples, independently. Discriminant validity testing confirmed the ability of both total and domain scores to differentiate between functional and nondysfunctional women. On the basis of sensitivity and specificity analyses and the CART procedure, we found an FSFI total score of 26.55 to be the optimal cut score for differentiating women with and without sexual dysfunction. On the basis of this cut-off we found 70.7% of women with sexual dysfunction and 88.1% of the sexually functional women in the cross-validation sample to be correctly classified. Addition of the lubrication score in the model resulted in slightly improved specificity (from .707 to .772) at a slight cost of sensitivity (from .881 to .854) for identifying women without sexual dysfunction. We discuss the results in terms of potential strengths and weaknesses of the FSFI, as well in terms of further clinical and research implications.
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A long-term follow-up study of 55 transsexual patients (32 male-to-female and 23 female-to-male) post-sex reassignment surgery (SRS) was carried out to evaluate sexual and general health outcome. Relatively few and minor morbidities were observed in our group of patients, and they were mostly reversible with appropriate treatment. A trend toward more general health problems in male-to-females was seen, possibly explained by older age and smoking habits. Although all male-to-females, treated with estrogens continuously, had total testosterone levels within the normal female range because of estrogen effects on sex hormone binding globulin, only 32.1% reached normal free testosterone levels. After SRS, the transsexual person's expectations were met at an emotional and social level, but less so at the physical and sexual level even though a large number of transsexuals (80%) reported improvement of their sexuality. The female-to-males masturbated significantly more frequently than the male-to-females, and a trend to more sexual satisfaction, more sexual excitement, and more easily reaching orgasm was seen in the female-to-male group. The majority of participants reported a change in orgasmic feeling, toward more powerful and shorter for female-to-males and more intense, smoother, and longer in male-to-females. Over two-thirds of male-to-females reported the secretion of a vaginal fluid during sexual excitation, originating from the Cowper's glands, left in place during surgery. In female-to-males with erection prosthesis, sexual expectations were more realized (compared to those without), but pain during intercourse was more often reported.
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The aim of the present study was to investigate the psychometric properties of the Female Sexual Function Index (FSFI; Rosen et al., 2000) and the Female Sexual Distress Scale (FSDS; Derogatis, Rosen, Leiblum, Burnett, & Heiman, 2002) within a Dutch population of approximately 350 women with and without sexual complaints. The main conclusions of this study are that the multidimensional structure of the FSFI and the unidimensional structure of the FSDS are fairly well replicated in a Dutch sample. The amount of variance explained by confirmatory and exploratory factor analyses was good. Internal consistency and stability of the FSFI and its subscales and the FSDS are satisfactory to good, and the subscales are reasonably stable across demographic variables. The discriminant validity and the ability of the scales to predict the presence or absence of sexual complaints was excellent. The convergent and divergent construct validity of the FSFI and the FSDS was good. These results support the reliability and psychometric validity of the FSFI and the FSDS in the assessment of dimensions of female sexual functioning and sexual distress in clinical and nonclinical samples.
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An unknown proportion of transsexual women (defined as post-operative male-to-female transsexuals on oestrogen replacement) experience hypoactive sexual desire disorder (HSDD). It has been suggested that the absence of ovarian androgen production together with oestrogen treatment-related increase in sex hormone-binding globulin (SHBG) levels could be leading to HSDD, due to low levels of biologically available testosterone. This study wishes to document the HSDD prevalence among transsexual women and the possible association to androgen levels. Cross-sectional study. Transsexual women (n=62) and a control group of ovulating women (n=30) participated in this study. Questionnaires measuring sexual desire (sexual desire inventory) and relationship and sexual satisfaction (Maudsley Marital Questionnaire) were completed. Serum levels of total testosterone, LH and SHBG were measured in blood samples obtained at random in transsexual women and in the early follicular phase in ovulating women. The transsexual group had lower levels of total and calculated free testosterone (both P<0.001) than the ovulating women. HSDD was reported in 34% of the transsexual and 23% of the ovulating women (P=0.30). Both groups reported similar levels of sexual desire (P=0.97). For transsexual women, no significant correlation was found between sexual desire and total (P=0.64) or free testosterone (P=0.82). In ovulating women, these correlations were significant (P=0.006, resp. P=0.003). HSDD is reported in one-third of transsexual women. This prevalence is not substantially different from controls, despite markedly lower (free) testosterone levels, which argues against a major role of testosterone in this specific group.
