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Does method matter? Characterizing the effect of preoperative hair removal method on outcomes following penile inversion vaginoplasty

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Preoperative genital hair removal (PGHR) prior to penile inversion vaginoplasty (PIV) is vital to prevent postoperative hair-induced stenosis of the neovaginal canal, yet the approach remains unstandardized. We sought to better characterize current methods of PGHR and their effect on outcomes.

Methods

Adult transgender females who underwent PIV at a single center from December 2018 to July 2022 were invited to participate in an online survey via email. Reminder emails were distributed once every 2 weeks for a total of four reminders. Data concerning PGHR method, postoperative hair growth, and satisfaction were collected.

Results

Of the 128 patients contacted, 28 (21.9%) completed the survey. Twenty-three patients (82.1%) endorsed PGHR prior to PIV. Laser hair removal (n = 11, 47.8%) was the most common method, followed by electrolysis (n = 7, 30.4%), and at-home kits (n = 5, 17.9%). Treatment sessions most frequently began > 6 months preoperatively (n = 9, 39.1%), occurring once weekly (n = 12, 52.2%) for a total of 5–6 treatments (n = 7, 30.4%). Postoperatively, 9 patients (32.1%) developed hair growth. There were no differences in incidence, time to hair growth, satisfaction with sexual function, or overall satisfaction between PGHR methods. PGHR was associated with lower rates of hair growth (0.069, CI 0.006–0.769), while hair growth was associated with lower satisfaction with sexual function (0.100, CI 0.024–0.427), and lower overall satisfaction (0.069, (0.006–0.769)).

Conclusions

While the ideal method of PGHR remains unclear, preventing hair growth is important to preserve sexual function and maximize postoperative satisfaction. Patients should be properly counseled regarding alternative hairless methods of vaginoplasty, including the intestinal approach, to optimize outcomes.

Level IV, Risk/Prognostic study

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References

  1. Wiegmann AL, Young EI, Baker KE et al (2021) The affordable care act and its impact on plastic and gender-affirmation surgery. Plastic and Reconstructive Surgery. 147(1):135e–153e

    Article  PubMed  Google Scholar 

  2. Deutsch MB (2016) Gender-affirming surgeries in the era of insurance coverage: developing a framework for psychosocial support and care navigation in the perioperative period. Journal of Health Care for the Poor and Underserved. 27(2):386–391

    Article  PubMed  Google Scholar 

  3. Shoureshi P, Dugi D (2019) Penile inversion vaginoplasty technique. Urologic Clinics. 46(4):511–525

    PubMed  Google Scholar 

  4. Pan S, Honig SC (2018) Gender-affirming surgery: current concepts. Current urology reports. 19(8):1–8

    Article  Google Scholar 

  5. Lawrence AA (2006) Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Archives of sexual behavior. 35(6):717–727

    Article  PubMed  Google Scholar 

  6. Chi AC, Poh MM, Reyblat P (2021) Complications of vaginoplasty. A Comprehensive Guide, Urological Care for the Transgender Patient, pp 83–97

    Google Scholar 

  7. Yuan N, Feldman AT, Chin P, Zaliznyak M, Rabizadeh S, Garcia MM (2022) Comparison of permanent hair removal procedures before gender-affirming vaginoplasty: why we should consider laser hair removal as a first-line treatment for patients who meet criteria. Sexual Medicine. 10(5):100545

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zhang WR, Garrett GL, Arron ST, Garcia MM (2016) Laser hair removal for genital gender affirming surgery. Translational andrology and urology. 5(3):381

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bradford NJ, Rider GN, Spencer KG (2021) Hair removal and psychological well-being in transfeminine adults: associations with gender dysphoria and gender euphoria. Journal of Dermatological Treatment. 32(6):635–642

    Article  PubMed  Google Scholar 

  10. Görgü M, Aslan G, Aköz T, Erdoğan B (2000) Comparison of alexandrite laser and electrolysis for hair removal. Dermatologic surgery. 26(1):37–41

    Article  PubMed  Google Scholar 

  11. Chen ML, Reyblat P, Poh MM, Chi AC (2019) Overview of surgical techniques in gender-affirming genital surgery. Translational Andrology and Urology. 8(3):191

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Campos VB, Dierickx CC, Farinelli WA, Lin TYD, Manuskiatti W, Anderson RR (2000) Ruby laser hair removal: evaluation of long-term efficacy and side effects. Lasers in Surgery and Medicine: The Official Journal of the American Society for Laser Medicine and Surgery. 26(2):177–185

    Article  CAS  Google Scholar 

  13. Eremia S, Li C, Newman N (2001) Laser hair removal with alexandrite versus diode laser using four treatment sessions: 1-year results. Dermatologic surgery. 27(11):925–930

