title: Aesthetic and Functional Outcomes of Neovaginoplasty Using Penile Skin in Male-to-Female Transsexuals.
abstract: BACKGROUND
  In the treatment of transgender women, the surgical construction of a neo-vagina, or vaginoplasty, is the final stage in the transition to the desired gender. Surgeons aim to create a neovagina that is in function and appearance as close to a biological vagina as possible. However, to date, it is insufficiently clear whether transgender women are satisfied with the functional and cosmetic outcomes of vaginoplasty.
  
  
  OBJECTIVE
  Our aim was to assess if penile skin inversion neovaginoplasty performed in transgender women meet the objectives strived for, by determining functional and aesthetic outcomes, as well as the physical and sexual well-being and satisfaction.
  
  
  METHODS
  We performed a retrospective survey study on 49 transgender women who underwent vaginoplasty using the penile skin inversion technique. Participants were asked to fill out the Female Sexual Function Index (FSFI), a combination of the Amsterdam Hyperactive Pelvic Floor Scale--Women (AHPFS-W) and the Female Genital Self-Imaging Scale, and a short questionnaire for self-evaluation of vaginoplasty. Photographs of the genitalia were taken for objective assessment by an independent panel.
  
  
  METHODS
  Primary outcomes were the functional and aesthetic evaluation as perceived by the trangender women themselves. Secondary outcomes were the aesthetic evaluation of the vaginoplasty by an independent panel.
  
  
  RESULTS
  Functionality and appearance were both given an average score of 8 out of 10. Despite this high score, 56% is sexually dysfunctional according to the FSFI, mainly because of not being sexually active, or due to problems with lubrication and discomfort. In 75%, the result met the expectation and 70% thinks their genital is feminine enough.
  
  
  CONCLUSIONS
  This study demonstrates that, despite relatively low FSFI scores, this group of transgender women is very satisfied with both the functional and aesthetic results of neovaginoplasty using penile skin inversion.
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.|Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Marlon E
authors.initials: ME
authors.lastname: Buncamper
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Jara S
authors.initials: JS
authors.lastname: Honselaar
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.|Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Mark-Bram
authors.initials: MB
authors.lastname: Bouman
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.|Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Müjde
authors.initials: M
authors.lastname: Özer
authors.affiliation: Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.|Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands.|EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Baudewijntje P C
authors.initials: BP
authors.lastname: Kreukels
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.|Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.|EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Margriet G
authors.initials: MG
authors.lastname: Mullender
mesh_terms: D000328:Adult; D001504:Beauty; D003075:Coitus / Q000502:physiology*; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D009042:Motivation; D010413:Penis / Q000601:surgery*; D010502:Perineum / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D057566:Self Report; D057830:Gender-Affirming Surgery / Q000379:methods*; D063106:Transgender Persons; D014621:Vagina / Q000294:innervation* / Q000601:surgery; D014844:Vulva / Q000601:surgery
keywords: Male-to-Female Transgender; Patient-Reported Outcome; Penile Inversion; Sexual Function; Surgery; Vaginoplasty