Surgical outcomes after gender-affirming hysterectomies: a consecutive case series of 72 patients
Creators: name: Alder, Susanna
name: Papaikonomou, Kiriaki
name: Tebani, Leonora
name: Rooda, Ilmatar
name: Dhejne, Cecilia
name: Damdimopoulou, Pauliina
name: Gidlöf, Sebastian
Publisher: name: Taylor & Francis
Year: 2025
Subjects: Medicine
Neuroscience
Biotechnology
Marine Biology
Cancer
Mental Health

description: Hysterectomy is a significant component of gender-affirming treatment for transgender individuals. The choice of surgical technique and associated complications have been studied, but very few studies have used a standardised classification system to grade surgical complications. This study aimed to describe our hospital’s experience on gender-affirming hysterectomies with regards to patient demographics, surgical techniques, and postoperative complications using a validated classification system. The study is a prospective follow-up case-series study of 72 consecutive patients undergoing gender-affirming hysterectomy at Karolinska University Hospital between 2016 and 2023. Patient demographics (age and mean body mass index), tobacco and alcohol habits, medical history and comorbidities, route of hysterectomy, complications and 30-days postoperative outcomes were reported. Surgical complications were graded according to the Clavien-Dindo classification system. The study population, with an average age of 27.6 years, presented diverse medical conditions, with psychiatric diagnoses being the most prevalent. The most common procedure was total laparoscopic hysterectomy, with low intraoperative blood loss. Surgical complications were rare, and primarily required minimal interventions. The 30-day Clavien-Dindo postoperative complication rate of grade II or higher was 19%, although only 4% experienced complications necessitating re-surgery (grade III or higher). Postoperative follow-up emerged as a critical aspect, with 22% of patients seeking non-elective medical attention within the first month, often due to vaginal bleeding or abdominal pain. Our findings support the safety and feasibility of gender-affirming hysterectomies, particularly when performed laparoscopically, with very few severe complications observed using a validated scoring system. Extensive follow-up care, as well as addressing common postoperative concerns, is essential. Despite a relatively small sample size and lack of a control group, this study provides valuable insights into transgender healthcare from a previously unstudied region. Future research should preferably include larger cohorts, multicentre and registry-based studies. Gender-affirming hysterectomy means removing the uterus in transgender individuals assigned female at birth. There are no specific recommendations on the best surgical technique for transgender surgery. Here, we report the experience from Karolinska University Hospital on gender-affirming hysterectomies, focusing on patient characteristics, medical conditions, surgical techniques, surgical complications, and the need for additional medical care within the first month after surgery. The study used a system called Clavien-Dindo to assess complications. The findings showed that the study population was quite young, and many had other medical conditions, with almost half having a psychiatric diagnosis. The most common procedure was removing the uterus using a keyhole technique (laparoscopic hysterectomy). Complications were rare, and primarily required minimal interventions. One out of five patients sought emergency medical care within the first month, mainly due to vaginal bleeding and abdominal pain.