A critical component of gender-affirming vaginoplasty is the creation of a functional neovaginal canal capable of penetrative intercourse.Canal creation is inherently challenging due to the deep pelvic anatomy and ris...A critical component of gender-affirming vaginoplasty is the creation of a functional neovaginal canal capable of penetrative intercourse.Canal creation is inherently challenging due to the deep pelvic anatomy and risk of injury to the urethra,bladder,and rectum.These challenges are amplified in revision cases undertaken to correct neovaginal stenosis or convert minimal-depth to full-depth canals.With increasing interest in and access to gender-affirming surgery,myriad techniques for canal creation have arisen.These utilize a variety of donor tissues to line the canal,including genital and extragenital skin grafts,xenografts,allografts,peritoneum,and intestine.Moreover,the rectoprostatic dissection necessary for canal creation can be performed via a perineal approach or with robotic assistance.However,few comparative studies exist to inform the choice of surgical approach or donor tissue.In this article,we briefly review the donor tissue options available for neovaginal canal creation,discuss the associated advantages and disadvantages,and reference pertinent contemporary research.We additionally describe our institutional approach for canal creation in primary and revision vaginoplasties,highlighting technical nuances for success.展开更多
Aim:To evaluate surgical and functional outcomes of assigned male at birth(AMAB)transgender patients who received penoscrotal vaginoplasty at an Italian referral center.Methods:A retrospective analysis included AMAB t...Aim:To evaluate surgical and functional outcomes of assigned male at birth(AMAB)transgender patients who received penoscrotal vaginoplasty at an Italian referral center.Methods:A retrospective analysis included AMAB transgender patients who received penoscrotal vaginoplasty between April 2018 and April 2024.Patient demographic data,surgical outcomes,complications,and functional outcomes were collected and analyzed.Functional outcomes were assessed using validated questionnaires,including the Operated Male-to-Female Sexual Function Index(oMtFSFI),the Female Sexual Function Index(FSFI),and the Female Genital Self-Image Scale(FGSIS).A follow-up period of 12 months was used,with statistical analyses to identify predictors of complications and patient dissatisfaction.Results:The study included 47 AMAB transgender patients,with 30 providing complete functional outcome data.Surgical outcomes showed that the median operative time was 315 min,with a median neovaginal depth of 14 cm.Major complications occurred in 21.2%,including meatal stenosis and one case of rectovaginal fistula.Functional outcomes showed significant improvement,with 63.3%of patients achieving normal oMtFSFI scores at 12 months.FSFI scores also improved across all domains,and genital self-image progressively improved over time.Conclusion:Penoscrotal vaginoplasty demonstrates favorable surgical and functional outcomes in AMAB transgender patients,with high levels of patient satisfaction.Despite the complexity and potential for complications,penoscrotal vaginoplasty represents an effective surgical option for aligning physical appearance with gender identity,with progressive improvements in sexual function and genital self-image observed over the first postoperative year.展开更多
While the number of gender-affirming procedures continues to boom all over the world,resulting complications from genital surgeries are on the rise as well.This paper aims to review some of the most commonly described...While the number of gender-affirming procedures continues to boom all over the world,resulting complications from genital surgeries are on the rise as well.This paper aims to review some of the most commonly described complications of gender-affirming vaginoplasties and provide our expert opinion on how to mitigate them based on the senior author’s experience.Specifically,poor cosmesis,soft tissues related complications,rectal and urethral injuries,neovaginal stenosis,as well as intraoperative and postoperative bleeding will be addressed.展开更多
Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcome...Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis （Mayer-Rokitansky-Kuster-Hauser syndrome）.Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.展开更多
Background The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. As the laparoscopy has been an important tool for the treatment of uterovaginal a...Background The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. As the laparoscopy has been an important tool for the treatment of uterovaginal anomalies, we evaluated the feasibility of laparoscopic vaginoplasty using an ileal segment retrospectively. Methods Totally 86 patients who underwent laparoscopic vaginoplasty using an ileal segment in Beijing Anzhen Hospital during February 2004 to July 2007 were enrolled in this study. Of the 86 patients, 70 （81.4%） underwent primary operations and 16 （18.6%） secondary operations. Nineteen （22.1%） patients underwent total laparoscopic vaginoplasty and 67 （77.9%） patients underwent laparoscope-assisted vaginoplasty. The operation time, cost of hospitalization, and hospital duration were compared between