Southern California Transgender Counseling, Los Angeles, CA, USA.
Southern California Transgender Counseling, Los Angeles, CA, USA.
J Sex Med. 2019 Apr;16(4):586-595. doi: 10.1016/j.jsxm.2019.01.316. Epub 2019 Mar 2.
Rising numbers of trans women are undergoing genital surgeries, such as vulvoplasty or vulvovaginoplasty, to create a neovagina. Medical professionals who adhere to the World Professional Association for Transgender Health (WPATH) Standards of Care, Version 7, and who recommend or perform these procedures, are expected to balance best practices with patient preferences, specifically the decision to create or omit the vaginal canal. Due to a paucity of literature on gender-confirming vulvoplasty (GCV) in trans women, there has been no documentation of factors that prompt practitioners to reject or recommend the procedure.
The aim of the study was to provide descriptive data of WPATH-affiliated medical professionals' knowledge, experiences, and attitudes toward GCV; surgical risks, benefits, and any considerations when referring transgender women 18-21 years of age for this procedure.
Purposive sampling of all physicians, surgeons, nurse practitioners, physician assistants, and registered nurses listed in the WPATH membership directory was initiated via invitational e-mails. The 32-item survey focused on demographics, medical practices, surgical techniques, and reasons for recommending or rejecting the procedure. Data analysis included frequencies and Pearson's χ test.
Key outcome measures included frequency of cases performed; reasons for recommending, rejecting, or performing GCV; and differences in attitudes toward the procedure among various medical professionals.
N = 198 (20.7%) of 956 solicited professionals completed the survey. Surgeons (n = 61) comprised 30.8% of the total sample. 46 surgeons (76.7%) reported having performed vulvovaginoplasty, and 25 (41.7%) had performed GCV. "Patient request" was the most common reason for recommending or performing GCV. Surgeons were more likely to either agree and perform (30.4%), or reject (32.1%) GCV in a patient aged 18-21 than other practitioners, who were more likely to be "unsure" (68.5%). These differences were statistically significant (χ = 16.467 [2]; n = 193; P < .001).
The data identify a lack of standardized terminology and surgical techniques concerning GCV.
STRENGTH & LIMITATIONS: This is the first exploratory study to assess medical practitioner experiences and attitudes toward a seldom documented procedure. A larger, more inclusive sample would increase the statistical strength and representative aspect of the study.
The study shows divergence in attitudes and knowledge among medical practitioners who recommend or perform GCV, and uncertainty when the patient is 18-21 years old. The study contributes to an expanded description and specific indications of performing GCV in the updated WPATH SOC Version 8. Milrod C, Monto M, Karasic DH. Recommending or Rejecting "the Dimple": WPATH-Affiliated Medical Professionals' Experiences and Attitudes Toward Gender-Confirming Vulvoplasty in Transgender Women. J Sex Med 2019;16:586-595.
越来越多的跨性别女性接受生殖器手术，如外阴成形术或阴道成形术，以创建新阴道。遵守世界跨性别健康专业协会（WPATH）第七版护理标准，并推荐或进行这些手术的医疗专业人员，预计将在最佳实践和患者偏好之间取得平衡，特别是是否创建阴道的决定。由于跨性别女性性别肯定性外阴成形术（GCV）的文献很少，因此没有记录促使从业者拒绝或推荐该手术的因素。
本研究旨在提供 WPATH 相关医疗专业人员对 GCV 的知识、经验和态度的描述性数据；手术风险、益处，以及当推荐 18-21 岁的跨性别女性接受该手术时的任何考虑因素。
通过邀请电子邮件，对 WPATH 会员目录中列出的所有医生、外科医生、护士从业者、医师助理和注册护士进行了有针对性的抽样。32 项调查重点是人口统计学、医疗实践、手术技术以及推荐或拒绝该手术的原因。数据分析包括频率和 Pearson χ 检验。
主要观察指标包括手术次数；推荐、拒绝或进行 GCV 的原因；以及不同医疗专业人员对该手术的态度差异。
在邀请的 956 名专业人员中，有 198 名（20.7%）完成了调查。外科医生（n=61）占总样本的 30.8%。46 名外科医生（76.7%）报告曾进行过阴道成形术，25 名（41.7%）进行过 GCV。“患者要求”是推荐或进行 GCV 的最常见原因。与其他从业者相比，外科医生更有可能同意并进行（30.4%）或拒绝（32.1%）年龄在 18-21 岁的患者的 GCV，而其他从业者更有可能持“不确定”态度（68.5%）。这些差异具有统计学意义（χ=16.467[2]；n=193；P<0.001）。
数据确定了 GCV 方面缺乏标准化的术语和手术技术。
这是第一项评估医疗从业者对很少有文献记录的手术的经验和态度的探索性研究。更大、更具包容性的样本将提高研究的统计学强度和代表性。
该研究表明，推荐或进行 GCV 的医疗从业者之间存在态度和知识差异，并且当患者年龄在 18-21 岁时存在不确定性。该研究为 WPATH 第 8 版护理标准更新中 GCV 的具体描述和特定适应症提供了参考。Milrod C, Monto M, Karasic DH. Recommending or Rejecting "the Dimple": WPATH-Affiliated Medical Professionals' Experiences and Attitudes Toward Gender-Confirming Vulvoplasty in Transgender Women. J Sex Med 2019;16:586-595.
