To evaluate if the vaginoplasty for sex reassignment surgery can cause some kind of sexual, urinary and / or bowel dysfunction.

This is a cross-sectional, quantitative, and descriptive study, that was carried out from June to October 2017. 
Participants were contacted by phone, were of varying ages, and were male biological transgender women who underwent the surgical process of sex reassignment. Each participant signed and consented to the free and informed consent form.  They were then given a questionnaire designed for this research and consisted of questions about bladder emptying, urinary incontinence, urinary frequency, evacuation frequency, constipation, fecal incontinence, genito-pelvic pain/penetration and local sensitivity. The questionnaire application was made once a week for a period of six weeks. 
Exclusion criteria were individuals who were still in the test period, biologically female individuals and those who did not accept the invitation to participate. 
Variables were tabulated in Microsoft Excel 2019, as well as the descriptive analysis of the data. Numerical variables were presented as means, standard deviations and categorical variables in absolute frequency and percentages.

Were recruited twenty-one male biologically transgendered women who underwent the surgical process of sex reassignment surgery. Sixteen of them accepted to participate in the research, two declined due to not wanting to expose themselves, two were excluded because they were in the transition process and one due to scheduling issues.
Participants had an average age of 40 years and an average of 5.5 years since the surgery, with a mean surgery duration of 4.5 hours and a need for 1 repair.
As for urinary complaints, there was an increase in complaints after surgery regarding increased frequency of urination (before 43.75% to 87.50% after), urinary infection (31.25% to 50%), effort to complete urination (6.25% to 31.25%) and loss of urine (6.25% to 25 %), respectively.
As for evacuation complaints, there was a reduction in evacuation effort, from 31.25% before surgery to 18.75% after.
Regarding sexual complaints, there was an increase in complaints of genito-pelvic pain/penetration, from before 31.25% to 50% after, and an increase in sensitivity, from 25% to 81.25%, respectively.

Gender-affirming vaginoplasty results in significant changes in the anatomy of the pelvic floor that can lead to dysfunction. Several superficial and deep structures are dissected and repositioned for the construction of the neovagina, such as shortening the urethra, creating a space between the rectum, urethra, prostate and bladder, in addition to the detachment of some muscles, which can compromise the function of the pelvic systems (JIANG et al., 2019; FRANCO et al., 2010). 
Manrique et al (2019) showed that the patient index of transgender women who had some pelvic floor dysfunction prior to surgery was high (77.5%), and that after the procedure there was no increase in the occurrence of complaints of pelvic floor dysfunction, unlike our findings, in which voiding, bowel movements and sexual complaints appeared or increased in frequency after the surgical intervention, although complaints were also reported previously. The occurrence of these complaints before surgery seems to be associated with the use of hormone therapy, presence of comorbidities and socioeconomic status.

It can be concluded that vaginoplasty for sexual reassignment may cause pelvic floor dysfunctions such as voiding, evacuation and sexual alterations, as well as some pelvic floor limitations. Future studies are needed to investigate pre and post-surgical complaints so that we can outline effective prevention and treatment strategies for this population.

Jiang DD, Gallagher S, Burchill L, Berli J, Dugi D 3rd. Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty. Obstet Gynecol. 2019;133(5):1003-1011. doi: 10.1097/AOG.0000000000003236. PMID: 30969210.
Franco, T., Miranda, L. C., Franco, D., Zaidhaft, S., & Aran, M. (2010). Male-to-female transsexual surgery: experience at the UFRJ University Hospital. Revista do Colegio Brasileiro de Cirurgioes, 2010, 37(6), 426-434.
Manrique OJ, Adabi K, Huang TC, Jorge-Martinez J, Meihofer LE, Brassard P, Galan R. Assessment of Pelvic Floor Anatomy for Male-to-Female Vaginoplasty and the Role of Physical Therapy on Functional and Patient-Reported Outcomes. Ann Plast Surg. 2019 Jun;82(6):661-666. doi: 10.1097/SAP.0000000000001680. PMID: 30422842.

Continence 7S1 (2023) 101029
DOI: 10.1016/j.cont.2023.101029