the two laparoscopic groups. The Student＇s t test and the Mann-Whitney test were used to examine the differences. Results All the surgeries were successfully completed with no any intraoperative complication. There were three major surgical complications in the postoperative period： one case of intra-abdominal hemorrhage, one case of meatal stenosis and one case of intestinal obstruction. The mean follow-up period of this series was 18 months. Seventy-eight patients were satisfied with their sexual lives after the surgeries except 5 women complaining of vaginal stenosis and 3 with no sexual partner during the follow-up. Significant differences were obtained between total laparoscopic and laparoscope-assisted vaginoplasty groups, such as the operation time, cost of hospitalization, and hospital duration （P 〈0.01）. There were no significant differences in sexual function between the two groups. Conclusions The laparoscopic vaginoplasty using an ileal segment is satisfactory for cosmetic, functional, and anatomic results. Vaginoplasty with an ileal segment, performed by either total laparoscopic or laparoscope-assisted techniques, has a high success rate for a functional vagina.展开更多
BACKGROUND Traumatic cloacal deformities are a result of major obstetric injury and usually happens after a fourth-degree perineal laceration.This is characterized by complete disruption of the perineal body,anterior ...BACKGROUND Traumatic cloacal deformities are a result of major obstetric injury and usually happens after a fourth-degree perineal laceration.This is characterized by complete disruption of the perineal body,anterior defect of the internal and external anal sphincter,and loss of the distal rectovaginal and/or anovaginal septum.The common chamber incorporating vagina and recto anal outlet ensues as cloaca.CASE SUMMARY We present a case of unmarried 15-year female,who developed hematometra and was diagnosed as cervical ostia obstruction at the age of 12 year.She underwent drainage of hematometra,and later some abdominal and perineal procedures elsewhere and subsequently developed fecal discharge from the vagina.Examination revealed absence of posterior wall of vagina and anterior wall of anorectum.In addition,the anterior half of the anal sphincter was also absent.She underwent vaginoplasty,anorectoplasty,sphincteroplasty with levatorplasty with creation of rectovaginal septum.CONCLUSION This case report highlights expert management of a case of mismanaged benign gynaecological condition in a young female that resulted in lifelong impairment of the patient's quality of life following hysterectomy and salpingo-oophorectomy,leading to the development of a common cloaca.展开更多
Introduction: Androgen insensitivity syndrome is a rare congenital abnormality of genital organs revealing a female phenotype in a person with XY chromosomes. The aim of our work is to describe the clinical aspects, t...Introduction: Androgen insensitivity syndrome is a rare congenital abnormality of genital organs revealing a female phenotype in a person with XY chromosomes. The aim of our work is to describe the clinical aspects, to determine the chromosomal sex and to report our therapeutic management. Observation: A 28-year-old woman with female phenotype, feminine voice, normal breast development, normal underarms and pubic hair, absence of menstruation, fusion of small and large vaginal lips leaving a small pertuis to serve as urethral meatus. On the dorsal surface of the large, left lip was a mass the size of a date. Hormonal balance was normal. A feminizing genitoplasty was performed as well as excision of the mass. Histological analysis of the mass concluded that it was a feminizing testicular. Conclusion: Androgen insensitivity syndrome is a rare abnormality of the genitals. Multidisciplinary management is essential both for the designation of the breeding sex and feminizing genitoplasty.展开更多
Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly characterized by <span style="font-family:Verdana;">triad</span><span style="font-family:Verdana;"> of uterus ...Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly characterized by <span style="font-family:Verdana;">triad</span><span style="font-family:Verdana;"> of uterus didelphys, obstructed </span><span style="font-family:Verdana;">hemi</span><span style="font-family:Verdana;"> vagina, and ipsilateral renal agenesis. The most common presentation is abdominal pain, dysmenorrhea, and abdominal mass secondary to </span><span style="font-family:Verdana;">hemi</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">hematometrocolpos</span><span style="font-family:Verdana;">. We report an emergency presentation of this syndrome during the pandemic of COVID-19 in Qatif Central Hospital, Saudi Arabia, April 2020. An 11-year-old Saudi girl presented to the emergency room with three months history of cyclical lower abdominal pain. The pain was progressive, continuous </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> not relieved by analgesics. Abdominal examination revealed a tender abdominal mass mainly in the left iliac fossa, Ultrasound evaluation showed two uterine bodies. The left uterus was distended with complex fluid. Pelvic MRI findings consistent with Herlyn-Werner-Wunderlich (HWW) syndrome were found with uterine </span><span style="font-family:Verdana;">didelphys</span><span style="font-family:Verdana;"> and </span><span style="font-family:Verdana;">left sided</span><span style="font-family:Verdana;"> hematometra resulting from obstructed </span><span style="font-family:Verdana;">hemi</span><span style="font-family:Verdana;">-vagina and ipsilateral agenesis of the left kidney. Resection of the vaginal septum and drainage of hematometra was done. The patient recovered with normal cyclical menstruation. Cyclical or continuous lower abdominal pain with or without amenorrhea is the usual presentation of HWW syndrome during adolescence. Diagnosis is made by ultrasonography and MRI. Early diagnosis and accurate management can provide pain relief, prevent future complications, and preserve fertility.</span>展开更多
