title: Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery.
abstract: Surveys on quality of life (QOL) of male-to-female (MTF) transsexuals have found low QOL scores before and increased satisfaction scores after sex-reassignment surgery (SRS). To our knowledge, many of them lack standardized questionnaires and comparisons with normative data to evaluate different vaginoplasty techniques.
  
  
  
  To analyze patient satisfaction and QOL after SRS.
  
  
  
  Forty-seven patients participated in this study. All patients had surgery with our self-developed combined technique on average 19 months before the survey. They completed a self-developed indication-specific questionnaire concerning demographic and socioeconomic issues and postoperative satisfaction. Furthermore, a standardized self-assessment questionnaire on satisfaction and QOL (Fragen zur LebenszufriedenheitModule[FLZM]; Questions on Life SatisfactionModules) was used. The FLZMconsists of three modules (general life satisfaction, satisfaction with health, and satisfaction with body image) with scores of weighted satisfaction for each item. Results of the general and health modules were compared with normative data.
  
  
  
  Demographics, QOL, general life satisfaction, satisfaction with health, and satisfaction with body image.
  
  
  
  The self-developed indication-specific questionnaire showed that 91% experienced an improvement of QOL. All patients stated they would undergo SRS again and did not regret it at all. Patients stated their femininity significantly increased. For the FLZM, the sum score for general life satisfaction (P < .001) was significantly lower than the normative data, whereas the sum score of the satisfaction with health module (P = .038) did not reach statistical significance. The two modules also showed positive trends for different items. Values of the body image module showed a significant increase in satisfaction with breasts (P < .001) and genitals (P = .002).
  
  
  
  The findings of this survey emphasize the importance of SRS in the interdisciplinary gender-reassignment process. The detailed description of our combined technique could help to improve the surgical outcome and patient satisfaction of this complex and non-standardized surgery.
  
  
  
  This is the first description of a new surgical technique (combined technique) for MTF SRS. QOL was assessed by a large number of patients by standardized questionnaires and could be compared with normative data. Because this is a retrospective study, we can draw only careful conclusions for pre- and postoperative changes.
  
  
  
  Our self-developed combined surgical technique seemed to have a positive influence on QOL after SRS. Satisfaction with breasts, genitals, and femininity increased significantly and show the importance of surgical treatment as a key therapeutic option for MTF transsexuals. Papadopulos NA, Lellé J-D, Zavlin D, et al. Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery. J Sex Med 2017;14:721-730.
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany; Department of Plastic Surgery and Burns, Alexandroupoli University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece. Electronic address: nikolaos.papadopulos@mri.tum.de.
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Papadopulos
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany; Department of Plastic Surgery, University Teaching Hospital Rotkreuzklinikum München, Munich Technical University, Munich, Germany.
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Lellé
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany; Department of Plastic Surgery, University Teaching Hospital Rotkreuzklinikum München, Munich Technical University, Munich, Germany.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Zavlin
authors.affiliation: Roman-Herzog-Krebszentrum Comprehensive Cancer Center, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Herschbach
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Henrich
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Kovacs
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ehrenberger
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany.
authors.forename: Anna-Katharina
authors.initials: AK
authors.lastname: Kluger
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany.
authors.forename: Hans-Guenther
authors.initials: HG
authors.lastname: Machens
authors.affiliation: Department of Plastic Surgery, University Teaching Hospital Rotkreuzklinikum München, Munich Technical University, Munich, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Schaff
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000523:psychology*; D012959:Socioeconomic Factors
keywords: Body Image; Fragen zur Lebenszufriedenheit(Module); Male-to-Female; Patient Satisfaction; Quality of Life; Questions on Life Satisfaction; Sex Reassignment Surgery; Transgender; Transsexual