女性向男性跨性别男性行阴道子宫切除术的可行性

Feasibility of Vaginal Hysterectomy for Female-to-Male Transgender Men.

作者信息

Obedin-Maliver Juno, Light Alexis, de Haan Gene, Jackson Rebecca A

机构信息

Departments of Obstetrics, Gynecology, and Reproductive Sciences and Epidemiology and Biostatistics, University of California, San Francisco, and the Department of General Internal Medicine, San Francisco Department of Veterans Affairs, San Francisco, California; the Department of Obstetrics and Gynecology, Washington Hospital Center, Washington, DC; and the Department of Obstetrics and Gynecology, Oregon Health Sciences University, Portland, Oregon.

出版信息

Obstet Gynecol. 2017 Mar;129(3):457-463. doi: 10.1097/AOG.0000000000001866.

DOI:10.1097/AOG.0000000000001866

PMID:28178042

Abstract

OBJECTIVE

To describe the hysterectomy data among a cohort of transgender men and nontransgender (ie, cisgender) women with a particular goal to evaluate the feasibility of vaginal hysterectomy among transgender men.

METHODS

This cohort study includes all hysterectomies performed for benign indications on transgender men and cisgender women at a single academic county hospital from 2000 to 2012. Hysterectomy cases and patient gender were identified by billing records and confirmed by review of medical records. Primary study outcome was the hysterectomy route among transgender men compared with cisgender women. We also examined risk factors and operative outcomes. Student two-sided t tests, χ analysis, and descriptive statistics are presented; sensitivity analyses using regression techniques were performed.

RESULTS

Hysterectomies for benign gynecologic procedures were performed in 883 people: 33 on transgender men and 850 on cisgender women. Transgender men were younger, had fewer pregnancies and deliveries, and smaller uteri. The leading indication for hysterectomy differed significantly: pain (85%) was most common among transgender men (compared with 22% in cisgender women; P<.001), whereas leiomyomas (64%) was most common for cisgender women (compared with 21% in transgender men; P<.001). Vaginal hysterectomies were performed in 24% transgender men and 42% of cisgender women. Estimated blood loss was less among transgender men (P=.002), but when uterine size and route of hysterectomy were considered, the difference between gender groups was no longer significant. There was no difference in patients experiencing complications between the groups.

CONCLUSION

Transgender men and cisgender women have different preoperative characteristics and surgical indications. Vaginal hysterectomies have been successfully completed among transgender men. Because vaginal hysterectomy is a viable procedure for this population, it should be considered in surgical planning for transgender men.

摘要

目的

描述一组变性男性和非变性（即顺性别）女性的子宫切除数据，特别旨在评估变性男性行阴道子宫切除术的可行性。

方法

这项队列研究纳入了2000年至2012年在一家学术性县级医院因良性指征对变性男性和顺性别女性进行的所有子宫切除术。通过计费记录识别子宫切除病例和患者性别，并经病历审查确认。主要研究结局是变性男性与顺性别女性的子宫切除途径。我们还检查了危险因素和手术结局。呈现了学生双侧t检验、χ分析和描述性统计；使用回归技术进行了敏感性分析。

结果

883人接受了良性妇科手术子宫切除术：33例为变性男性，850例为顺性别女性。变性男性更年轻，怀孕和分娩次数更少，子宫更小。子宫切除的主要指征差异显著：疼痛（85%）在变性男性中最常见（顺性别女性中为22%；P<0.001），而平滑肌瘤（64%）在顺性别女性中最常见（变性男性中为21%；P<0.001）。24%的变性男性和42%的顺性别女性接受了阴道子宫切除术。变性男性的估计失血量较少（P=0.002），但在考虑子宫大小和子宫切除途径后，性别组之间的差异不再显著。两组患者发生并发症的情况无差异。