Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

UROLOGICAL HEALTH AND VAGINAL URINARY TRACT COMPLICATIONS IN TRANSGENDER WOMEN

Ahmet Yüce

Ordu University, Faculty of Medicine, Department of Urology, Ordu, Türkiye

Yüce A. Urological Health and Vaginal Urinary Tract Complications in Transgender Women. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.197-205.

ABSTRACT

Penile inversion vaginoplasty (PIV) surgery is considered the gold standard method for feminization aginoplasty. Studies investigating urinary system symptoms that may develop after PIV surgery, protection of urinary system health, and complications related to the neovaginal urinary tract have recently begun to appear in the literature. In existing studies, it is seen that urinary system complications are generally used as exclusion criteria or are not discussed at an advanced level. In addition, patient factors may prevent access to accurate information about urological health and urinary tract complications. There are significant differences in the urogenital system in transgender women (TW) compared to ciswomen. In TW individuals, the absence of protective mucosal vaginal tissue under hormonal control, the absence of commensal bacteria in the urethra and vulva, differences in hygienic practices, dilator procedures applied, the entry of foreign microorganisms into the neovagina during showering, and the higher rates of meatal stenosis in the TW group are important. In addition, the lack of centers for safe surgical practices and appropriate follow-up of TW individuals, low procedure volumes, lack of personnel with necessary training on this subject, cultural differences and stigmatization, and failure to reflect existing problems may also prevent awareness of urogenital problems. Lower urinary tract complications and urinary tract infections can be considered important topics in TW. The most common symptoms include urinary retention, urinary incontinence, dysuria, decreased urine flow rate, misdirected stream, anterior spraying of urine, storage symptoms, and associated lower urinary tract symptoms. The management of these complications should be approached in a patient-specific manner and, if possible, the process should be managed by specific urologists. In conclusion, considering the increased frequency of transition-related surgeries and the associated postoperative urinary system complications, detailed and large-scale studies are needed to recognize these complications and reduce their adverse outcomes.

Keywords: Vaginoplasty; Transgender persons; Voiding dysfunction; Urinary tract infection; Meatal stenosis

