More than half of trans women who have “buttock” surgery are in so much pain years later that they need medical attention, a study suggests.
Up to a third of patients also had difficulty using the toilet or had sexual problems 12 months after surgery, with patients transitioning from male to female who received a surgically constructed vagina.
Researchers at Women’s College Hospital (WCH) in Ontario, Canada, analysed the medical records of 80 patients who sought help from the clinic between three months and five years after surgery.
Campaigners say the findings show that complex surgeries such as vaginoplasty often carry risks that patients are unaware of – at a time when the number of gender reassignment surgeries in the US and Canada has risen dramatically.
Of the 80 trans women sampled in the Canadian study, nearly 54% reported persistent pain for up to two years after their vaginoplasty. Many had more than one symptom, including vaginal dryness, numbness, bad odor, and problems with the wound healing
Research in October indicated that the number of patients going under the knife increased more than 150 times between 2010 and 2018.
The reduced stigma and increased awareness around trans issues are believed to have contributed to the rise.
In the latest study, Canadian researchers looked at the medical records of patients seeking care at WCH’s newly opened postoperative care clinic between 2018 and 2020.
All 80 patients had the original vaginoplasty procedure outside of the Women’s College health system, but experienced symptoms that required follow-up care.
Some had even traveled to India and Thailand to undergo the operations, which the researchers say could explain the relatively high number of medical complaints.
The most common symptoms reported by postoperative patients were pain (53.5 percent), bleeding (42.5 percent), and dilation problems (46.3 percent).
Serious side effects were much rarer, but in 12 cases — or 15 percent — patients experienced vaginal stenosis, the narrowing and shortening of the vagina.
In two other cases, patients had serious infections around the surgical site and another two were hospitalized with mental health problems.
Minor outcomes were much more common, such as difficulty urinating (22.5 percent), sexual problems (33.8 percent), and poorly healing wounds (21.3 percent).
A total of 15 patients (18.8 percent) also told the clinic that they were dissatisfied with the appearance of their new vulva and wanted a cosmetic revision.
Most complaints of persistent pain could be treated with topical medication or more regular checkups.
Although classified as “mild” in medical records, many of these had symptoms the potential to develop into much more serious problems if patients had not sought treatment, the study highlighted.
For this reason, “surgical centers should provide ongoing postoperative care, especially in the first year after surgery,” the researchers urged.
This is especially critical given the popularity of the procedure in recent years and the high cost, which allows those who want to have the surgery to go to cheaper and less well-regulated surgeons abroad.
The map above shows the population of transgender adults and children across America in 2020, according to the Williams Institute at the University of California, Los Angeles. The estimate for children ages 13 to 17 has doubled since 2017. It shows that most residents are in the Southern states, followed by those along the East Coast
Bottom surgeries such as vaginoplasties and phalloplasties — genital reconstruction undergone by women transitioning to men — cost about $25,000.
“It’s very clear from the latest studies that vaginoplasty and other genital surgeries don’t work the way people hope,” said Stella O’Malley, psychotherapist and director of campaign group Genspect.
“The reason there are so many problems is because this is an incredibly difficult operation. Young vulnerable people need to know about the challenges they face after surgery, but very few know that.’
In recent years, more and more de-transitioners — those who regret their decision to transition and later reverse it — have spoken out about medical side effects of the procedures they were previously unaware of.
One such detransitioner, named Shape Shifter, claimed he regretted his mastectomy and vaginoplasty after they led to fistulas and other painful consequences. He says he realized he was just a gay man who liked to show his feminine side and started to change.
A Massachusetts-based detransitioner named Shape Shifter transitioned from male to female, but ran into terrible medical problems. He has since transitioned and identifies as a gay man with a feminine appearance
The latest study is published in the journal Neurourology and urodynamics.
In Canada, the first country to collect and publish gender diversity data from a national census, 100.815 transgender people make up 0.33 percent of the over-15s.
There are about 1.6 million transgender and non-binary adults living in the US, who make up about 0.5 percent of the adult population.
Gender-affirming care for US adults and adolescents may include a number of medical, behavioral, and social changes, as well as surgery.
For adolescents who have not yet gone through puberty, puberty-suppressing drugs can suppress the release of the sex hormones testosterone and estrogen, which stops the development of secondary sex characteristics such as breasts and facial hair.
Whether or not the original puberty was blocked, trans adults and adolescents can also begin hormone therapy, which essentially triggers the puberty of their gender identity. These hormones can be taken as pills, patches, and gels and are taken continuously throughout adulthood, or until desired physical properties are achieved.
Surgical options include facial, breast, and genital remodeling procedures, and are generally the last step of the transition process.
According to the World Professional Association for Transgender Health, anyone wishing to undergo soil surgery is recommended to meet certain criteria, such as: reaching adulthood at their location; have persistent, diagnosed gender dysphoria; have the ability to make an informed decision; and completing 12 continuous months of hormone therapy while living the congruent gender identity.
Vaginoplasty – the procedure patients in the new study undergo – is a particularly invasive procedure, requiring surgery to remove the penis and testicles and create a functional vagina.
The most common form of vaginoplasty is penile inversion, in which the skin removed from the penis is inverted to form a pouch and inserted into a cavity between the urethra and rectum. The urethra is then partially removed, shortened and repositioned.
The operation usually takes two to five hours and is performed under general anesthesia.
For female-to-male genital reconstruction, doctors can construct a penis by taking a piece of skin, fat, nerves, and arteries — usually from the arm or thigh — and grafting it onto the groin. In some cases, surgeons will lengthen the urethra to allow urination from the tip of the penis, or add testicular implants and an erectile device.