Sexual Function and Psychosocial Factors in trans Women After Penile Inversion Vulvo-Vaginoplasty Without Scrotal Skin Grafts

METHODS

Study design

          This is a retrospective cross-sectional questionnaire study. All participants were surveyed using a paper-pencil questionnaire. Women who underwent penile inversion vulvo-vaginoplasty at Klinik Landstraße Vienna between 2009 and 2020 were contacted via telephone and subsequently received the study questionnaire by mail. Clinical data were extracted from digital medical records. Since all participants were operated by the same surgeon, this study is considered a single-surgeon study. The study was approved in advance by the Ethics Committee of the City of Vienna (EK-22-123-1122).

Survey instruments

          Sexual function was assessed using the operated Male-to-Female Sexual Function Index. The oMtFSFI is a validated questionnaire designed to assess sexual function in trans women following genital GAS. The questionnaire consists of eighteen questions answered on a four-point Likert scale (1 = almost always to always; 4 = almost never to never) and covers three domains of sexual dysfunction: sexual dissatisfaction (10 items), genital self-image (4 items) and sexual pain (4 items). Each domain is categorized into four levels: normal, mild to moderate, borderline critical and critical. One additional item specifically assessed overall satisfaction with the neogenitalia using a four-point Likert scale (ranging from dissatisfied to very satisfied).

The items related to societal acceptance are derived from a validated quality of life questionnaire specifically designed for trans individuals, the Essener Transidentität Lebensqualitäts-Inventar (ETLI). For this study, only selected items from the ETLI were used, specifically those addressing social acceptance and exclusion. The questions assess: perceived ability to openly express one's trans identity, feeling ostracized by society, frequency of experiencing insults in public spaces, and acceptance of one's trans identity by family members. The questions were answered on a four-point Likert scale (ranging from never to always). 

Peri- and postoperative complications

          Digital medical records were used to evaluate the complication rates associated with penile inversion vulvo-vaginoplasty (impuls.kis and webokra software).