Pelvic floor and sexual dysfunctions after genital gender-affirming

[George K]

https://pubmed.ncbi.nlm.nih.gov/39545366/

"Twenty-five papers were considered for systematic review, while 17 studies were included for meta-analysis. There was significant statistical heterogeneity across the included studies. Among transwomen who had undergone vaginoplasty, pelvic organ prolapse occurred in 1%-7.5% of patients, urinary incontinence affected up to 15% of patients, while urinary irritative symptoms up to 20%. Sexual dysfunctions were reported by 25%-75% of patients. Among transmen who underwent hysterectomy and phalloplasty, pelvic organ prolapse occurred in 3.8% of patients, urinary incontinence affected up to 50% of patients, while urinary irritative symptoms up to 37%. Finally, sexual dysfunctions were reported by 54% of patients."

Males who underwent vaginoplasty:
Organ prolapse: up to 7.5%
Urinary incontinence: up to 15%
Irritative urinary symptoms: up to 20%
Sexual dysfunction: up to 75%

Females who underwent hysterectomy/phalloplasty:
Organ prolapse: up to 3.8%
Urinary incontinence: up to 50%
Irritative urinary symptoms: up to 37%
Sexual dysfunction: up to 54%

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How could anyone recommend a "therapy" in which half the people end up with sexual dysfunction.

"You have a 15% chance of becoming incontinent of urine. Still want to proceed?"

ETA: Wait a minute. Am I reading this correctly - 46% of women who have a phalloplasty do NOT have sexual dysfunction?

[Klaus]

Well, I guess it depends on how you define sexual dysfunction.

[LuFins Dad]

Oh yeah? Well incontinence is 100% when you die! Nobody can control their bowels then! And that’s what will happen if you don’t trans your kid! Do you want a dead daughter with 100% chance incontinence and 85% chance of sexual dysfunction, or a living son that only pees himself a little?

[George K]

@Klaus said in Pelvic floor and sexual dysfunctions after genital gender-affirming:

I guess it depends on how you define sexual dysfunction.

Being unable to get and maintain an erection would qualify.
Being unable to sense "vaginal" penetration would qualify.
Dysparunia would qualify.

@LuFins-Dad , LOL.

[LuFins Dad]

Stop genociding me, boomer!

[jon-nyc]

Oddly Wikipedia says pelvic organ prolapse occurs in 9.8% of women worldwide. I’m guessing that’s mostly older women and the people transitioning are much younger on average. Probably includes really minor cases too.

[Klaus]

@George-K said in Pelvic floor and sexual dysfunctions after genital gender-affirming:

@Klaus said in Pelvic floor and sexual dysfunctions after genital gender-affirming:

I guess it depends on how you define sexual dysfunction.

Being unable to get and maintain an erection would qualify.
Being unable to sense "vaginal" penetration would qualify.
Dysparunia would qualify.

I assume dysfunction is measured relative to the "best case" outcome of the procedure,
which I assume would be something like "you can manually inflate the fake penis or have
a semi-rigid fake penis and you feel some kind of sexual arousal during intercourse and don't feel pain".

In particular, it's not measured relative to how healthy biological men have sex.

[George K]

@jon-nyc said in Pelvic floor and sexual dysfunctions after genital gender-affirming:

Wikipedia says pelvic organ prolapse occurs in 9.8% of women worldwide

Yup. Vaginal prolapse and rectal prolapse are very common and I've been involved with a ton of operations to repair that.

But, there's a difference between something that occurs (usually) as a result of childbirth and something that is caused by surgery. I know, I'm splitting pubic hairs here, but the fact stands that a surgical procedure has an 8% chance of causing a problem that would not occur without the procedure.

[Jolly]

Some wise person said somewhere "First, do no harm."