Osswald Ramona, Villiger Anna-Sophie, Ruggeri Giovanni, Hoehn Diana, Mueller Michael, Kuhn Annette
Department of Obstetrics and Gynecology, Cantonal Hospital of Schaffhausen, Geissbergstrasse 81, 8208 Schaffhausen, Switzerland.
Department of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland.
Int Urogynecol J. 2025 Aug 2. doi: 10.1007/s00192-025-06251-6.
Various techniques for neovagina creation have been developed and refined. The aim of this study was to evaluate the incidence of prolapse and possible consecutive therapies in transfemale patients who have received a neovagina as part of their sex reassignment surgery (SRS).
This prospective single-centre case control study was performed at Bern University Hospital (Department of Gynaecology) between 2017 and 2023. Sixty-eight patients who had received SRS (all male to female) were undergoing regular gynaecologic examinations assessing the ICS-Pelvic Organ Prolapse Staging (POP-Q score) and VAS score for symptom burden. Appropriate management for prolapse correction was initiated. Linear and logistic regression were employed for the average comparison of the parameters in correlation to the type of sex reassignment surgery applied.
Fifty-four of the 68 participant patients had undergone penis-scrotum inversion technique, six had a neovagina created by peritoneum and seven had an intestinal neovagina. Mean follow-up was 27.5 years. Thirteen patients (19.4%) experienced genital prolapse in this cohort. The group after peritoneal neovagina surgery demonstrated the highest odds ratio for rectocele (OR 4.9, p = 0.17 95% CI 0.71-33.78) and vaginal prolapse (OR 16.67, p = 0.005 95% CI 2.3-120.65). Statistically significant differences in all POP-Q parameters for the penile inversion group indicate smaller vaginal prolapse. Prolapse surgery significantly decreased the VAS score (p < 0.001; 95% CI 5.92-8.38).
One in five transfemale patients who have undergone sex reassignment surgery experience genital prolapse. The prevalence of prolapse was found to be highest in the peritoneum reconstruction group, followed by the patients with intestinal neovagina and penile inversion. Surgical intervention for prolapse appears to significantly alleviate symptoms.
多种阴道再造技术已得到发展与完善。本研究旨在评估接受阴道再造作为性别重置手术（SRS）一部分的跨性别女性患者中脱垂的发生率及可能的后续治疗。
本前瞻性单中心病例对照研究于2017年至2023年在伯尔尼大学医院（妇科）进行。68例接受了SRS（均为男性变女性）的患者正在接受定期妇科检查，评估国际尿控学会盆腔器官脱垂分期（POP-Q评分）和症状负担的视觉模拟评分（VAS评分）。针对脱垂矫正采取了适当的治疗措施。采用线性回归和逻辑回归对与所应用的性别重置手术类型相关的参数进行均值比较。
68例参与研究的患者中，54例接受了阴茎阴囊翻转术，6例通过腹膜创建了新阴道，7例有肠道阴道。平均随访时间为27.5年。该队列中有13例患者（19.4%）出现生殖器脱垂。腹膜新阴道手术后的组直肠膨出（比值比4.9，p = 0.17，95%置信区间0.71 - 33.78）和阴道脱垂（比值比16.67，p = 0.005，95%置信区间2.3 - 120.65）的比值比最高。阴茎翻转组所有POP-Q参数的统计学显著差异表明阴道脱垂较小。脱垂手术显著降低了VAS评分（p < 0.001；95%置信区间5.92 - 8.38）。
五分之一接受性别重置手术的跨性别女性患者会出现生殖器脱垂。发现脱垂发生率在腹膜重建组最高，其次是肠道阴道患者和阴茎翻转患者。针对脱垂的手术干预似乎能显著缓解症状。
