A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen

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Abstract

Background Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. Aim To evaluate motivations for and psychosexual outcomes after GCS. Methods A longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery. Outcomes Data collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records. Results Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100%), enabling sexual intercourse (78%), and voiding while standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31–78%). Clinical Implications The present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent. Strength and Limitations Study strengths include its longitudinal design and the novelty of the studied outcomes. The main limitations include the sample size and the nature of the assessment. Conclusion Counseling and decision making for GCS in transmen should be a highly personalized and interdisciplinary practice. van de Grift TC, Pigot GLS, Boudhan S, et al. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen. J Sex Med 2017;14:1621–1628.

Original languageEnglish
Pages (from-to)1621-1628
Number of pages8
JournalJournal of Sexual Medicine
Volume14
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

Cite this

@article{05fbe7dd1b12416cacb54f924c0488ca,
title = "A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen",
abstract = "Background Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. Aim To evaluate motivations for and psychosexual outcomes after GCS. Methods A longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery. Outcomes Data collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records. Results Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100{\%}), enabling sexual intercourse (78{\%}), and voiding while standing (74{\%}). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31–78{\%}). Clinical Implications The present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent. Strength and Limitations Study strengths include its longitudinal design and the novelty of the studied outcomes. The main limitations include the sample size and the nature of the assessment. Conclusion Counseling and decision making for GCS in transmen should be a highly personalized and interdisciplinary practice. van de Grift TC, Pigot GLS, Boudhan S, et al. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen. J Sex Med 2017;14:1621–1628.",
keywords = "Gender Dysphoria, Gender-Confirming Surgery, Phalloplasty, Quality of Life, Sexuality",
author = "{van de Grift}, {Tim C.} and Pigot, {Garry L.S.} and Siham Boudhan and Lian Elfering and Kreukels, {Baudewijntje P.C.} and Gijs, {Luk A.C.L.} and Buncamper, {Marlon E.} and M{\"u}jde {\"O}zer and {van der Sluis}, Wouter and Meuleman, {Eric J.H.} and Bouman, {Mark Bram} and Mullender, {Margriet G.}",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.jsxm.2017.10.064",
language = "English",
volume = "14",
pages = "1621--1628",
journal = "Journal of Sexual Medicine",
issn = "1743-6095",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen

AU - van de Grift, Tim C.

AU - Pigot, Garry L.S.

AU - Boudhan, Siham

AU - Elfering, Lian

AU - Kreukels, Baudewijntje P.C.

AU - Gijs, Luk A.C.L.

AU - Buncamper, Marlon E.

AU - Özer, Müjde

AU - van der Sluis, Wouter

AU - Meuleman, Eric J.H.

AU - Bouman, Mark Bram

AU - Mullender, Margriet G.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. Aim To evaluate motivations for and psychosexual outcomes after GCS. Methods A longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery. Outcomes Data collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records. Results Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100%), enabling sexual intercourse (78%), and voiding while standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31–78%). Clinical Implications The present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent. Strength and Limitations Study strengths include its longitudinal design and the novelty of the studied outcomes. The main limitations include the sample size and the nature of the assessment. Conclusion Counseling and decision making for GCS in transmen should be a highly personalized and interdisciplinary practice. van de Grift TC, Pigot GLS, Boudhan S, et al. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen. J Sex Med 2017;14:1621–1628.

AB - Background Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. Aim To evaluate motivations for and psychosexual outcomes after GCS. Methods A longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery. Outcomes Data collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records. Results Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100%), enabling sexual intercourse (78%), and voiding while standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31–78%). Clinical Implications The present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent. Strength and Limitations Study strengths include its longitudinal design and the novelty of the studied outcomes. The main limitations include the sample size and the nature of the assessment. Conclusion Counseling and decision making for GCS in transmen should be a highly personalized and interdisciplinary practice. van de Grift TC, Pigot GLS, Boudhan S, et al. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen. J Sex Med 2017;14:1621–1628.

KW - Gender Dysphoria

KW - Gender-Confirming Surgery

KW - Phalloplasty

KW - Quality of Life

KW - Sexuality

UR - http://www.scopus.com/inward/record.url?scp=85034419724&partnerID=8YFLogxK

U2 - 10.1016/j.jsxm.2017.10.064

DO - 10.1016/j.jsxm.2017.10.064

M3 - Article

VL - 14

SP - 1621

EP - 1628

JO - Journal of Sexual Medicine

JF - Journal of Sexual Medicine

SN - 1743-6095

IS - 12

ER -