Pang Karl H, Sahdev Varun, Haider Aiman, Alnajjar Hussain M, Rees Rowland, Muneer Asif
Male Genital Cancer Centre, Department of Andrology, University College London Hospitals NHS Foundation Trust, London, UK.
Division of Surgery and Interventional Sciences, University College London, London, UK.
Int J Impot Res. 2025 Mar 29. doi: 10.1038/s41443-025-01048-z.
Gender-affirming vaginoplasty is performed for transwomen desiring surgical alignment of their genitalia with their perceived gender. The commonest technique performed for vaginoplasty is penile skin inversion, which utilises penile and scrotal skin to construct a neovagina and vulva. An uncommon risk is squamous cell carcinoma of the neovagina. A systematic review was performed, which identified 9 cases of neovaginal squamous cell carcinoma following gender-affirming vaginoplasty for transgender women. In addition, the authors also presented a case of their own and their experience of managing such case. Squamous cell carcinoma may present at least 8 years following the initial vaginoplasty, and presenting symptoms include neovaginal bleeding, discharge, pain, urinary or bowel symptoms. Treatment depends on the stage of disease and include radical surgery, neoadjuvant, adjuvant or palliative chemoradiotherapy. Due to the rarity of neovaginal squamous cell carcinoma, it is important that clinicians are familiar with the anatomy and clinical examination of individuals who have had gender-affirming vaginoplasty. In addition, such cases should ideally be managed at an expert centre in a multidisciplinary setting. As squamous cell carcinoma can present decades following vaginoplasty, sexual health education is important as well as long-term sexual transmitted infection and cancer screening.
性别肯定性阴道成形术是为那些希望通过手术使生殖器与自我认知性别相符的跨性别女性进行的。阴道成形术最常用的技术是阴茎皮肤翻转术，即利用阴茎和阴囊皮肤构建一个新阴道和外阴。一种罕见的风险是新阴道鳞状细胞癌。进行了一项系统综述，确定了9例接受性别肯定性阴道成形术的跨性别女性发生新阴道鳞状细胞癌的病例。此外，作者还介绍了他们自己的一个病例以及处理该病例的经验。鳞状细胞癌可能在初次阴道成形术后至少8年出现，表现症状包括新阴道出血、分泌物、疼痛、泌尿或肠道症状。治疗取决于疾病阶段，包括根治性手术、新辅助、辅助或姑息性放化疗。由于新阴道鳞状细胞癌罕见，临床医生熟悉接受过性别肯定性阴道成形术者的解剖结构和临床检查很重要。此外，此类病例理想情况下应在多学科环境中的专家中心进行管理。由于鳞状细胞癌可在阴道成形术后数十年出现，性健康教育以及长期的性传播感染和癌症筛查也很重要。