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Blanchard's (J Nerv Ment Dis 177:616-623, 1989) theory of autogynephilia suggests that male-to-female transsexuals can be categorized into different types based on their sexuality. Little previous research has compared the sexuality of male-to-female transsexuals to biological females. The present study examined 15 aspects of sexuality among a non-clinical sample of 234 transsexuals and 127 biological females, using either an online or a paper questionnaire. The results showed that, overall, transsexuals tended to place more importance on partner's physical attractiveness and reported higher scores on Blanchard's Core Autogynephilia Scale than biological females. In addition, transsexuals classified as autogynephilic scored significantly higher on Attraction to Feminine Males, Core Autogynephilia, Autogynephilic Interpersonal Fantasy, Fetishism, Preference for Younger Partners, Interest in Uncommitted Sex, Importance of Partner Physical Attractiveness, and Attraction to Transgender Fiction than other transsexuals and biological females. In accordance with Blanchard's theory, autogynephilia measures were positively correlated to Sexual Attraction to Females among transsexuals. In contrast to Blanchard's theory, however, those transsexuals classified as autogynephilic scored higher on average on Sexual Attraction to Males than those classified as non-autogynephilic, and no transsexuals classified as autogynephilic reported asexuality.
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syn. “categorized” VAS → see Likert scale, visual Analogue cale.
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syn. linear analogue self assessment (LASA); scale with finite boundaries at 0 and 100 mm (end of the scale) for the conventional 10 cm line presentation; in general such scales are more reliable and sensitive but also more difficult to explain to patients than e.g. a Numerical Pain Scale (NPS, discontinuous 0 to 10 data collection between the same boundaries) ordinal scales; an “anchored” or “categorized” VAS has the addition of one or more intermediate marks positioned along the line with reference terms assigned to each mark to help subjects to identify the locations between the ends of the scale; → see also scale, quality of life scale.
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Although the greater longevity of married people as compared with unmarried persons has been demonstrated repeatedly, there have been very few studies of a comparative nature. We use log-linear rate models to analyze marital-status-specific death rates for a large number of developed countries. The results indicate that divorced persons, especially divorced men, have the highest death rates among the unmarried groups of the respective genders; the excess mortality of unmarried persons relative to the married has been generally increasing over the past two to three decades; and divorced and widowed persons in their twenties and thirties have particularly high risks of dying, relative to married persons of the same age. In addition, the analysis suggests that a selection process is operating with regard to single and divorced persons: the smaller the proportion of persons who never marry or who are divorced, the higher the resulting death rates.
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The primary objectives of this research were to translate, validate, and generate normative data on the SF-36 Health Survey for use among Dutch-speaking residents of the Netherlands. Translation of the SF-36 into Dutch followed the stepwise, iterative procedures developed by the IQOLA Project. Following extensive pilot testing, the SF-36 was administered to: (1) a random sample of adult residents of Amsterdam (n = 4172); (2) a random, nationwide sample of adults (n = 1742); (3) a sample of migraine sufferers (n = 423); and (4) a sample of cancer patients undergoing active anti-neoplastic treatment (n = 485). Data quality across the four studies was consistently high. The rates of missing data ranged from 1% to 5% at the item level, and from 1.2% to 2.6% at the scale level. Multitrait scaling analysis confirmed the hypothesized scale structure of the SF-36 and associated scale scoring in all four samples. Cronbach's alpha coefficients surpassed the 0.70 criterion for group comparisons in all but one case (the Social Functioning scale in the cancer sample), with a mean alpha coefficient across all scales and samples of 0.84. Known-group comparisons yielded consistent support for the validity of the SF-36. In the two community samples, statistically significant differences in SF-36 mean scale scores were observed as a function of age, gender, and the prevalence of chronic health conditions. In the migraine and cancer samples, mean SF-36 scale scores varied significantly as a function of various indicators of disease severity. The SF-36 profiles for the two community samples were highly similar. The cancer sample yielded the lowest SF-36 scores, with the migraine sample holding an intermediate position. On-going studies will generate data on the responsiveness of the SF-36 to within-group changes in health over time. Efforts are underway to translate and validate the questionnaire for use among ethnic minority groups in the Netherlands.
