Skip to main content
Top

13-04-2024 | Hysterectomy | REVIEW

Genital Reconstructive Surgery for the Transmasculine Patient: An Overview for the OBGYN Practitioner

Authors: Brianna C. Sohl, Skiey Hardin, Kristin M. Jacobs

Published in: Current Obstetrics and Gynecology Reports

Login to get access

Abstract

Purpose of Review

Transmasculine patients will often seek care with obstetrician-gynecologists before, during, or after genital gender-affirmation surgery. This review provides an overview of gynecologic and reconstructive surgical procedures related to masculinizing genital surgery and highlights essential considerations for the OBGYN provider.

Recent Findings

The field of gender-affirming surgery continues to evolve, with a return of care to academic medical centers and a refocus on pooling data and evidence-based care. Nevertheless, the establishment of standardized surgical outcome measures and patient-centered metrics remains a work in progress. Encouraging advancements in urethroplasty techniques demonstrate notable efficacy in mitigating urethral strictures and fistulas.

Summary

Obstetrician-gynecologists are essential members of the surgical care team and provide preoperative, postoperative, and surgical services desired by transmasculine patients. We recommend that all OBGYN providers be familiar with the surgical options for transmasculine patients and follow the most up-to-date care guidelines as outlined by the American College of Obstetricians and Gynecologists and the World Professional Association for Transgender Health.
Literature
2.
go back to reference •• Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022;23(1):S1-259. https://doi.org/10.1080/26895269.2022.2100644. This clinical consensus document provided by WPATH includes the most up-to-date and comprehensive guidelines for providing quality and ethical care to TGD individuals.CrossRefPubMedPubMedCentral •• Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, et al. Standards of care for the health of transgender and gender diverse people, version 8. Int J Transgend Health. 2022;23(1):S1-259. https://​doi.​org/​10.​1080/​26895269.​2022.​2100644. This clinical consensus document provided by WPATH includes the most up-to-date and comprehensive guidelines for providing quality and ethical care to TGD individuals.CrossRefPubMedPubMedCentral
9.
21.
go back to reference •• Bordas N, Stojanovic B, Bizic M, Szanto A, Djordjevic ML. Metoidioplasty: surgical options and outcomes in 813 cases. Front Endocrinol. 2021. https://doi.org/10.3389/fendo.2021.760284. One of the largest, longitudinal, cohort studies on metoidioplasty to date. After long-term follow-up, the study revealed a 10.5% complication rate with urethroplasty, and 99% of patients expressed high satisfaction.CrossRefPubMedPubMedCentral •• Bordas N, Stojanovic B, Bizic M, Szanto A, Djordjevic ML. Metoidioplasty: surgical options and outcomes in 813 cases. Front Endocrinol. 2021. https://​doi.​org/​10.​3389/​fendo.​2021.​760284. One of the largest, longitudinal, cohort studies on metoidioplasty to date. After long-term follow-up, the study revealed a 10.5% complication rate with urethroplasty, and 99% of patients expressed high satisfaction.CrossRefPubMedPubMedCentral
23.
go back to reference • Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, Mullender MG, Groenman F, et al. Colpectomy significantly reduces the risk of urethral fistula formation after urethral lengthening in transgender men undergoing genital gender affirming surgery. J Urol. 2018;200(6):1315–22. https://doi.org/10.1016/j.juro.2018.07.037. This study provides data to support vaginal obliteration at the time of urethral lengthening to reduce the risk of urethral fistula.CrossRefPubMed • Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, Mullender MG, Groenman F, et al. Colpectomy significantly reduces the risk of urethral fistula formation after urethral lengthening in transgender men undergoing genital gender affirming surgery. J Urol. 2018;200(6):1315–22. https://​doi.​org/​10.​1016/​j.​juro.​2018.​07.​037. This study provides data to support vaginal obliteration at the time of urethral lengthening to reduce the risk of urethral fistula.CrossRefPubMed
34.
go back to reference • Ortengren CD, Blasdel G, Damiano EA, Scalia PD, Morgan TS, Bagley P, et al. Urethral outcomes in metoidioplasty and phalloplasty gender affirming surgery (MaPGAS) and vaginectomy: a systematic review. Transl Androl Urol. 2022;11(12):1762–70. https://doi.org/10.21037/tau-22-174. This meta-analysis examined data published since 2000 to observe urethral-related complications with transmasculine gender-affirming surgery.CrossRefPubMedPubMedCentral • Ortengren CD, Blasdel G, Damiano EA, Scalia PD, Morgan TS, Bagley P, et al. Urethral outcomes in metoidioplasty and phalloplasty gender affirming surgery (MaPGAS) and vaginectomy: a systematic review. Transl Androl Urol. 2022;11(12):1762–70. https://​doi.​org/​10.​21037/​tau-22-174. This meta-analysis examined data published since 2000 to observe urethral-related complications with transmasculine gender-affirming surgery.CrossRefPubMedPubMedCentral
40.
go back to reference Levine LA, Elterman L. Urethroplasty following total phallic reconstruction. J Urol. 1998;160(2):378–82.CrossRefPubMed Levine LA, Elterman L. Urethroplasty following total phallic reconstruction. J Urol. 1998;160(2):378–82.CrossRefPubMed
Metadata
Title
Genital Reconstructive Surgery for the Transmasculine Patient: An Overview for the OBGYN Practitioner
Authors
Brianna C. Sohl
Skiey Hardin
Kristin M. Jacobs
Publication date
13-04-2024
Publisher
Springer US
Published in
Current Obstetrics and Gynecology Reports
Electronic ISSN: 2161-3303
DOI
https://doi.org/10.1007/s13669-024-00385-y