Referanslar

  1. Huang JB, Lai A, Morgantini LA, Smith JB, Millman AL, Cedeno JD, et al. Gender-affirming vaginoplasty: Technical considerations in patients with genital skin deficiency. Neurourol Urodyn. 2023;42(5):947-955. [Crossref]  [PubMed]
  2. Bustos SS, Rios-Sanchez M, Fahradyan V. Penile Inversion Vaginoplasty: An Evolving Technique. Cureus. 2024;16(9):e68949. [Crossref]  [PubMed]  [PMC]
  3. Boas SR, Ascha M, Morrison SD, Massie JP, Nolan IT, Shen JK, et al. Outcomes and predictors of revision labiaplasty and clitoroplasty after gender-affirming genital surgery. Plast Reconstr Surg. 2019;144:1451-61. [Crossref]  [PubMed]
  4. Fletke KJ, Jeong DH, Herrera AV. Urinary Catheter Management. Am Fam Physician. 2024;110(3):251-8. [PubMed]
  5. Horbach SER, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in maleto-female transgenders: A systematic review of surgical techniques. J Sex Med. 2015;12:1499-1512. [Crossref]  [PubMed]
  6. Gonzalez G, Anger JT. Voiding Dysfunction in Transgender Patients: What We Know and What We Do Not Know. Curr Urol Rep. 2024;26(1):16. [Crossref]  [PubMed]  [PMC]
  7. Shah V, Hassan B, Hassan R, Alexis M, Bhoopalam M, Agandi L, et al. Gender-Affirming Surgery in Low- and Middle-Income Countries: A Systematic Review. J Clin Med. 2024;13(12):3580. [Crossref]  [PubMed]  [PMC]
  8. Ding C, Khondker A, Goldenberg MG, Kwong JCC, Lajkosz K, Potter E, et al. Urinary complications after penile inversion vaginoplasty in transgender women Systematic review and meta-analysis. Can Urol Assoc J. 2023;17(4):121-8. [Crossref]  [PubMed]  [PMC]
  9. Nolan IT, Dy GW, Levitt N. Considerations in GenderAffirming Surgery: Demographic Trends. Urol Clin North Am. 2019;46(4):459-65. [Crossref]  [PubMed]
  10. Geerlings SE. Clinical Presentations and Epidemiology of Urinary Tract Infections. Microbiol Spectr. 2016;4(5). [Crossref]  [PubMed]
  11. Sheth R, Bhaskara A, Brown H, Varley CD, Streifel A, Maier M, et al. Infections Following Gender-Affirming Vaginoplasty: A Single-Center Experience. Open Forum Infect Dis. 2024;11(10):ofae526. [Crossref]  [PubMed]  [PMC]
  12. Gilbert D, Gautam A, Tabernacki T, Rhodes S, McNamara M, Banik S, et al. Rates of Urinary Tract Infection in Transgender Women Postvaginoplasty vs Cisgender Women: A Retrospective Cohort Study in a Large US Health Network. Urology. 2024;188:150-5. [Crossref]  [PubMed]
  13. Weyers S, Verstraelen H, Gerris J, Monstrey S, Santiago Gdos S, Saerens B, et al. Microflora of the penile skinlined neovagina of transsexual women. BMC Microbiol.2009;9:102. [Crossref]  [PubMed]  [PMC]
  14. Mayomba C, Matovelo D, Kiritta R, Kashinje Z, Seni J. Asymptomatic bacteriuria and its associated fetomaternal outcomes among pregnant women delivering at Bugando Medical Centre in Mwanza, Tanzania. PLoS One.2024;19(10):e0303772. [Crossref]  [PubMed]  [PMC]
  15. Foxman B, Foxman P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin of North Am. 2003;17(2):227-41. [Crossref]  [PubMed]
  16. Maffucci F, Clark J, Jun M, Douglass L. A urologist's guide to caring for transgender and gender diverse patients. Urologic Clinics. 2023;50(4):577-85. [Crossref]  [PubMed]
  17. Ricks JM, Horan J. Associations Between Childhood Sexual Abuse, Intimate Partner Violence Trauma Exposure, Mental Health, and Social Gender Affirmation Among Black Transgender Women. Health Equity. 2023;7(1):743-52. [Crossref]  [PubMed]  [PMC]
  18. Lazarus JE, Gupta K. Recurrent UTI in Women-Risk Factors and Management. Infect Dis Clin North Am. 2024;38(2):325-41. [Crossref]  [PubMed]
  19. Dixon BE, Price J, Valvi NR, Allen KS, Heumann CL, Titus MK, et al. Treatment Rates for Chlamydia trachomatis and Neisseria gonorrhoeae in a Metropolitan Area: Observational Cohort Analysis. Sex Transm Dis. 2024;51(5):313-9. [Crossref]  [PubMed]
  20. MacCarthy S, Poteat T, Xia Z, Roque NL, Hyun Jin Kim A, Baral S, et al. Current research gaps: a global systematic review of HIV and sexually transmissible infections among transgender populations. Sex Health. 2017;14(5):456-68. [Crossref]  [PubMed]  [PMC]
  21. Tordoff DM, Dombrowski JC, Ramchandani MS, Barbee LA. Trans-inclusive Sexual Health Questionnaire to Improve Human Immunodeficiency Virus/Sexually Transmitted Infection (STI) Care for Transgender Patients: Anatomic Site-Specific STI Prevalence and Screening. Clin Infect Dis.2023;76(3):e736-43. [Crossref]  [PubMed]  [PMC]
  22. Morris SR, Klausner JD, Buchbinder SP, Wheeler SL, Koblin B, Coates T, et al. Prevalence and incidence of pharyngeal gonorrhea in a longitudinal sample of men who have sex with men: the EXPLORE study. Clin Infect Dis. 2006;43(10):1284-9. [Crossref]  [PubMed]
  23. Chhim S, Ngin C, Chhoun P, Tuot S, Ly C, Mun P, et al. HIV prevalence and factors associated with HIV infection among transgender women in Cambodia: results from a national Integrated Biological and Behavioral Survey. BMJ Open. 2017;7(8):e015390. [Crossref]  [PubMed]  [PMC]
  24. Gonzalez G, Anger J. Creating an Inclusive Urology Practice. Curr Bladder Dysfunct Rep. 2023;18(2):131-8. [Crossref]  [PubMed]  [PMC]
  25. Chen ML, Reyblat P, Poh MM, Chi AC. Overview of surgical techniques in gender-affirming genital surgery. Transl Androl Urol. 2019;8(3):191-208. [Crossref]  [PubMed]  [PMC]
  26. Krakowsky Y, Shah G, Nguyen AV, Kavanagh AG, Potter E, Remondini T, et al. Gender-affirming care in urology: emergency care of the gender-affirming surgical patientwhat the primary urologist needs to know. BJU Int.2024;133(2):124-31. [Crossref]  [PubMed]
  27. van der Sluis WB, Bouman MB, Buncamper ME, Pigot GLS, Mullender MG, Meijerink WJHJ. Clinical Characteristics and Management of Neovaginal Fistulas After Vaginoplasty in Transgender Women. Obstet Gynecol. 2016;127(6):1118-26. [Crossref]  [PubMed]
  28. Sofic A, Beslic S, Sehovic N, Caluk J, Sofic D. MRI in evaluation of perianal fistulae. Radiol Oncol. 2010;44(4):220-7. [Crossref]
  29. Schloericke E, Hoffmann M, Zimmermann M, Kraus M,Bouchard R, Roblick UJ, et al. Transperineal omentum flap for the anatomic reconstruction of the rectovaginal space in the therapy of rectovaginal fistulas. Colorectal Dis. 2012;14(5):604-10. [Crossref]  [PubMed]
  30. Salgarello M, Farallo E, Barone-Adesi L, Cervelli D, Scambia G, Salerno G, et al. Flap algorithm in vulvar reconstruction after radical, extensive vulvectomy. Ann Plast Surg. 2005;54(2):184-90. [Crossref]  [PubMed]
  31. Mundy AR, Andrich DE. Urorectal fistulae following the treatment of prostate cancer. BJU Int. 2011;107(8):1298-303. [Crossref]  [PubMed]
  32. Schofield E, Drake M, Tindle R, Rashid T, Shiridzinomwa C, Abrams P, Bohr J, Anderson K. Transgender and gender diverse (TGD) inclusivity in the investigation of lower urinary tract symptoms-Fundamental considerations for evaluation. Continence. 2023;8:101055. [Crossref]
  33. Ferrando CA. Vaginoplasty Complications. Clin Plast Surg.2018;45(3):361-8. [Crossref]  [PubMed]