Prodger Jessica, Parmar Reeya, Monari Bern, Potter Emery, Rojas-Vargas Jorge, Wilcox Hannah, Zuanazzi David, Poon Annabel, Shouldice Ainslie, Edwards Vonetta, Krakowsky Yonah, Ravel Jacques
Res Sq. 2025 Sep 8:rs.3.rs-7428168. doi: 10.21203/rs.3.rs-7428168/v1.
: Transfeminine people were assigned male at birth and experience a female or feminine gender identity. Many elect to undergo vaginoplasty, a surgical procedure that constructs a neovagina, typically using penile and scrotal tissue. Like cisgender females, transfeminine people experience gynecological symptoms, including pain, discharge, and malodor. In cisgender females, clinicians attribute these symptoms to bacterial dysbiosis and can be diagnosed by Nugent scoring of gram-stained vaginal smears. The Nugent score assesses the abundance of large gram-positive rod vs. small or curved gram-variable rod morphotypes, traditionally for the detection of spp., , and spp. (curved rod), respectively. Although unvalidated for neovaginal samples, this method is frequently applied to diagnose dysbiosis in transfeminine people with vaginoplasty. This study assessed the Nugent score's utility as a clinical tool for diagnosing neovaginal dysbiosis in transfeminine people who underwent penile inversion vaginoplasty. : As a part of the TransBiota study, n=39 transfeminine participants self-collected neovaginal smears. Smears were Gram stained and Nugent scored, and Nugent scores were correlated with existing data on neovaginal bacterial composition (16S rRNA gene sequencing), neovaginal cytokines (Luminex multiplex immunoassay), and self-reported symptoms. More than 70% of smears fell in the 7-10 range that would indicate Bacterial Vaginosis in cisgender women. However, Nugent score failed to correlate with the abundance of Nugent-targeted bacteria. Bacteria with similar morphotypes, but not belonging to , , or , were highly abundant and prevalent in the neovagina. Nugent score also failed to predict local inflammation or clinical symptoms. : The Nugent score is not an effective tool to identify neovaginal dysbiosis or indicators of health in transfeminine individuals. Clinicians need the development of accurate, evidence-based diagnostic tools for the neovagina.
跨性别女性出生时被指定为男性，但经历女性或女性化的性别认同。许多人选择接受阴道成形术，这是一种通常使用阴茎和阴囊组织构建新阴道的外科手术。与顺性别女性一样，跨性别女性会经历妇科症状，包括疼痛、分泌物和异味。在顺性别女性中，临床医生将这些症状归因于细菌失调，可通过对革兰氏染色阴道涂片进行纽金特评分来诊断。纽金特评分评估大革兰氏阳性杆菌与小或弯曲革兰氏可变杆菌形态类型的丰度，传统上分别用于检测 spp.、 spp.和 spp.（弯曲杆菌）。尽管该方法未在新阴道样本中得到验证，但常用于诊断接受阴道成形术的跨性别女性的失调情况。本研究评估了纽金特评分作为诊断接受阴茎倒置阴道成形术的跨性别女性新阴道失调的临床工具的效用。作为跨生物群研究的一部分，n = 39 名跨性别女性参与者自行采集新阴道涂片。涂片进行革兰氏染色和纽金特评分，纽金特评分与新阴道细菌组成（16S rRNA 基因测序）、新阴道细胞因子（Luminex 多重免疫分析）和自我报告症状的现有数据相关。超过 70% 的涂片落在 7 - 10 的范围内，这在顺性别女性中表明患有细菌性阴道病。然而，纽金特评分与纽金特靶向细菌的丰度无关。形态类型相似但不属于 spp.、 spp.或 spp.的细菌在新阴道中高度丰富且普遍存在。纽金特评分也未能预测局部炎症或临床症状。纽金特评分不是识别跨性别个体新阴道失调或健康指标的有效工具。临床医生需要开发针对新阴道的准确、基于证据的诊断工具。
