Brown Lee K, Butcher Rebecca L, Kinney Linda M, Nigriny John F, Moses Rachel A
Department of Surgery, Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, United States.
Geisel School of Medicine at Dartmouth, Hanover, NH 03755, United States.
J Sex Med. 2025 Apr 8;22(3):526-535. doi: 10.1093/jsxmed/qdae193.
Understanding patient goals for metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) is paramount to achieving satisfactory, preference-sensitive outcomes, yet there is a lack of understanding of MaPGAS priorities and how these may vary between transgender men and non-binary individuals assigned female at birth (AFAB).
To understand the surgical goals of transgender men and non-binary individuals AFAB considering MaPGAS.
An online survey was created following literature review and qualitative interviews and distributed via social media and a community health center to participants AFAB aged ≥18 years who had considered but not yet undergone MaPGAS. We collected demographics, surgical history, Likert ratings of importance of 14 possible MaPGAS goals, and selection of the 5 most important goals. Differences in goal importance ratings were compared using the Mann-Whitney U test. Responses to an open-ended question on additional MaPGAS goal considerations were thematically analyzed by 2 reviewers.
A total of 248 eligible participants completed the survey; participants included transgender men (64%) and non-binary individuals (36%).
Both groups rated maintaining tactile and erogenous sensations as top priorities. Significant differences emerged in half of the goals, with transgender men more likely to place importance on being seen as male, public restroom comfort, peeing through the tip of the penis, standing urination through the fly, and resolution of gender dysphoria. Non-binary individuals were more likely to place importance on retaining a vaginal canal to receive penetration and for gender identity affirmation. These differences in goal prioritization between the 2 groups were most apparent when individuals provided their top 5 goals. In open-ended responses, aesthetics was a major consideration for transgender men, sexual pleasure was a consideration for non-binary individuals, and complications were cited as major concerns by both groups.
Individual MaPGAS goals should be incorporated into preoperative counseling and may vary by gender identity.
This is the largest study to our knowledge evaluating patient MaPGAS goals and comparing gender identity cohorts. Our results incorporate qualitative open-ended feedback and underscore the importance of understanding patient-specific MaPGAS goals to better facilitate personalized preoperative counseling. Results will be used to guide decision support tool development. Limitations include the cross-sectional study design and reduced socioeconomic diversity.
While maintaining tactile and erogenous sensation and minimizing surgical complications were universally important goals, significant variations emerged between transgender men and non-binary individuals' MaPGAS goals highlighting the need for personalized preoperative counseling.
了解患者对于男性化乳房切除术和阴茎成形术等性别确认手术（MaPGAS）的目标，对于实现令人满意的、符合偏好的结果至关重要，但目前对于MaPGAS的优先事项以及这些优先事项在出生时被指定为女性的跨性别男性和非二元性别人群之间可能存在的差异缺乏了解。
了解考虑进行MaPGAS的出生时被指定为女性的跨性别男性和非二元性别人群的手术目标。
在文献综述和定性访谈之后创建了一项在线调查，并通过社交媒体和一个社区健康中心分发给年龄≥18岁、考虑过但尚未接受MaPGAS的出生时被指定为女性的参与者。我们收集了人口统计学信息、手术史、对14个可能的MaPGAS目标重要性的李克特评分，以及选择5个最重要的目标。使用曼-惠特尼U检验比较目标重要性评分的差异。由两名评审员对关于MaPGAS目标其他考虑因素的开放性问题的回答进行主题分析。
共有248名符合条件的参与者完成了调查；参与者包括跨性别男性（64%）和非二元性别人群（36%）。
两组都将保持触觉和性敏感视为首要任务。在一半的目标中出现了显著差异，跨性别男性更有可能重视被视为男性、公共卫生间舒适度、通过阴茎顶端排尿、通过拉链站立排尿以及性别焦虑的缓解。非二元性别人群更有可能重视保留阴道通道以接受插入以及用于性别认同确认。当个体列出他们最重要的5个目标时，两组在目标优先级上的这些差异最为明显。在开放性回答中，美学是跨性别男性的一个主要考虑因素，性快感是非二元性别人群的一个考虑因素，两组都将并发症列为主要担忧。
个体的MaPGAS目标应纳入术前咨询，并且可能因性别认同而异。
据我们所知，这是评估患者MaPGAS目标并比较性别认同队列的最大规模研究。我们的结果纳入了定性的开放性反馈，并强调了了解患者特定的MaPGAS目标对于更好地促进个性化术前咨询的重要性。结果将用于指导决策支持工具的开发。局限性包括横断面研究设计以及社会经济多样性降低。
虽然保持触觉和性敏感以及将手术并发症降至最低是普遍重要的目标，但跨性别男性和非二元性别人群的MaPGAS目标之间出现了显著差异，凸显了个性化术前咨询的必要性。