For many individuals,sexual health is an important part of overall health and well-being,yet it remains an overlooked aspect of care for transgender and gender diverse(TGD)patients.While cisgender and TGD individuals ...For many individuals,sexual health is an important part of overall health and well-being,yet it remains an overlooked aspect of care for transgender and gender diverse(TGD)patients.While cisgender and TGD individuals share many sexual health needs,TGD patients face unique clinical considerations that physicians-particularly surgeons-must understand in the context of gender-affirming surgery(GAS).As demand for GAS grows,it is essential that plastic surgeons and other surgical specialists recognize how these procedures affect sexual health,sexual function,and satisfaction.This review summarizes current evidence on sexual health outcomes in TGD populations following commonly performed GASs,including chest masculinization,breast augmentation,phalloplasty,metoidioplasty,vaginoplasty,and vulvoplasty.These procedures can substantially enhance quality of life(QOL)by improving body congruence and sexual well-being;however,they may also introduce anatomical,neurological,or psychosocial challenges that influence sexual health.To ensure that patients can provide fully informed consent,surgeons must understand these outcomes and communicate them effectively as part of surgical planning and throughout both pre-and postoperative care.展开更多
Aim:Gender dysphoria causes significant psychological distress in individuals,leading many to seek medical interventions,including hormone therapy and gender-affirming surgery(GAS).This study sought to enhance the und...Aim:Gender dysphoria causes significant psychological distress in individuals,leading many to seek medical interventions,including hormone therapy and gender-affirming surgery(GAS).This study sought to enhance the understanding of life satisfaction and self-harm and suicidal thoughts among transgender women after genital GAS.Methods:A retrospective cohort of 102 transgender women who underwent GAS during 2011-2021 at Sahlgrenska University Hospital,with a follow-up period of at least 1 year after genital GAS,was studied.Data were collected as part of a larger initiative that focused on transgender women.The participants were surveyed using the Life Satisfaction Questionnaire,Gender Congruence and Life Satisfaction Scale,and a general demographic health survey.Data were analyzed using descriptive statistics.Results:Of the 98 eligible participants,50 completed the questionnaire.Although 28%of the respondents experienced thoughts of self-harm or suicidal ideation postoperatively,they reported overall satisfaction with life and mental health,suggesting that surgical treatment may have had a positive impact on life satisfaction and gender congruence.Conclusion:Our study highlights the significant issues of thoughts of self-harm or suicidal ideation among transgender women after genital GAS.Although the prevalence thereof was lower than that reported previously,it remains concerning.Nevertheless,most participants reported life satisfaction and finding life meaningful postsurgery.These findings emphasize the need for integrating continuous mental health support with access to GAS to address the mental health challenges of transgender women after genital GAS,while aiming to improve the quality of life as the primary goal.展开更多
Information available on gender-affirming surgeries is often limited to those classified by the binary standard of masculinizing or feminizing genital aesthetics.Scant information is available on surgical options for ...Information available on gender-affirming surgeries is often limited to those classified by the binary standard of masculinizing or feminizing genital aesthetics.Scant information is available on surgical options for non-binary and gender-diverse individuals who may opt for less frequently requested surgeries.We discuss preoperative counseling,surgical techniques,and postoperative care of such procedures,including a discussion of scrotectomy,penile-sparing vaginoplasty,and nullification procedures for non-binary and gender-diverse individuals assigned male at birth(AMAB).Frequent and open discussions are key to helping manage expectations of surgical outcomes.Creating an inclusive and safe environment is pivotal in understanding the needs and goals of all genderdiverse patients.展开更多
