Piloting a Genital Affirmation Surgical Priorities Scale for Trans Masculine Patients

Abstract

Purpose: Many transgender men seek surgical interventions to create male genitalia. Currently, there is no standardized tool to assess individual goals and expectations for such reconstructive genital surgery. The purpose of this study was to develop and pilot a genital affirmation surgical priorities scale (GASPS) in transgender men seeking metoidioplasty and/or phalloplasty. Methods: The research team developed the GASPS and piloted it with 63 patients seeking reconstructive genital surgery. The scale was constructed after a comprehensive literature review identified key areas of importance, including size, erogenous and tactile sensation, interest in penetrative sex, ability to urinate standing up, and maintenance of orgasmic function. Results were then tabulated and analyzed to look for trends. Results: Sixty three consecutive patients, mean age 24.98 years (standard deviation [SD]=5.87), were administered the assessment. On the 5 point Likert scale, patients were most concerned about being able to stand to urinate (mean=4.38, SD=1.06) and erotic sensation (mean=4.21, SD=0.8). The ability to engage in penetrative intercourse (mean=3.98, SD=1.34), tactile sensation (mean=3.93, SD=1.01), and penis length (mean=3.37, SD=1.18), and girth (mean=3.09, SD=1.20) were not universally considered to be important and responses varied widely. Most patients (86%) stated they had a history of being able to orgasm, and 8% did not know. Feedback suggested that scale use helped patients clarify goals for surgery. Conclusion: GASPS use confirmed the diversity of patient priorities and the importance of individualized goal assessment. It also confirmed previous reports that standing to urinate is a major genital affirmation motivation for many transgender men.

Keywords: bottom surgery; gender identity; metoidioplasty; phalloplasty; trans masculine; transgender.

FIG. 1.

The genital affirmation surgical priorities scale. The *’d item was added in response to feedback and only piloted on the final 22 patients.

FIG. 2.

Box and whisker plot of genital affirmation priorities in trans masculine patients seeking gender-affirming surgery. The middle bar denotes the median value, the box encloses the 25th through 75th percentiles, and the whiskers extend to the minimum and maximum result. Where there is no middle bar visible, it coincides with the top edge of the box. This indicates that half or more of the results were recorded as “very important.” N=63 except for the appearance question, where N=22.