Pain and Dysfunction Reported After Gender-Affirming Surgery: A Scoping Review

Abstract

Objective: The goal of this scoping review was to determine the types and rates of pain and dysfunction outcomes reported after gender-affirming surgical procedures. In addition, a summary of the involvement of conservative care reported in the literature was produced.

Methods: A research librarian conducted searches through multiple databases from inception to 2021. Abstracts and full texts were reviewed by a team of at least 2 reviewers. Data were extracted from a custom survey and exported for summary.

Results: Thirty-one papers discussed masculinizing interventions, and 87 papers discussed feminizing procedures. Most of the studies emphasized surgical outcomes. Of the studies reporting pain or dysfunction, few standardized outcomes were used to collect information from patients. The pain was experienced across body regions after surgery for both feminizing and masculinizing procedures. Vaginal stenosis and incontinence were the most common complications reported. Patients were most often managed by physical therapists for vaginal stenosis or dyspareunia.

Conclusion: Many published studies do not systematically collect specific or standardized information about pain and dysfunction after gender-affirming surgery. Of those studies that do report these outcomes, few detail the involvement of physical therapists in the recovery after surgery.

Impact: Pain and urogenital dysfunction, often managed by physical therapists, occur after gender-affirming surgery, suggesting that physical therapists could have a larger role in the recovery of this patient population after surgery. The extent to which interventions used to manage these conditions in cisgender people will be equally effective in transgender people is unknown at this time. Future studies should use recognized measures to characterize patients' experiences with pain and dysfunction after surgery.

Keywords: Dysfunctions; Dysphoria; Gender; Pain; Surgery.