(001) EVALUATION OF GENITAL SENSITIVITY, BODY IMAGE, ANXIETY, DEPRESSION, CONGRUENCE AND SEXUAL FUNCTION IN TRANSGENDER WOMEN SUBMITTED TO GENDER-AFFIRMING SURGERY USING PENILE INVERSION TECHNIQUE
Authors: Monteiro Filho M , Batista R , Tassi F , Sá M , Silva L , Silva B , Domenice S , Costa E , Tavares A , Mendonça B , Denes F , Sircili MH 
Published: December 2024

Abstract

Introduction
Evaluation of Genital Sensitivity, Body Image, Anxiety, Depression, Congruence and Sexual Function in Transgender Women submitted to Gender-Affirming Surgery Using Penile Inversion Technique. Gender-affirming surgeries (GAS) represent a crucial step for many transgender women seeking to align their bodies with their gender identities. Neovaginoplasty involves significant changes in the genital region, affecting sensitivity and pleasure. After surgery new understandings of pleasure and orgasm emerge. Sexual function and pleasure are influenced by sociocultural, psychological factors, acceptance of gender identity, and body image. The sexuality of transgender women significantly impacts their quality of life and should be understood by healthcare professionals providing care to these individuals.

Objective
To evaluate genital sensitivity, body image, sociocultural, and psychological factors related to the sexual function of transgender women after neovaginoplasty.

Methods
This cross-sectional observational analytical study evaluated 49 transgender women aged 31 to 65 years, all operated on by the same surgical team using penile skin inversion. In 35 women, the penile glans was positioned at the inner part of the neovagina, and in 13 women, the glans was remodeled to create the neoclitoris. Data were collected through structured interviews and questionnaires, including the Female Sexual Function Index (FSFI), Transgender Congruence Scale (TCS), Body Image Scale (BIS), and Hospital Anxiety and Depression Scale (HADS). Genital physical exams and sensitivity evaluations using Von Frey filaments were conducted. Associations between categorical variables were tested using 2x2 contingency tables and the chi-square test. Correlations of continuous variables were tested using Pearson’s correlation coefficient. A p-value &lt;0.05 was considered significant. Statistical analyses were performed using SPSS version 28.0.

Results
The majority of patients, 89.8%, were satisfied or very satisfied with the surgery. Sexual life rated as good or very good increased from 34.5% before GAS to 87.2% after. After surgery 83.7% of participants reported experiencing orgasm, and 61.2% stated that orgasms were better or much better after GAS. The incidence of orgasm increased over the first 36 months after surgery, stabilizing in almost 100% of patients after this period. The areas of greatest genital sensitivity were those related to the penile glans. The neoclitoris had the highest sensitivity, with a sensitivity threshold of 0.380 g. There was no relationship between the sensitivity threshold and the presence of orgasm, FSFI score, BIS, TCS, or HADS. A negative correlation (r = −0.560; p = 0.008) was found between the HADS-Anxiety scale score and FSFI, indicating that higher anxiety symptoms were associated with lower sexual satisfaction. BIS positively correlated with HADS-Anxiety (r = 0.321; p = 0.024) and HADS-Depression (r = 0.315; p = 0.028), showing that increased body dissatisfaction was associated with higher anxiety and depressive symptoms. TCS negatively correlated with BIS (r = −0.368; p = 0.009), indicating that greater acceptance of gender identity was associated with lower body dissatisfaction.

Conclusions
Genital sensitivity does not significantly influence sexual function, body image, or congruence. Sexual function is more closely related to psychological factors, particularly anxiety. Orgasm is directly related to postoperative time. Psychological symptoms are related to body image and congruence. Understanding these factors is crucial for healthcare providers assisting transgender women post-GAS.

Disclosure
No.