Medical professionals don’t typically recommend gender-confirming vulvoplasty (GCV) to transgender women, according to survey results published in the Journal of Sexual Medicine.
In general, male-to-female gender-confirming surgery involves the creation of female genitalia, including a hooded clitoris, labia majora, and labia minora. The urethra is also shortened to allow for seated urination.
For a vagina, surgeons may choose one of two routes. During vulvovaginoplasty, a vaginal canal is created for penetrative intercourse. In contrast, gender-confirming vulvoplasty forms a shallow vagina (“dimple”) which cannot be penetrated.
Transgender women may undergo vulvoplasty if they have medical conditions that make them poor candidates for vulvovaginoplasty (such as previous radical prostatectomy with urinary incontinence) or if they are unable or do not wish to take care of a neovagina. Also, some patients simply aren’t interested in receptive intercourse.
However, there is little formal research on why medical practitioners recommend – or don’t recommend – GCV.
The current study included 198 medical practitioners who were members of the World Professional Association for Transgender Health (WPATH). About 70% of the respondents lived and worked in the United States. Almost 31% were surgeons. Forty-six had performed vulvovaginoplasty in transgender women; twenty-five had performed GCV.
About three-quarters of the surgeons who performed GCV did so because patients requested it, the authors reported. About a third said they did so because of their patients’ older age or health risks.
About two-thirds of the respondents had never been asked about GCV by their patients and the same percentage said they “never” recommended this type of surgery.
The survey also asked about GCV in patients aged 18 to 21. Non-surgical professionals were more likely to feel “unsure” about the procedure (69%), compared to surgeons, who seemed to have more definitive opinions. (About 30% of the surgeons supported GCV, 32% rejected it, and 38% were unsure about it.)
Some practitioners wondered whether younger women having GCV would change their minds later and request secondary surgery to create a vagina. “Often, they want depth eventually, even if lesbian, to feel whole, etc.,” said one respondent.
The vast majority of respondents (94%) said they had not seen published, peer-reviewed research that described GCV procedures.
The authors noted that this was the first study of its kind and that a larger sample, including practitioners who were not WPATH members, might have different results. They also recommended adding the perspectives of patients to future research in this area.
The Journal of Sexual Medicine
Milrod, Christine, Ph.D., et al.
“Recommending or Rejecting “the Dimple”: WPATH-Affiliated Medical Professionals’ Experiences and Attitudes Toward Gender-Confirming Vulvoplasty in Transgender Women”
(Full-text. Published online: March 1, 2019)