Transgender Post-reassignment Urogynecologic Measures and Perceptions

Study Overview
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Brief Summary
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The intent of this mixed methods study for transgender women after gender confirmation surgery is to characterize and subsequently create a validated screening questionnaire for postoperative urologic and pelvic floor symptoms. For individuals who seek gender-confirming treatment, about 13% undergo genital surgery for cosmetic purposes with or without gonadectomy, and this number is increasing. Patient satisfaction following surgery is high, particularly regarding sexual and cosmetic outcomes; however, unexpected negative functional outcomes such as bowel and bladder dysfunction and pelvic organ prolapse impact overall patient satisfaction. The available information suggests that 16-33% of patients experience incontinence postoperatively, with stress predominance, 32-47% experience abnormal voiding, and 24-66% experience overactive bladder symptoms. Outside of the typically assessed voiding symptoms, unique complaints of MTF postoperative patients include obstructive voiding symptoms due to urethral stenosis, persistent perimeatal erectile tissue, prostatic hypertrophy, and irritation from neovaginal tissue. Additionally, may of these patients develop symptomatic neovaginal prolapse, requiring re-suspension. We suggest that further clarification regarding MTF postoperative urologic and pelvic floor complaints can be achieved via a mixed methods approach. By using focus group interviews to create specific evaluative questions for this unique population, we can then prospectively assess patients undergoing surgery via a national multicenter sampling strategy. The goal of the study is to better understand the unique symptoms these women experience and create a validated, reliable screening questionnaire to monitor patients after surgery.

Official Title
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Assessment of Postoperative Urologic and Pelvic Floor Complaints in Male-to-female Transgender Patients: a Mixed Methods Study

Conditions
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Gender Identity Disorder of Adult, Voiding Disorders, Sexual Dysfunction

Intervention / Treatment
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* Other: Focus group interviews
* Diagnostic Test: Questionnaire packet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Stage 1 -- Male-to-female transgender women who are at least 4 weeks postoperative following genital surgery for gender confirmation Stage 2 -- Male-to-female transgender women who are scheduled to undergo surgery or are within 4 weeks postoperative Both stages -- Minimum age 18 years old Both stages -- English fluency Both stages -- Reliable contact information and/or permanent residence Exclusion Criteria: Preexisting pelvic pathology, including abnormal anatomy or baseline voiding dysfunction Urinary or intestinal problems prior to surgery lasting greater than 6 weeks

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Stage 1 Focus Groups<br>The focus groups will involve transgender women who have completed gender confirmation surgery who volunteer to discuss their postoperative experience regarding bladder function, genital complaints, and sexual function. | Other: Focus group interviews<br>* Focus group participants will be asked about their postoperative urogynecologic experience. Confidentiality will be enforced and participants will be made aware that they may opt out of answering any questions.<br>|
| Stage 2 Questionnaire Groups<br>Stage 2 participants will be asked to complete a questionnaire packet after surgery followed by a second questionnaire completion 2 weeks later. Participants' operative notes and postoperative visit records will be reviewed. | Diagnostic Test: Questionnaire packet<br>* Participants will be asked to complete a questionnaire packet comprised of three previously validated questionnaires and one newly created focused questionnaire. They will be asked to complete the new questionnaire again 2 weeks later. We estimate about 10 minutes will be required to complete the packet.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stage 1: Focus groups | Characterization of genital, urologic, bowel, and sexual symptoms following male-to-female gender confirmation surgery | 3 months | 
| Stage 2: Questionnaire testing | Validity and reliability testing of new questionnaire | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency and severity of symptoms | Frequency and severity of symptoms | 15 months | 
| Relationship between surgical technique and symptoms | Relationship between surgical technique and symptoms | 15 months | 
| Effect of hormonal therapy usage and symptoms | Effect of hormonal therapy usage and symptoms | 15 months | 
| Length of time since surgery and development of symptoms | Length of time since surgery and development of symptoms | 15 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Transgender women, Male-to-female, Gender confirmation surgery, Voiding disorder, Vaginal dysfunction