title: Long-Term Follow-Up of Transgender Women After Secondary Intestinal Vaginoplasty.
abstract: BACKGROUND
  Intestinal vaginoplasty with a sigmoid colon or ileal segment is an established surgical technique for vaginal reconstruction. Little has been reported on long-term (functional) outcome and postoperative quality of life.
  
  
  OBJECTIVE
  To assess the surgical and long-term psychological outcomes of secondary intestinal vaginoplasty performed from 1970 through 2000 in transgender women.
  
  
  METHODS
  Transgender women who underwent intestinal vaginoplasty from 1970 through 2000 were identified from our hospital registry. Demographics, surgical characteristics, complications, and reoperations were recorded. Traceable women were invited to fill out a set of questionnaires (quality-of-life questionnaire, Female Sexual Function Index, Amsterdam Hyperactive Pelvic Floor Scale for Women, Female Genital Self-Imaging Scale, and self-evaluation of vaginoplasty questionnaire) and attend the outpatient clinic for physical, endoscopic, and histologic examination of the neovagina.
  
  
  METHODS
  Primary outcomes were complications, reoperations, self-perceived quality of life, and functional and esthetic self-evaluation.
  
  
  RESULTS
  Twenty-four transgender women were identified who underwent intestinal vaginoplasty as a secondary procedure from 1970 through 2000. There were no intraoperative complications. Three intestinal neovaginas were surgically removed because of postoperative complications. Nineteen women (79%) underwent at least one genital reoperation, most commonly introitus plasty (n = 13, 54%). Five women were deceased at time of analysis. Nine women consented to partake in the study (median age = 58 years, range = 50-73; median postoperative time = 29.6 years, range = 17.2-34.3). They were generally satisfied with life and scored 5.9 of 7 on a subjective happiness scale. Neovaginal functionality was rated as 7.3 and appearance as 7.4 of 10.
  
  
  CONCLUSIONS
  In our institution, intestinal vaginoplasty before 2000 was always performed as a revision procedure after a previous vaginoplasty had failed. Although surgical corrections were frequently necessary, women reported satisfaction with the surgical outcome and with life in general.
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: w.vandersluis@vumc.nl.
authors.forename: Wouter B
authors.initials: WB
authors.lastname: van der Sluis
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mark-Bram
authors.initials: MB
authors.lastname: Bouman
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Nanne K H
authors.initials: NK
authors.lastname: de Boer
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Marlon E
authors.initials: ME
authors.lastname: Buncamper
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands; Department of Gastroenterology, Geriatrics, Intensive Care Medicine and Internal Medicine, Zuyderland Medical Center, Heerlen-Sittard-Geleen, The Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: van Bodegraven
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: E Andra
authors.initials: EA
authors.lastname: Neefjes-Borst
authors.affiliation: EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands; Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Baudewijntje P C
authors.initials: BP
authors.lastname: Kreukels
authors.affiliation: Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands; Department of Gastrointestinal Surgery and Advanced Laparoscopy, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Wilhelmus J H J
authors.initials: WJ
authors.lastname: Meijerink
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Margriet G
authors.initials: MG
authors.lastname: Mullender
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007422:Intestines / Q000637:transplantation*; D008875:Middle Aged; D010502:Perineum / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011184:Postoperative Period; D011788:Quality of Life; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000266:history / Q000379:methods; D011795:Surveys and Questionnaires; D063106:Transgender Persons / Q000266:history / Q000523:psychology; D016896:Treatment Outcome; D014621:Vagina / Q000503:physiopathology / Q000601:surgery*; D008297:Male
keywords: Gender Affirming Surgery; Gender Dysphoria; Intestinal Vaginoplasty; Quality of Life; Sex Reassignment Surgery; Surgery; Transgendered Persons; Vaginoplasty