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Simulations are of particular advantage in research studies where large samples are necessary to achieve statistical power and the information must be collected under uniform conditions in order to aid interpretation. In the study reported below, simulation was achieved through the use of medical photography accompanied by case studies of the same patients. All information was collected on the same day. The purpose of the study was to determine the validity of the three pressure ulcer risk assessment scales most commonly used in clinical nursing practice in the UK. Each clinical nurse assessed the same four patients using three risk assessment scales and a visual analogue scale designed to capture their own clinical judgement. External validity was assessed by a panel of tissue viability experts who provided independent ratings. Data were obtained from 236 clinical nurses, yielding 941 risk assessments. Experience with this approach to data collection suggests that it requires careful planning. This should include measures to ensure that the simulated information is valid and that all data collectors have been adequately trained and are able to motivate the nurses participating in the study. Providing consideration is given to these issues, the use of simulation can help to collect data that would be difficult to obtain by more conventional means. It is also important to recognize that clinical decisions are de-contextualized in simulations because they are reduced to verbal and visual summaries. The decision to use simulations should thus be taken only if this is acknowledged.
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This study examined factors associated with satisfaction or regret following sex reassignment surgery (SRS) in 232 male-to-female transsexuals operated on between 1994 and 2000 by one surgeon using a consistent technique. Participants, all of whom were at least 1-year postoperative, completed a written questionnaire concerning their experiences and attitudes. Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret. Dissatisfaction was most strongly associated with unsatisfactory physical and functional results of surgery. Most indicators of transsexual typology, such as age at surgery, previous marriage or parenthood, and sexual orientation, were not significantly associated with subjective outcomes. Compliance with minimum eligibility requirements for SRS specified by the Harry Benjamin International Gender Dysphoria Association was not associated with more favorable subjective outcomes. The physical results of SRS may be more important than preoperative factors such as transsexual typology or compliance with established treatment regimens in predicting postoperative satisfaction or regret.
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The Belgian medical world has acknowledged the diagnosis of transsexualism and accepted Sex Reassignment Surgery (SRS) as one of the steps in the treatment of choice since 1985. This prevalence and demographic study analyses data on all Belgian individuals who have undergone SRS since that year. All (188) plastic surgeons as well as all gender teams (Antwerp, Bruges, Ghent, and Liège) in Belgium were sent demographic questionnaires to be completed for each of their transsexual patients. The results show an overall prevalence of 1:12,900 for male-to-female and 1:33,800 for female-to-male transsexuals in Belgium. In Wallonia (the French-speaking region of Belgium) the prevalence is significantly lower than in Flanders (the Dutch-speaking region) and in Brussels (the bilingual capital region). In the total Belgian population the male/female sex ratio is 2.43:1, again with a substantial difference between Wallonia on the one hand and Flanders on the other. While in Flanders and in Brussels the prevalence is comparable to that in other Western European countries, in Wallonia it is markedly lower. Transsexualism in Wallonia appears to be socially less acceptable: persons suffering from gender dysphoria in that part of Belgium encounter more problems accessing gender clinics and receiving treatment.
