Temporal Trends and Outcomes of Gender-Affirming Gynecologic Surgery

Abstract

We performed a population-based analysis to examine the trends in utilization and outcomes of gynecologic surgical procedures performed for gender-affirming care using the National Inpatient and Ambulatory Surgery Samples. Overall, 3,344,186 (95% CI, 3,281,163–3,407,209) unique individuals who underwent gynecologic surgery were identified. Transgender and gender-diverse (TGD) individuals accounted for 19.7% (345/1,748) of the labiaplasty–clitoroplasty procedures, 15.0% (3,355/22,433) of vaginoplasties, 2.0% (212/10,679) of vaginectomies, 0.2% (5,369/2,346,748) of hysterectomies, and 0.1% (515/962,578) of oophorectomies. The percentage of cases performed in TGD individuals increased substantially from 2016 to 2020 for vaginoplasty (6.2–24.1%) and clitoroplasty–labiaplasty (8.0–35.1%). Among patients who underwent vaginoplasty, the complication rate was significantly higher among TGD individuals (16.5% vs 11.1%) (adjusted odds ratio 1.85, 95% CI, 1.22–2.81). For the other procedures, the complication rate was not higher.