Gender-affirming genital surgery includes a constellation of pelvic procedures that can help feminize or masculinize the genitalia.Technological advances in robotic surgery can aid surgical access to and visualization...Gender-affirming genital surgery includes a constellation of pelvic procedures that can help feminize or masculinize the genitalia.Technological advances in robotic surgery can aid surgical access to and visualization of the pelvis,thereby facilitating certain procedures.In this scoping review,we will discuss the developing role of the robot in genital affirming genital surgery.Indications,techniques,and outcomes using the robot in both feminizing and masculinizing genital procedures will be reviewed.展开更多
The use of body mass index(BMI)to determine eligibility for gender-affirming surgery in transgender and nonbinary individuals has been contested.While BMI thresholds are often meant to be protective,restricting patien...The use of body mass index(BMI)to determine eligibility for gender-affirming surgery in transgender and nonbinary individuals has been contested.While BMI thresholds are often meant to be protective,restricting patients from access to surgery can also cause harm.There is a rationale for the continued use of BMI,but the inherent problems with it must also be recognized,including how weight stigma impacts patients’access to gender-affirming surgery and influences clinical care.This article uses a narrative review of current literature to discuss how high BMI affects surgical outcomes in gender-affirming genital surgeries,as well as analogous procedures,existing de facto BMI thresholds,and how to both minimize the harms of proceeding with surgery in patients with a high BMI or the harms of delaying for weight loss.BMI factors into surgical decision-making based on the existing literature,which demonstrates that high BMI is associated with increased surgical risk,including higher incidences of surgical site infections and poor wound healing,as well as the possibility of free flap complications,which are a component of certain genital procedures.This patient population is at higher risk for eating disorders,and it is prudent to find alternatives to requiring patient self-monitored weight management.The impacts of weight stigma should be considered when treating gender-affirming surgery patients,and further data and research are needed to augment shared decision-making and lead to practice change.展开更多
文摘A critical component of gender-affirming vaginoplasty is the creation of a functional neovaginal canal capable of penetrative intercourse.Canal creation is inherently challenging due to the deep pelvic anatomy and risk of injury to the urethra,bladder,and rectum.These challenges are amplified in revision cases undertaken to correct neovaginal stenosis or convert minimal-depth to full-depth canals.With increasing interest in and access to gender-affirming surgery,myriad techniques for canal creation have arisen.These utilize a variety of donor tissues to line the canal,including genital and extragenital skin grafts,xenografts,allografts,peritoneum,and intestine.Moreover,the rectoprostatic dissection necessary for canal creation can be performed via a perineal approach or with robotic assistance.However,few comparative studies exist to inform the choice of surgical approach or donor tissue.In this article,we briefly review the donor tissue options available for neovaginal canal creation,discuss the associated advantages and disadvantages,and reference pertinent contemporary research.We additionally describe our institutional approach for canal creation in primary and revision vaginoplasties,highlighting technical nuances for success.
文摘Aim:To evaluate surgical and functional outcomes of assigned male at birth(AMAB)transgender patients who received penoscrotal vaginoplasty at an Italian referral center.Methods:A retrospective analysis included AMAB transgender patients who received penoscrotal vaginoplasty between April 2018 and April 2024.Patient demographic data,surgical outcomes,complications,and functional outcomes were collected and analyzed.Functional outcomes were assessed using validated questionnaires,including the Operated Male-to-Female Sexual Function Index(oMtFSFI),the Female Sexual Function Index(FSFI),and the Female Genital Self-Image Scale(FGSIS).A follow-up period of 12 months was used,with statistical analyses to identify predictors of complications and patient dissatisfaction.Results:The study included 47 AMAB transgender patients,with 30 providing complete functional outcome data.Surgical outcomes showed that the median operative time was 315 min,with a median neovaginal depth of 14 cm.Major complications occurred in 21.2%,including meatal stenosis and one case of rectovaginal fistula.Functional outcomes showed significant improvement,with 63.3%of patients achieving normal oMtFSFI scores at 12 months.FSFI scores also improved across all domains,and genital self-image progressively improved over time.Conclusion:Penoscrotal vaginoplasty demonstrates favorable surgical and functional outcomes in AMAB transgender patients,with high levels of patient satisfaction.Despite the complexity and potential for complications,penoscrotal vaginoplasty represents an effective surgical option for aligning physical appearance with gender identity,with progressive improvements in sexual function and genital self-image observed over the first postoperative year.
