Dominoni Mattia, Scatigno Annachiara Licia, Pasquali Marianna Francesca, Bergante Carola, Gariboldi Fulvio, Gardella Barbara
Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, 27100, Italy.
Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, 27100, Italy.
J Sex Med. 2025 Jan 3;22(1):184-195. doi: 10.1093/jsxmed/qdae146.
Genital gender-affirming surgery has become a crucial step in the transitioning process of numerous transgender people.
To highlight the consequences of genital gender-affirming surgery on pelvic floor function in transgender people.
Medical databases (PubMed, EMBASE, and Cochrane Library) were consulted according to a combination of keywords. All papers published up to February 29, 2024 were considered. Two reviewers independently screened the abstracts of the selected studies and extracted data from the full-text articles included. Data were subsequently tabulated and compared for consistency. The bias associated with each included study was evaluated according to the Observational Study Quality Evaluation (OSQE) method. This study is registered on PROSPERO number CRD42024522580.
Pelvic floor dysfunctions in individuals who undergo gender-affirming surgery, factors that may be involved in the increased prevalence of these dysfunctions and perspectives of treatment of the complications through pelvic floor physical therapy.
Twenty-five papers were considered for systematic review, while 17 studies were included for meta-analysis. There was significant statistical heterogeneity across the included studies. Among transwomen who had undergone vaginoplasty, pelvic organ prolapse occurred in 1%-7.5% of patients, urinary incontinence affected up to 15% of patients, while urinary irritative symptoms up to 20%. Sexual dysfunctions were reported by 25%-75% of patients. Among transmen who underwent hysterectomy and phalloplasty, pelvic organ prolapse occurred in 3.8% of patients, urinary incontinence affected up to 50% of patients, while urinary irritative symptoms up to 37%. Finally, sexual dysfunctions were reported by 54% of patients.
The findings of this study could be helpful for transgender patients pre-operative counselling.
This is the first systematic review and meta-analysis about pelvic floor dysfunctions in transgender people undergoing genital gender-affirming surgery. The main limitations are the limited number of studies included and their heterogeneity.
Pelvic floor dysfunctions following genital gender-affirming surgery are an emerging issue. Adequate information for each surgical procedure, explicit postoperative instructions, continuity of care, communication with healthcare providers, and recommendation for tailored perioperative pelvic floor physiotherapy are necessary for a better surgical result.
生殖器性别确认手术已成为众多跨性别者转变过程中的关键一步。
强调生殖器性别确认手术对跨性别者盆底功能的影响。
根据关键词组合检索医学数据库（PubMed、EMBASE和Cochrane图书馆）。纳入截至2024年2月29日发表的所有论文。两名评审员独立筛选所选研究的摘要，并从纳入的全文文章中提取数据。随后将数据制成表格并进行一致性比较。根据观察性研究质量评估（OSQE）方法评估每项纳入研究的偏倚。本研究已在PROSPERO注册，注册号为CRD42024522580。
对25篇论文进行了系统评价，17项研究纳入荟萃分析。纳入的研究存在显著的统计学异质性。在接受阴道成形术的跨性别女性中，1%-7.5%的患者发生盆腔器官脱垂，高达15%的患者出现尿失禁，高达20%的患者出现尿路刺激症状。25%-75%的患者报告有性功能障碍。在接受子宫切除和阴茎成形术的跨性别男性中，3.8%的患者发生盆腔器官脱垂，高达50%的患者出现尿失禁，高达37%的患者出现尿路刺激症状。最后，54%的患者报告有性功能障碍。
本研究结果有助于为跨性别患者进行术前咨询。
这是关于接受生殖器性别确认手术的跨性别者盆底功能障碍的首次系统评价和荟萃分析。主要局限性是纳入研究数量有限及其异质性。
生殖器性别确认手术后的盆底功能障碍是一个新出现的问题。为了获得更好的手术效果，每种手术的充分信息、明确的术后指导、持续护理、与医疗服务提供者的沟通以及针对性围手术期盆底物理治疗的建议都是必要的。
