Abstract
Background
A rising number of female-affirmed transgender adolescents are being treated with
gonadotropin-releasing hormone analogues and subsequently cross-sex hormones at early
or mid-puberty, with vaginoplasty as the presumed final step in their physical transition.
But, despite the minimum age of 18 years defining eligibility to undergo this irreversible
procedure, anecdotal reports have shown that vaginoplasties are being performed on
minors by surgeons in the United States, thereby contravening the World Professional
Association for Transgender Health (WPATH) standards of care (SOC).
Aim
To explore surgeons' attitudes toward ethical guidelines in the SOC; any professional
experiences of performing vaginoplasty on transgender minors; views of surgical risks,
benefits, and harm reduction measures; and perceptions of future challenges and concerns
in this area of surgical practice.
Methods
A qualitative semistructured interview approach was used to collect data from 13 male
and 7 female surgeons who perform transgender vaginoplasty in the United States.
Outcomes
Professional experiences and attitudes toward vaginoplasty in transgender minors were
analyzed using the constant comparative method applied to 20 individual interview
transcripts.
Results
While there was close agreement concerning surgical techniques, proper patient selection,
and predictive elements of postoperative success, attitudes toward the SOC and the
reliance on the guidelines varied. The sole practitioner model is gradually giving
way to a more holistic team approach, with patient responsibility dispersed among
different professionals. Different approaches to surgical training, professional standards,
and fellowship programs were suggested. Several participants expressed a need for
centralized data collection, patient tracking, and increased involvement of the WPATH
as a sponsor of studies in this emergent population.
Clinical Implications
Drawing on surgeons' attitudes and experiences is essential for the development of
standards and practices. A more precise and transparent view of this surgical procedure
will be essential in contributing to the updated version 8 of the WPATH SOC.
Strengths and Limitations
The abundant data elicited from the interviews address several meaningful research
questions, most importantly patient selection criteria, surgical methods, and issues
critical to the future of the profession. Nevertheless, the limited sample might not
be representative of the surgical cadre at large, particularly when exploring experiences
and attitudes toward vaginoplasty in minors. A larger participant pool representing
WPATH-affiliated surgeons outside the United States would improve the generalizability
of the study.
Conclusion
Taken together, the study and its findings make a significant contribution to the
planned revision of the WPATH SOC.
Milrod C, Karasic DH. Age Is Just a Number: WPATH-Affiliated Surgeons' Experiences
and Attitudes Toward Vaginoplasty in Transgender Females Under 18 Years of Age in
the United States. J Sex Med 2017;14:624–634.
Key Words
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Article Info
Publication History
Published online: March 19, 2017
Accepted:
February 11,
2017
Received:
October 17,
2016
Footnotes
Conflicts of Interest: The authors report no conflicts of interest.
Funding: None.
Identification
Copyright
© 2017, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
