Milrod Christine, Karasic Dan H
Southern California Transgender Counseling, West Hollywood, CA, USA.
Department of Psychiatry, University of California-San Francisco, San Francisco, CA, USA.
J Sex Med. 2017 Apr;14(4):624-634. doi: 10.1016/j.jsxm.2017.02.007. Epub 2017 Mar 17.
A rising number of female-affirmed transgender adolescents are being treated with gonadotropin-releasing hormone analogues and subsequently cross-sex hormones at early or mid-puberty, with vaginoplasty as the presumed final step in their physical transition. But, despite the minimum age of 18 years defining eligibility to undergo this irreversible procedure, anecdotal reports have shown that vaginoplasties are being performed on minors by surgeons in the United States, thereby contravening the World Professional Association for Transgender Health (WPATH) standards of care (SOC).
To explore surgeons' attitudes toward ethical guidelines in the SOC; any professional experiences of performing vaginoplasty on transgender minors; views of surgical risks, benefits, and harm reduction measures; and perceptions of future challenges and concerns in this area of surgical practice.
A qualitative semistructured interview approach was used to collect data from 13 male and 7 female surgeons who perform transgender vaginoplasty in the United States.
Professional experiences and attitudes toward vaginoplasty in transgender minors were analyzed using the constant comparative method applied to 20 individual interview transcripts.
While there was close agreement concerning surgical techniques, proper patient selection, and predictive elements of postoperative success, attitudes toward the SOC and the reliance on the guidelines varied. The sole practitioner model is gradually giving way to a more holistic team approach, with patient responsibility dispersed among different professionals. Different approaches to surgical training, professional standards, and fellowship programs were suggested. Several participants expressed a need for centralized data collection, patient tracking, and increased involvement of the WPATH as a sponsor of studies in this emergent population.
Drawing on surgeons' attitudes and experiences is essential for the development of standards and practices. A more precise and transparent view of this surgical procedure will be essential in contributing to the updated version 8 of the WPATH SOC.
The abundant data elicited from the interviews address several meaningful research questions, most importantly patient selection criteria, surgical methods, and issues critical to the future of the profession. Nevertheless, the limited sample might not be representative of the surgical cadre at large, particularly when exploring experiences and attitudes toward vaginoplasty in minors. A larger participant pool representing WPATH-affiliated surgeons outside the United States would improve the generalizability of the study.
Taken together, the study and its findings make a significant contribution to the planned revision of the WPATH SOC. Milrod C, Karasic DH. Age Is Just a Number: WPATH-Affiliated Surgeons' Experiences and Attitudes Toward Vaginoplasty in Transgender Females Under 18 Years of Age in the United States. J Sex Med 2017;14:624-634.
越来越多自我认同为女性的跨性别青少年在青春期早期或中期接受促性腺激素释放激素类似物治疗，随后接受跨性别激素治疗，阴道成形术被认为是他们身体转变的最后一步。但是，尽管规定接受这种不可逆手术的最低年龄为18岁，但轶事报道显示，美国的外科医生正在为未成年人实施阴道成形术，这违反了世界跨性别健康专业协会（WPATH）的护理标准（SOC）。
探讨外科医生对SOC中伦理准则的态度；对跨性别未成年人实施阴道成形术的任何专业经验；对手术风险、益处和减少伤害措施的看法；以及对该手术领域未来挑战和担忧的认知。
采用定性半结构化访谈方法，从美国13名男性和7名女性实施跨性别阴道成形术的外科医生中收集数据。
使用恒定比较法对20份个人访谈记录进行分析，以了解外科医生对跨性别未成年人阴道成形术的专业经验和态度。
虽然在手术技术、合适的患者选择以及术后成功的预测因素方面存在密切共识，但对外科手术标准和对指南的依赖程度的态度各不相同。单一执业者模式正逐渐让位于更全面的团队方法，患者责任分散在不同专业人员之间。提出了不同的手术培训、专业标准和进修项目方法。几位参与者表示需要集中数据收集、患者跟踪，并增加WPATH作为这一新兴人群研究赞助者的参与度。
借鉴外科医生的态度和经验对于制定标准和实践至关重要。对该手术过程更精确和透明的看法对于为WPATH SOC第8版做出贡献至关重要。
访谈中获取的丰富数据解决了几个有意义的研究问题，最重要的是患者选择标准、手术方法以及对该专业未来至关重要的问题。然而，有限的样本可能无法代表整个外科医生群体，特别是在探讨对未成年人阴道成形术的经验和态度时。一个更大的代表美国以外WPATH附属外科医生的参与者群体将提高研究的普遍性。
总体而言，该研究及其结果对WPATH SOC的计划修订做出了重大贡献。米尔罗德C，卡拉西克DH。年龄只是一个数字：WPATH附属外科医生对美国18岁以下跨性别女性阴道成形术的经验和态度。《性医学杂志》2017年；14：624 - 634。
