Twenty-Seven Years After Sex Reassignment Surgery in Female Transgender Patients: Is Prolapse of the Neovagina an Issue?

Introduction And Hypothesis
Various techniques for neovagina creation have been developed and refined. The aim of this study was to evaluate the incidence of prolapse and possible consecutive therapies in transfemale patients who have received a neovagina as part of their sex reassignment surgery (SRS).Methods
This prospective single-centre case control study was performed at Bern University Hospital (Department of Gynaecology) between 2017 and 2023. Sixty-eight patients who had received SRS (all male to female) were undergoing regular gynaecologic examinations assessing the ICS-Pelvic Organ Prolapse Staging (POP-Q score) and VAS score for symptom burden. Appropriate management for prolapse correction was initiated. Linear and logistic regression were employed for the average comparison of the parameters in correlation to the type of sex reassignment surgery applied.Results
Fifty-four of the 68 participant patients had undergone penis-scrotum inversion technique, six had a neovagina created by peritoneum and seven had an intestinal neovagina. Mean follow-up was 27.5 years. Thirteen patients (19.4%) experienced genital prolapse in this cohort. The group after peritoneal neovagina surgery demonstrated the highest odds ratio for rectocele (OR 4.9, p = 0.17 95% CI 0.71-33.78) and vaginal prolapse (OR 16.67, p = 0.005 95% CI 2.3-120.65). Statistically significant differences in all POP-Q parameters for the penile inversion group indicate smaller vaginal prolapse. Prolapse surgery significantly decreased the VAS score (p < 0.001; 95% CI 5.92-8.38).Conclusions
One in five transfemale patients who have undergone sex reassignment surgery experience genital prolapse. The prevalence of prolapse was found to be highest in the peritoneum reconstruction group, followed by the patients with intestinal neovagina and penile inversion. Surgical intervention for prolapse appears to significantly alleviate symptoms.