Complications following gender-affirming surgery can be treated by primary care physicians: study

A new Canadian study explores on the postoperative complications and adverse events in patients who received vaginoplasty. The majority of the complications are minor and could be treated by primary care practitioners, the authors suggest. The study involved a retrospective chart review of 80 patients visiting a transition-related surgery postoperative care clinic at Women’s College Hospital in Toronto—notably a city where about 200 people receive vaginoplasty each year. The patients all received vaginoplasty, a surgical technique that creates a vulva and a vaginal canal, sometimes using penile and scrotal skin. All the patients had the procedure done elsewhere. Follow-up is essential for patients who have had vaginoplasty because the surgery has high rates of complications and patients have a lot of questions, explained Emery Potter, a nurse practitioner at the clinic and lead author of the study. The recovery is also long—up to one year. Canadian patients often have to travel to receive the surgery because it is only available in Vancouver, Toronto and Montreal. This means postoperative care can not usually be given by the surgical centre, and patients must seek help elsewhere. The Women’s College Hospital’s postoperative clinic is the only one of its kind in Canada, leaving many patients to be managed by primary care practitioners in their home communities. “Physicians, when they are referring patients for surgery, should be expecting to see patients with concerns and complications after surgery,” Potter said. “The responsibility lands on them because no one else is able to manage these concerns.” Read: Cuts to telehealth in Ontario mean fewer trans and non-binary people will have access to life-saving healthcare Pain was the most common patient-reported symptom, and was usually related to an adverse outcome that could be treated in a primary care setting, such as hypergranualtion, cysts or nodules or a skin condition, the authors suggest. The pain usually accompanied certain situations or activities, such as pain with dilation, walking or as a result of wound separation, Potter said. “This is the kind of postsurgical pain that physicians have the skill and knowledge to be able to manage.” Hypergranulation was present in 38.8% of patients presented at the clinic. “This is a complication that could potentially have significant multiple negative clinical outcomes,” Potter said. “Hypergranualtion is tissue that overgrows, and it could overgrow over the clitoris, it could grow over the urethral meatus, it could grow into the vaginal wall, creating lack of depth and stenosis, so it really is a complication that could have severe possible sequalae. However, it is completely manageable in primary care.” Primary care physicians are used to treating hypergranualtion in other situations, such as ostomy care, Potter said. Read: B.C.’s new family doctor payment model takes aim at ‘crisis’ in primary care Sexual dysfunction was another common adverse effect. A third of patients reported sexual dysfunction and healthcare providers identified it in 21.3% of cases. In some cases, just reviewing the anatomy and having a conversation about the egonomics and dynamics or sex could help patients, Potter said. “People have this new body part and sometimes knowing how to use it isn’t completely self-explanatory, and people have a lot of apprehensions and fears about sex after surgery.” The most common major adverse event was vaginal stenosis, a clinically significant narrowing and shortening of the vaginal canal that requires further surgery. Concern about proper dilation was reported by 46.3% of patients. Regular dilation is important following vaginoplasty, and the frequency of concern suggests that more education and evaluation of postsurgical dilation practices is important, the authors wrote. Other adverse effects included urinary complications (17.5%), anatomic obstruction of urethral meatus (10%) and wound healing problems (12.5%). The majority of the patients in the study had surgery in North America, but 22.5% had surgery overseas. Most patients were referred to the clinic within two years of their surgery, with 22.5 % presenting in the first three months after surgery and 32.5% presenting from three months to one year after surgery. Physicians are welcome to send patients to the clinic at Women’s College Hospital, but Potter said the goal is to have primary care comfortable providing support. A course on postoperative care following vaginoplasty is available through Rainbow Health Ontario. There is also information on the clinic’s website. “Hopefully we can continue to build more accessible courses for people in the future,” Potter said. The paper was published in a recent issue of Neurourology and Urodynamics. Read: Report finds taboos in women's health can limit access to knowledge and care

Complications following gender-affirming surgery can be treated by primary care physicians: study

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