(354) A Call for a Validated Survey to Assess Sexual Function and Satisfaction for Trans Women Post Vaginoplasty
Authors: Fraiman E , Goldblatt C , Loria M , Gupta S , Pope R 
Published: May 2023

Abstract

Introduction
The path toward standardized assessment of sexual function and satisfaction (SFS) in women has progressed significantly since it was forged in the 1970s. There are many current reliable options such as the FSFI and the PROMIS Sexual Function & Satisfaction v2.0, which have been validated in North American English speakers to assess SFS in a clinical setting. However, these questionnaires are inadequate to effectively assess SFS of a trans woman post-vaginoplasty due to both absence of appropriate questions (e.g. addressing post-op restoration of sensation) and the presence of inappropriate questions (e.g. assessing endogenous lubrication).

Objective
Upon analysis of the current measures to assess SFS, we hope to demonstrate the need for a validated tool to assess SFS of trans women post-vaginoplasty.

Methods
Surveys which assess female SFS validated in North American English speakers were compiled and reviewed to assess the appropriateness for trans women post-vaginoplasty. The variables assessed included whether the surveys discussed endogenous lubrication, pain/discomfort specific to penetration, and pain/discomfort in other areas of the genitalia. Surveys were also assessed for the lack of factors specific to trans women post-vaginoplasty such as dilation and depth of the neovagina, scarring and restoration of sensation, prostate stimulation, and cosmetic appearance of the genitalia.

Results
A total of 18 surveys were assessed. 8 surveys were excluded if they were designed for specific populations or diseases (WSID; MSFQ; DSDS; TSS; PFSF; SFQ) or their tools could not be accessed (DISF; DSFI). 70% of questionnaires asked about endogenous lubrication. 40% asked about pain limited to penetration. In the studies which asked about pain, 25% (n=1) assessed pain in other areas of the genitalia. 1 survey asked about vaginal dilation or depth to assess difficulty with penetration. There were no questionnaires that assessed prostate stimulation, the appearance of the genitalia, scarring, or the restoration of sensation.

Conclusions
Although the tools available contain many questions which are appropriate for the assessment of SFS of trans women post-vaginoplasty, most surveys assessed endogenous lubrication which is irrelevant to trans women and none assessed several domains important for trans women post-vaginoplasty. A survey specific to post-op trans women should assess neovaginal dilation and depth, scarring and restoration of sensation, as well as a cosmetic satisfaction with genitalia as measures of SFS. For example, trans women report sexual pleasure from stimulation of the prostate through the neovaginal canal during penetration; this type of pleasure is not applicable to cis women and is therefore not assessed in existing surveys, rendering the available tools incomplete. Due to the inadequacy of the current tools in the assessment of SFS for trans women post-vaginoplasty, we call for the development of a validated survey for this population which is in line with the precedent set by several other SFS questionnaires validated for similarly specific populations.

Disclosure
No