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Tactile and erogenous sensitivity in reconstructed genitals is one of the goals in sex reassignment surgery. Since November 1993 until April 2003, a total of 105 phalloplasties with the radial forearm free flap and 127 vaginoclitoridoplasties with the inverted penoscrotal skin flap and the dorsal glans pedicled flap have been performed at Ghent University Hospital. The specific surgical tricks used to preserve genital and tactile sensitivity are presented. In phalloplasty, the dorsal hood of the clitoris is incorporated into the neoscrotum; the clitoris is transposed, buried, and fixed directly below the reconstructed phallic shaft; and the medial and lateral antebrachial nerves are coapted to the inguinal nerve and to one of the 2 dorsal nerves of the clitoris. In vaginoplasty, the clitoris is reconstructed from a part of the glans penis inclusive of a part of the corona, the inner side of the prepuce is used to reconstruct the labia minora, and the penile shaft is inverted to line the vaginal cavity. A long-term sensitivity evaluation (performed by the Semmes-Weinstein monofilament and the Vibration tests) of 27 reconstructed phalli and 30 clitorises has been performed. The average pressure and vibratory thresholds values for the phallus tip were, respectively, 11.1 g/mm and 3 microm. These values have been compared with the ones of the forearm (donor site). The average pressure and vibratory thresholds values for the clitoris were, respectively, 11.1 g/mm and 0.5 microm. These values have been compared with the ones of the normal male glans, taken from the literature. We also asked the examined patients if they experienced orgasm after surgery, during any sexual practice (ie, we considered only patients who attempted to have orgasm): all female-to-male and 85% of the male-to-female patients reported orgasm. With our techniques, the reconstructed genitalia obtain tactile and erogenous sensitivity. To obtain a good tactile sensitivity in the reconstructed phallus, we believe that the coaptation of the cutaneous nerves of the flap with the ilioinguinalis nerve and with one of the 2 nerves of the clitoris is essential in obtaining this result. To obtain orgasm after phalloplasty, we believe that preservation of the clitoris beneath the reconstructed phallus and some preservation of the clitoris hood are essential. To obtain orgasm after a vaginoplasty, the reconstruction of the clitoris from the neurovascular pedicled glans flap is essential.
Article
The objectives of this descriptive study were (1) to characterize sexual functioning of lesbian women, (2) to validate the use of a modified version of the Female Sexual Function Index (FSFI) with lesbians, and (3) to evaluate correlates of sexual functioning in lesbians. The current study was a cross-sectional examination of correlates of sexual functioning in lesbian women. Participants were 350 self-identified lesbians, aged > or = 18 (mean age 35.5 +/- 11.4 years), who completed an anonymous, Internet-based survey. The survey instrument included measures of sociodemographics, sexual functioning, psychological symptoms, and relationship characteristics. Adequate reliability was demonstrated for all domains of the FSFI, as well as for the total score. Reliability coefficients were comparable to those obtained with the normative sample of heterosexual women. In univariate analyses, age, psychological symptoms, and relationship characteristics were related to many dimensions of sexual functioning in lesbians. Older age was associated with less desire for sexual activity, greater difficulty with lubrication during sexual activity, and lower scores for overall sexual functioning. Psychological symptoms were associated with decreased arousal, pleasure (i.e., orgasm), satisfaction, overall sexual functioning, and increased difficulty with lubrication during sexual activity. Higher relationship satisfaction was associated with increased arousal during sexual activity, less difficulty with lubrication during sexual activity, greater pleasure/orgasm, greater sexual satisfaction, and better overall sexual functioning. Psychological symptoms and relationship characteristics were consistently associated with aspects of sexual functioning in multivariate models. Age, psychological symptoms, and relationship characteristics were related to some but not all indices of female sexual functioning. Findings provide a solid empirical basis upon which to explore other determinants of sexual functioning in lesbians.