文摘While the number of gender-affirming procedures continues to boom all over the world,resulting complications from genital surgeries are on the rise as well.This paper aims to review some of the most commonly described complications of gender-affirming vaginoplasties and provide our expert opinion on how to mitigate them based on the senior author’s experience.Specifically,poor cosmesis,soft tissues related complications,rectal and urethral injuries,neovaginal stenosis,as well as intraoperative and postoperative bleeding will be addressed.
文摘Background In the past several decades we have seen multiple advances in the reconstruction for girls born with vaginal agenesis.This study aimed to evaluate the technical feasibility,anatomical and functional outcomes of one-stage laparoscopic and gasless laparoscopic vaginoplasty with sigmoid colon for the patients of vaginal agenesis （Mayer-Rokitansky-Kuster-Hauser syndrome）.Methods We did a retrospective review of a total of 150 women with Mayer-Rokitansky-Kuster-Hauser syndrome treated at Beijing Anzhen Hospital,Capital Medical University from March 2006 to August 2010.The patients were divided into the CO2 pneumoperitoneum laparoscopic group and the abdominal wall lift of gasless laparoscopic group.Sigmoid colon vaginoplasty approaches were performed in all of the patients.The surgical techniques,perioperative results,complications,anatomical and functional outcomes of vaginoplasty were recorded.Results All procedures were performed successfully.Significant differences in the operative time and intraoperative blood loss existed in the laparoscopic vaginoplasty group compared with the gasless laparoscopic vaginoplasty group.The patients who underwent sigmoid colon vaginoplasty had good cosmetic results without the problem of excessive mucus production.The postoperative complications were minimal.During a mean follow-up of 15.6 months,no stenosis or shrinkage was encountered.The subjective sexual satisfaction rate with the surgical outcomes in all patients was 83.3%.Conclusions Laparoscopic or gasless laparoscopic vaginoplasty with sigmoid colon are effective and feasible approaches for women with congenital vaginal agenesis.The procedures have satisfactory anatomical and functional results.
文摘Background The surgical management of the absence of the vagina is a complex problem and constitutes a significant technical challenge. As the laparoscopy has been an important tool for the treatment of uterovaginal anomalies, we evaluated the feasibility of laparoscopic vaginoplasty using an ileal segment retrospectively. Methods Totally 86 patients who underwent laparoscopic vaginoplasty using an ileal segment in Beijing Anzhen Hospital during February 2004 to July 2007 were enrolled in this study. Of the 86 patients, 70 （81.4%） underwent primary operations and 16 （18.6%） secondary operations. Nineteen （22.1%） patients underwent total laparoscopic vaginoplasty and 67 （77.9%） patients underwent laparoscope-assisted vaginoplasty. The operation time, cost of hospitalization, and hospital duration were compared between the two laparoscopic groups. The Student＇s t test and the Mann-Whitney test were used to examine the differences. Results All the surgeries were successfully completed with no any intraoperative complication. There were three major surgical complications in the postoperative period： one case of intra-abdominal hemorrhage, one case of meatal stenosis and one case of intestinal obstruction. The mean follow-up period of this series was 18 months. Seventy-eight patients were satisfied with their sexual lives after the surgeries except 5 women complaining of vaginal stenosis and 3 with no sexual partner during the follow-up. Significant differences were obtained between total laparoscopic and laparoscope-assisted vaginoplasty groups, such as the operation time, cost of hospitalization, and hospital duration （P 〈0.01）. There were no significant differences in sexual function between the two groups. Conclusions The laparoscopic vaginoplasty using an ileal segment is satisfactory for cosmetic, functional, and anatomic results. Vaginoplasty with an ileal segment, performed by either total laparoscopic or laparoscope-assisted techniques, has a high success rate for a functional vagina.
