Does method matter? Characterizing the effect of preoperative hair removal method on outcomes following penile inversion vaginoplasty

Preoperative genital hair removal (PGHR) prior to penile inversion vaginoplasty (PIV) is vital to prevent postoperative hair-induced stenosis of the neovaginal canal, yet the approach remains unstandardized. We sought to better characterize current methods of PGHR and their effect on outcomes.

Adult transgender females who underwent PIV at a single center from December 2018 to July 2022 were invited to participate in an online survey via email. Reminder emails were distributed once every 2 weeks for a total of four reminders. Data concerning PGHR method, postoperative hair growth, and satisfaction were collected.

Of the 128 patients contacted, 28 (21.9%) completed the survey. Twenty-three patients (82.1%) endorsed PGHR prior to PIV. Laser hair removal (n = 11, 47.8%) was the most common method, followed by electrolysis (n = 7, 30.4%), and at-home kits (n = 5, 17.9%). Treatment sessions most frequently began > 6 months preoperatively (n = 9, 39.1%), occurring once weekly (n = 12, 52.2%) for a total of 5–6 treatments (n = 7, 30.4%). Postoperatively, 9 patients (32.1%) developed hair growth. There were no differences in incidence, time to hair growth, satisfaction with sexual function, or overall satisfaction between PGHR methods. PGHR was associated with lower rates of hair growth (0.069, CI 0.006–0.769), while hair growth was associated with lower satisfaction with sexual function (0.100, CI 0.024–0.427), and lower overall satisfaction (0.069, (0.006–0.769)).

While the ideal method of PGHR remains unclear, preventing hair growth is important to preserve sexual function and maximize postoperative satisfaction. Patients should be properly counseled regarding alternative hairless methods of vaginoplasty, including the intestinal approach, to optimize outcomes.

Level IV, Risk/Prognostic study