    CAS  PubMed  Google Scholar 

  14. Hontscharuk R, Alba B, Hamidian Jahromi A, Schechter L (2021) Penile inversion vaginoplasty outcomes: complications and satisfaction. Andrology. 9(6):1732–1743

    Article  PubMed  Google Scholar 

  15. van der Sluis WB, Bouman M-B, de Boer NK et al (2016) Long-term follow-up of transgender women after secondary intestinal vaginoplasty. The journal of sexual medicine. 13(4):702–710

    Article  PubMed  Google Scholar 

  16. Papadopulos NA, Lellé J-D, Zavlin D et al (2017) Quality of life and patient satisfaction following male-to-female sex reassignment surgery. The journal of sexual medicine. 14(5):721–730

    Article  PubMed  Google Scholar 

  17. Horbach SE, Bouman M-B, Smit JM, Özer M, Buncamper ME, Mullender MG (2015) Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. The journal of sexual medicine. 12(6):1499–1512

    Article  PubMed  Google Scholar 

  18. Hamilton MM, Dayan SH, Carniol PJ (2001) Laser hair removal update. Facial plastic surgery. 17(03):219–222

    Article  CAS  PubMed  Google Scholar 

  19. Lepselter J, Elman M (2004) Biological and clinical aspects in laser hair removal. Journal of Dermatological Treatment. 15(2):72–83

    Article  CAS  PubMed  Google Scholar 

  20. Kulkin JM, Flash S (2010) Laser hair removal. Obstetrics and Gynecology Clinics. 37(4):477–487

    PubMed  Google Scholar 

  21. Manrique OJ, Adabi K, Martinez-Jorge J, Nicoli F, Kiranantawat K (2018) Complications and patient-reported outcomes in male-to-female vaginoplasty—where we are today: a systematic review and meta-analysis. Ann Plast Surg. 80(6):684–691

    Article  CAS  PubMed  Google Scholar 

  22. Hadj-Moussa M, Ohl DA, Kuzon WM Jr (2018) Feminizing genital gender-confirmation surgery. Sexual Medicine Reviews. 6(3):457–468 e452

    Article  PubMed  Google Scholar 

  23. Peters BR, Martin LH, Butler C, Dugi D, Dy GW (2022) Robotic peritoneal flap vs. perineal penile inversion techniques for gender-affirming vaginoplasty. Current urology reports. 23:1–8

    Article  Google Scholar 

  24. Salgado CJ, Nugent A, Kuhn J, Janette M, Bahna H (2018) Primary sigmoid vaginoplasty in transwomen: technique and outcomes. Biomed Res Int

  25. Robinson IS, Blasdel G, Bluebond-Langner R, Zhao LC (2022) The management of intra-abdominal complications following peritoneal flap vaginoplasty. Urology. 164:278–285

    Article  PubMed  Google Scholar 

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Funding

The authors declare that no funds, grants, or other support were received during preparation of this manuscript.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA

    Lauren E. Berger, Samuel S. Huffman, Daisy L. Spoer & Kenneth L. Fan

  2. Plastic and Reconstructive Surgery Division, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Lauren E. Berger

  3. Georgetown University School of Medicine, Washington, DC, USA

    Christian X. Lava, Samuel S. Huffman, Daisy L. Spoer & Taylor Martin

  4. Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA

    Gabriel A. Del Corral

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  1. Lauren E. Berger
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  4. Daisy L. Spoer
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  5. Taylor Martin
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  6. Kenneth L. Fan
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  7. Gabriel A. Del Corral
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lauren E. Berger, Christian X. Lava, Samuel S. Huffman, Taylor Martin, and Daisy L. Spoer. The first draft of the manuscript was written by Lauren E. Berger and Christian X. Lava and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Gabriel A. Del Corral.

Ethics declarations

Ethical approval

Approval was granted by the Ethics Committee of MHRI (STUDY#00004148, approved September 2021). This study was performed in line with the principles of the Declaration of Helsinki.

Informed consent

Written informed consent was obtained prior to survey completion across all participants.

Conflict of Interest

Lauren E. Berger, Christian X. Lava, Samuel S. Huffman, Daisy L. Spoer, Taylor Martin, Kenneth L. Fan, and Gabriel A. Del Corral declare no conflict of interest.

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Berger, L.E., Lava, C.X., Huffman, S.S. et al. Does method matter? Characterizing the effect of preoperative hair removal method on outcomes following penile inversion vaginoplasty. Eur J Plast Surg 46, 1151–1159 (2023). https://doi.org/10.1007/s00238-023-02059-z

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  • DOI: https://doi.org/10.1007/s00238-023-02059-z

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