文摘BACKGROUND Traumatic cloacal deformities are a result of major obstetric injury and usually happens after a fourth-degree perineal laceration.This is characterized by complete disruption of the perineal body,anterior defect of the internal and external anal sphincter,and loss of the distal rectovaginal and/or anovaginal septum.The common chamber incorporating vagina and recto anal outlet ensues as cloaca.CASE SUMMARY We present a case of unmarried 15-year female,who developed hematometra and was diagnosed as cervical ostia obstruction at the age of 12 year.She underwent drainage of hematometra,and later some abdominal and perineal procedures elsewhere and subsequently developed fecal discharge from the vagina.Examination revealed absence of posterior wall of vagina and anterior wall of anorectum.In addition,the anterior half of the anal sphincter was also absent.She underwent vaginoplasty,anorectoplasty,sphincteroplasty with levatorplasty with creation of rectovaginal septum.CONCLUSION This case report highlights expert management of a case of mismanaged benign gynaecological condition in a young female that resulted in lifelong impairment of the patient's quality of life following hysterectomy and salpingo-oophorectomy,leading to the development of a common cloaca.
文摘Introduction: Androgen insensitivity syndrome is a rare congenital abnormality of genital organs revealing a female phenotype in a person with XY chromosomes. The aim of our work is to describe the clinical aspects, to determine the chromosomal sex and to report our therapeutic management. Observation: A 28-year-old woman with female phenotype, feminine voice, normal breast development, normal underarms and pubic hair, absence of menstruation, fusion of small and large vaginal lips leaving a small pertuis to serve as urethral meatus. On the dorsal surface of the large, left lip was a mass the size of a date. Hormonal balance was normal. A feminizing genitoplasty was performed as well as excision of the mass. Histological analysis of the mass concluded that it was a feminizing testicular. Conclusion: Androgen insensitivity syndrome is a rare abnormality of the genitals. Multidisciplinary management is essential both for the designation of the breeding sex and feminizing genitoplasty.
文摘Herlyn-Werner-Wunderlich (HWW) syndrome is a rare congenital anomaly characterized by <span style="font-family:Verdana;">triad</span><span style="font-family:Verdana;"> of uterus didelphys, obstructed </span><span style="font-family:Verdana;">hemi</span><span style="font-family:Verdana;"> vagina, and ipsilateral renal agenesis. The most common presentation is abdominal pain, dysmenorrhea, and abdominal mass secondary to </span><span style="font-family:Verdana;">hemi</span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">hematometrocolpos</span><span style="font-family:Verdana;">. We report an emergency presentation of this syndrome during the pandemic of COVID-19 in Qatif Central Hospital, Saudi Arabia, April 2020. An 11-year-old Saudi girl presented to the emergency room with three months history of cyclical lower abdominal pain. The pain was progressive, continuous </span><span style="font-family:Verdana;">and</span><span style="font-family:Verdana;"> not relieved by analgesics. Abdominal examination revealed a tender abdominal mass mainly in the left iliac fossa, Ultrasound evaluation showed two uterine bodies. The left uterus was distended with complex fluid. Pelvic MRI findings consistent with Herlyn-Werner-Wunderlich (HWW) syndrome were found with uterine </span><span style="font-family:Verdana;">didelphys</span><span style="font-family:Verdana;"> and </span><span style="font-family:Verdana;">left sided</span><span style="font-family:Verdana;"> hematometra resulting from obstructed </span><span style="font-family:Verdana;">hemi</span><span style="font-family:Verdana;">-vagina and ipsilateral agenesis of the left kidney. Resection of the vaginal septum and drainage of hematometra was done. The patient recovered with normal cyclical menstruation. Cyclical or continuous lower abdominal pain with or without amenorrhea is the usual presentation of HWW syndrome during adolescence. Diagnosis is made by ultrasonography and MRI. Early diagnosis and accurate management can provide pain relief, prevent future complications, and preserve fertility.</span>
文摘For many individuals,sexual health is an important part of overall health and well-being,yet it remains an overlooked aspect of care for transgender and gender diverse(TGD)patients.While cisgender and TGD individuals share many sexual health needs,TGD patients face unique clinical considerations that physicians-particularly surgeons-must understand in the context of gender-affirming surgery(GAS).As demand for GAS grows,it is essential that plastic surgeons and other surgical specialists recognize how these procedures affect sexual health,sexual function,and satisfaction.This review summarizes current evidence on sexual health outcomes in TGD populations following commonly performed GASs,including chest masculinization,breast augmentation,phalloplasty,metoidioplasty,vaginoplasty,and vulvoplasty.These procedures can substantially enhance quality of life(QOL)by improving body congruence and sexual well-being;however,they may also introduce anatomical,neurological,or psychosocial challenges that influence sexual health.To ensure that patients can provide fully informed consent,surgeons must understand these outcomes and communicate them effectively as part of surgical planning and throughout both pre-and postoperative care.
