The neovaginal microbiome of transgender women post-gender reassignment surgery

Abstract

Gender reassignment surgery can be gender-reaffirming for many transgender women. This process often involves using existing tissue to create a neovagina. For those assigned female at birth, optimal vaginal microbiota and microbes linked to increased risk of STIs and bacterial vaginosis are well characterized. In contrast, data about the microbial environment of the neovagina are limited. A new study aimed to further characterize the microbial composition and function of the neovagina. Researchers used metaproteomics to compare the microbiota found in neovaginal and rectal secretions from transgender women with those found in vaginal secretions from cisgender women. They found that bacterial taxa differed between neovaginal and cis vaginal samples. Interestingly, functional pathways upregulated in neovaginas were similar to those in cis vaginas during an inflammatory response to bacterial vaginosis, and estrogen-regulated keratins were expressed at a lower level in neovaginas. These results suggest that differences in the neovaginal compartment may increase susceptibility to inflammation and epithelial barrier damage. Although further study is needed, this study sheds light on the microbiome of neovaginal tissue, helping to improve the health of transgender women after gender reassignment surgery.

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The neovaginal microbiome of transgender women
post-gender reassignment surgery
Kenzie D. Birse
Kateryna Kratzer
Christina Farr Zuend
Sarah Mutch
Laura Noël-Romas
Alana Lamont
Max Abou
Emilia Jalil
Valdiléa Veloso
Beatriz Grinsztejn
Ruth Khalili Friedman
Kristina Broliden
Frideborg Bradley
Vanessa Poliquin
Fan Li
Carolyn Yanavich
Adam Burgener
Grace Aldrovandi
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Keywords: Transgender women, neovagina, gender reassignment surgery, microbiome, metaproteomics
DOI: https://doi.org/10.21203/rs.3.rs-99187/v1
License:   This work is licensed under a Creative Commons Attribution 4.0 International License. 
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Abstract
Gender reassignment surgery can be gender-rearming for many transgender women. This process often
involves using existing tissue to create a neovagina. For those assigned female at birth, optimal vaginal
microbiota and microbes linked to increased risk of STIs and bacterial vaginosis are well characterized. In
contrast, data about the microbial environment of the neovagina are limited. A new study aimed to further
characterize the microbial composition and function of the neovagina. Researchers used metaproteomics
to compare the microbiota found in neovaginal and rectal secretions from transgender women with those
found in vaginal secretions from cisgender women. They found that bacterial taxa differed between
neovaginal and cis vaginal samples. Interestingly, functional pathways upregulated in neovaginas were
similar to those in cis vaginas during an inammatory response to bacterial vaginosis, and estrogen-
regulated keratins were expressed at a lower level in neovaginas. These results suggest that differences
in the neovaginal compartment may increase susceptibility to inammation and epithelial barrier
damage. Although further study is needed, this study sheds light on the microbiome of neovaginal tissue,
helping to improve the health of transgender women after gender reassignment surgery.