Article
There are men in the Western world who are voluntarily castrated and are not male-to-female transsexuals. We surveyed members of this group to understand their responses to androgen deprivation (AD) and how their experiences matched their expectations of AD. We posted a questionnaire on the Eunuch Archive (http://www.eunuch.org) that received responses from 92 voluntarily orchiectomized males who identified as eunuchs. Data from this questionnaire were supplemented with interviews with 19 of the eunuchs. Participants completed questionnaire items regarding: (i) the side effects they expected and experienced; (ii) their current physical and psychological condition; (iii) their level of regret; (iv) what they appreciated most about their castrated status; and (v) who performed their orchiectomies. The most appreciated aspect of castration was the sense of control over sexual urges and appetite (52%). The major side effects experienced were loss of libido (66%), hot flashes (63%), and genital shrinkage (55%). The population had high self-rated sociability, and mental and physical health. Although there was an insignificant reduction in depression after castration, the overall level of self-reported obsessive-compulsive disorders decreased significantly (P < 0.01). Twenty-two percent of the population reported a change in sexual orientation. Many respondents (60%) took supplemental hormone treatments to counteract the side effects of AD. The use of both supplemental testosterone and high-dose estrogen correlated with a significant increase in self-reported sexual desire and activity above the agonadal level (P < 0.001). The majority of the castrations (53%) were not performed by medical professionals. The medical community needs to be aware of men at risk of unsafe castrations in order to provide them with more information on the side effects of AD and access to safe orchiectomies.
Article
The principal goal of surgical techniques for male to female gender reassignment is to provide aesthetic and functional external female genitalia. To present a new surgical technique which permits a safer and faster construction of the neoclitoris and the configuration of a natural-looking mons veneris. The neoclitoris sensitivity was reported by the patients themselves and checked during the follow-up medical examination. In order to define the degree of the patients' satisfaction with the mons veneris appearance, we used a simple questionnaire. From April 2004 to February 2007, 26 patients underwent male to female sex reassignment surgery. The new technique was applied in the last 15 cases. A strip of albuginea, with the penile dorsal neurovascular bundle and a little portion of glans, was prepared, bended on itself, and fixed in the suprapubic area in order to create the mons veneris and the neoclitoris. This technique was easy to perform, permitting the safe preservation of the penile dorsal neurovascular bundle and a reduction in the operation time of 30-45 minutes. No major complications occurred in this series. Neoclitoris trophism and sensitivity were preserved in all patients. At follow-up, ranging from 3 to 20 months, the genital appearance was satisfactory, and the neoclitoris was pleasantly sensitive after a short period of hypersensitivity. Moreover, seven patients reported some form of climax during intercourse. The technical outcome was successful in all cases. The patients' satisfaction was extremely high for the neoclitoris sensitivity (present in all patients) and high in 11 out of 15 for the appearance of the mons veneris. The neoclitoris and mons veneris configuration with a strip of albuginea is a new, safe, and time-saving surgical procedure. The cosmetic appearance and function of transsexual female external genitalia appears to be improved by using this technique.
Article
Gender dysphoria occurs in all societies and cultures. The prevailing social context has a strong impact on its manifestations as well as on applications by individuals with the condition for sex reassignment treatment. To describe a transsexual population seeking sex reassignment treatment in Serbia, part of former Yugoslavia. Data, collated over a period of 20 years, from subjects applying for sex reassignment to the only center in Serbia, were analyzed retrospectively. Age at the time of application, demographic data, family background, sex ratio, the prevalence of polycystic ovarian syndrome (PCOS) among female-to-male (FTM) transsexuals, and readiness to undergo surgical sex reassignment were tabulated. Applicants for sex reassignment in Serbia are relatively young. The sex ratio is close to 1:1. They often come from single-child families. More than 10% do not wish to undergo surgical sex reassignment. The prevalence of PCOS among FTM transsexuals was higher than in the general population but considerably lower than that reported in the literature from other populations. Of those who had undergone sex reassignment, none expressed regret for their decision. Although transsexualism is a universal phenomenon, the relatively young age of those applying for sex reassignment and the sex ratio of 1:1 distinguish the population in Serbia from others reported in the literature.
Information point: Visual analogue scale
  • Crichton
9 Crichton N. Information point: Visual analogue scale. J Clin Nurs 2001;10:697–706.
SF-36 Physical and Mental Summary Scales: A User's Manual The Health Institute; 1994. Long-term Health Assessment among Transsexual Women 759
  • Ware Je M Kosinski
  • Keller
  • Sd
Ware JE, Kosinski M, Keller SD. SF-36 Physical and Mental Summary Scales: A User's Manual. Boston, MA: New England Medical Center, The Health Institute; 1994. Long-term Health Assessment among Transsexual Women 759 J Sex Med 2009;6:752–760