文摘Aim:Gender dysphoria causes significant psychological distress in individuals,leading many to seek medical interventions,including hormone therapy and gender-affirming surgery(GAS).This study sought to enhance the understanding of life satisfaction and self-harm and suicidal thoughts among transgender women after genital GAS.Methods:A retrospective cohort of 102 transgender women who underwent GAS during 2011-2021 at Sahlgrenska University Hospital,with a follow-up period of at least 1 year after genital GAS,was studied.Data were collected as part of a larger initiative that focused on transgender women.The participants were surveyed using the Life Satisfaction Questionnaire,Gender Congruence and Life Satisfaction Scale,and a general demographic health survey.Data were analyzed using descriptive statistics.Results:Of the 98 eligible participants,50 completed the questionnaire.Although 28%of the respondents experienced thoughts of self-harm or suicidal ideation postoperatively,they reported overall satisfaction with life and mental health,suggesting that surgical treatment may have had a positive impact on life satisfaction and gender congruence.Conclusion:Our study highlights the significant issues of thoughts of self-harm or suicidal ideation among transgender women after genital GAS.Although the prevalence thereof was lower than that reported previously,it remains concerning.Nevertheless,most participants reported life satisfaction and finding life meaningful postsurgery.These findings emphasize the need for integrating continuous mental health support with access to GAS to address the mental health challenges of transgender women after genital GAS,while aiming to improve the quality of life as the primary goal.
文摘Information available on gender-affirming surgeries is often limited to those classified by the binary standard of masculinizing or feminizing genital aesthetics.Scant information is available on surgical options for non-binary and gender-diverse individuals who may opt for less frequently requested surgeries.We discuss preoperative counseling,surgical techniques,and postoperative care of such procedures,including a discussion of scrotectomy,penile-sparing vaginoplasty,and nullification procedures for non-binary and gender-diverse individuals assigned male at birth(AMAB).Frequent and open discussions are key to helping manage expectations of surgical outcomes.Creating an inclusive and safe environment is pivotal in understanding the needs and goals of all genderdiverse patients.
文摘Gender-affirming genital surgery includes a constellation of pelvic procedures that can help feminize or masculinize the genitalia.Technological advances in robotic surgery can aid surgical access to and visualization of the pelvis,thereby facilitating certain procedures.In this scoping review,we will discuss the developing role of the robot in genital affirming genital surgery.Indications,techniques,and outcomes using the robot in both feminizing and masculinizing genital procedures will be reviewed.
文摘The use of body mass index(BMI)to determine eligibility for gender-affirming surgery in transgender and nonbinary individuals has been contested.While BMI thresholds are often meant to be protective,restricting patients from access to surgery can also cause harm.There is a rationale for the continued use of BMI,but the inherent problems with it must also be recognized,including how weight stigma impacts patients’access to gender-affirming surgery and influences clinical care.This article uses a narrative review of current literature to discuss how high BMI affects surgical outcomes in gender-affirming genital surgeries,as well as analogous procedures,existing de facto BMI thresholds,and how to both minimize the harms of proceeding with surgery in patients with a high BMI or the harms of delaying for weight loss.BMI factors into surgical decision-making based on the existing literature,which demonstrates that high BMI is associated with increased surgical risk,including higher incidences of surgical site infections and poor wound healing,as well as the possibility of free flap complications,which are a component of certain genital procedures.This patient population is at higher risk for eating disorders,and it is prudent to find alternatives to requiring patient self-monitored weight management.The impacts of weight stigma should be considered when treating gender-affirming surgery patients,and further data and research are needed to augment shared decision-making and lead to practice change.
