de Brouwer Iris J, Elaut Els, Becker-Hebly Inga, Heylens Gunter, Nieder Timo O, van de Grift Tim C, Kreukels Baudewijntje P C
Amsterdam University Medical Center (location VUmc), Department of Plastic, Reconstructive and Hand Surgery, Amsterdam, the Netherlands; Amsterdam University Medical Center (location VUmc), Department of Medical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Institute, Amsterdam, the Netherlands.
University Hospital Ghent, Center of Sexology and Gender, Ghent, Belgium; Ghent University, Department of Experimental-Clinical and Health Psychology, Ghent, Belgium.
J Sex Med. 2021 Nov;18(11):1921-1932. doi: 10.1016/j.jsxm.2021.08.005. Epub 2021 Sep 20.
While much emphasis has been put on the evaluation of gender-affirming surgery (GAS) approaches and their effectiveness, little is known about the health care needs after completion of these interventions.
To assess post-GAS aftercare needs using a mixed-method approach and relate these to participant characteristics.
As part of the ENIGI follow-up study, data was collected 5 years after first contact for gender-affirming treatments in 3 large European clinics. For the current analyses, only participants that had received GAS were included. Data on sociodemographic and clinical characteristics was collected. Standard aftercare protocols were followed. The study focused on participants' aftercare experiences. Participants rated whether they (had) experienced (predefined) aftercare needs and further elaborated in 2 open-ended questions. Frequencies of aftercare needs were analyzed and associated with participant characteristics via binary logistic regression. Answers to the open-ended questions were categorized through thematic analysis.
Aftercare needs transgender individuals (had) experienced after receiving GAS and the relation to sociodemographic and clinical characteristics.
Of the 543 individuals that were invited for the ENIGI follow-up study, a total of 260 individuals were included (122 (trans) masculine, 119 (trans) feminine, 16 other, 3 missing). The most frequently mentioned aftercare need was (additional) assistance in surgical recovery (47%), followed by consultations with a mental health professional (36%) and physiotherapy for the pelvic floor (20%). The need for assistance in surgical recovery was associated with more psychological symptoms (OR=1.65), having undergone genital surgery (OR=2.55) and lower surgical satisfaction (OR=0.61). The need for consultation with a mental health professional was associated with more psychological symptoms and lower surgical satisfaction. The need for pelvic floor therapy was associated with more psychological symptoms as well as with having undergone genital surgery. Thematic analysis revealed 4 domains regarding aftercare optimization: provision of care, additional mental health care, improvement of organization of care and surgical technical care.
Deeper understanding of post-GAS aftercare needs and associated individual characteristics informs health care providers which gaps are experienced and therefore should be addressed in aftercare.
STRENGTHS & LIMITATIONS: We provided first evidence on aftercare needs of transgender individuals after receiving GAS and associated these with participant characteristics in a large multicenter clinical cohort. No standardized data on aftercare received was collected, therefore the expressed aftercare needs cannot be compared with received aftercare.
These results underline a widely experienced desire for aftercare and specify the personalized needs it should entail. IJ de Brouwer, E Elaut, I Becker-Hebly et al. Aftercare Needs Following Gender-Affirming Surgeries: Findings From the ENIGI Multicenter European Follow-Up Study. J Sex Med 2021;18:1921-1932.
虽然人们非常重视性别肯定手术（GAS）方法及其有效性的评估，但对于这些干预措施完成后的医疗保健需求却知之甚少。
采用混合方法评估性别肯定手术后的后续护理需求，并将其与参与者特征相关联。
作为ENIGI随访研究的一部分，在欧洲3家大型诊所首次接触性别肯定治疗5年后收集数据。对于当前分析，仅纳入接受过性别肯定手术的参与者。收集了社会人口统计学和临床特征数据。遵循标准的后续护理方案。该研究重点关注参与者的后续护理经历。参与者对他们是否经历过（预定义的）后续护理需求进行评分，并在两个开放式问题中进一步阐述。分析后续护理需求的频率，并通过二元逻辑回归将其与参与者特征相关联。通过主题分析对开放式问题的答案进行分类。
性别肯定手术后跨性别者经历的后续护理需求以及与社会人口统计学和临床特征的关系。
在受邀参加ENIGI随访研究的543人中，共纳入260人（122名男性化（跨性别）、119名女性化（跨性别）、16名其他性别、3人缺失）。最常提到的后续护理需求是手术恢复方面的（额外）协助（47%），其次是与心理健康专业人员的咨询（36%）以及盆底物理治疗（20%）。手术恢复方面的协助需求与更多心理症状相关（OR = 1.65）、接受过生殖器手术相关（OR = 2.55）以及手术满意度较低相关（OR = 0.61）。与心理健康专业人员咨询的需求与更多心理症状和较低手术满意度相关。盆底治疗的需求与更多心理症状以及接受过生殖器手术相关。主题分析揭示了关于优化后续护理的4个领域：护理提供、额外的心理健康护理、护理组织的改善以及手术技术护理。
对性别肯定手术后的后续护理需求及相关个体特征的更深入了解，能让医疗保健提供者知晓存在哪些差距，从而在后续护理中加以解决。
我们提供了关于跨性别者接受性别肯定手术后后续护理需求的首个证据，并在一个大型多中心临床队列中将这些需求与参与者特征相关联。未收集关于所接受后续护理的标准化数据，因此所表达的后续护理需求无法与所接受的后续护理进行比较。
这些结果强调了对后续护理的广泛需求，并明确了其应包含的个性化需求。IJ·德布鲁尔、E·埃劳特、I·贝克尔 - 赫布利等。性别肯定手术后的后续护理需求：ENIGI欧洲多中心随访研究的结果。《性医学杂志》2021年；18:1921 - 1932。
