Combined Robotic Revision Vaginoplasty for Neovaginal Stenosis and Postoperative Sexual Function Among Transgender Women: A Prospective Cohort Study
Astrid La Rosa, Paul Sabbagh, Aurelie Schirmann, Paul Neuville, Thierry Lebret, Adrien Vidart, Pierre-Olivier Bosset, François-Xavier MadecPurpose:
Robotic revision vaginoplasty combining skin graft and peritoneal flap techniques was performed for the treatment of neovaginal stenosis in transgender women. The aim of this study was to evaluate postoperative sexual function following this procedure.
Methods:
A prospective observational study was conducted. Fifteen transgender women with neovaginal stenosis who underwent vaginoplasty revision through this mixed approach between March 2023 and April 2024 in a tertiary university hospital in France were included. The vagina was reconstructed by combining a full-thickness abdominal skin graft with robotically harvested peritoneal flaps. The primary outcome was postoperative sexual function assessed by the Operated Male-to-Female Sexual Function Index (oMtFSFI) questionnaire, which evaluates seven domains: genital self-image, desire, arousal, lubrication, orgasm, satisfaction, and sexual pain. Secondary outcomes included complication rate.
Results:
Before revision surgery, penetration was impossible for 86.7% of patients, and the mean residual neovaginal depth was 5.1 ± 2.2 cm. Mean surgery length was 285 min. Two patients out of 15 required postoperative surgical hemostasis of the abdominoplasty site. At a mean follow-up of 11.1 months, 100% of patients reported satisfactory penetrative sexual intercourse. Among the 12 patients who completed the questionnaire, 91.7% had an oMtFSFI score of 36 or less, categorized as normal.
Conclusions:
Robotic mixed approach revision surgery shows promising results, allowing 100% of patients to have penetration again with a low complication rate.