Requests for vulvoplasty as gender-affirming surgery: a cross-sectional study in Denmark

Abstract

Background: Vulvoplasty, described as a promising procedure for transgender and gender diverse (TGD) persons who were assigned male at birth and who, for example, do not need a vagina or who have contraindications to vaginoplasty, is a procedure that in accordance with current guidelines is not offered as genital gender-affirming surgery in Denmark.

Aim: In this study we sought to quantify the need for offering vulvoplasty in Denmark.

Materials and methods: An online questionnaire was developed. The target group included TGD persons who were assigned male at birth and a minimum of 18 years old. Prior to data collection, the questionnaire was tested with stakeholders from the target group and was subsequently distributed exclusively in closed groups and online fora for TGD persons. Data collection took place from September 1 to October 31, 2022.

Outcomes: Primary outcomes were type of bottom surgery respondents preferred, when vulvoplasty was chosen, the reason(s) for choosing it.

Results: A total of 152 responses were included for data analysis, and 134 records were complete responses. Out of 134 respondents, 35 (26.1%) preferred vulvoplasty. The reasons for preferring vulvoplasty were the belief that there is less risk with the procedure (71%), followed by not wanting to dilate (54%), no need for a vagina (48%), and no need for vaginal penetration (40%). Health issues or other reasons were infrequent (5%). Out of 122 respondents who had not had prior bottom surgery, 106 (86.9%) wanted it in the future.

Clinical implications: Some TGD individuals in Denmark could benefit from vulvoplasty and would choose it if offered.

Strengths and limitations: Strengths of this study were that the questionnaire was thoroughly tested prior to application and that the survey could only be accessed via closed fora and groups for TDG persons. Limitations were that the sample size was small, and that the response rate could not be estimated.

Conclusion: The results of this study imply that there is an unmet need for vulvoplasty, and bottom surgery in general, in Denmark.

Keywords: bottom surgery; gender affirmation; gender incongruence; gender-affirming surgery; transgender; vulvoplasty.