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. 2025 May;49(10):2850-2859.
doi: 10.1007/s00266-024-04628-4. Epub 2025 Jan 8.

Surgical Experience and Outcome Evaluation of Genital Gender Affirmation Surgery for Transgender Female in China: A Case Series

Guanhuier Wang #  1 , Xu Chang #  1 , Xin Yang  1 , Runlei Zhao  1 , Jiaying Qian  1 , Ye Liu  1 , Qiannan Xing  1 , Bailin Pan  2
Affiliations

Surgical Experience and Outcome Evaluation of Genital Gender Affirmation Surgery for Transgender Female in China: A Case Series

Guanhuier Wang et al. Aesthetic Plast Surg. 2025 May.

Abstract

Background: Gender-affirming surgery (GAS) for transgender females developed relatively late and limited in China due to some reasons. To introduce GAS surgical experiences for Chinese transgender females is necessary.

Aims: To report surgical choices and experience including clitoral/urethral reconstruction, vaginoplasty, and vulvoplasty, and their outcomes.

Methods: A single-center, retrospective case series was conducted among transgender females who underwent GAS between September 2018 and March 2023. Surgical outcomes were evaluated including short-term and long-term complications. Scar-Q Scale, Female Sexual Function Index (FSFI), Amsterdam Hyperactive Pelvic Floor Scale-Women (AHPFS-W), and Female Genital Self-Imaging Scale (FGSIS) were carried out for outcome evaluation.

Results: Thirteen transgender females underwent GAS. Among them, 7 patients underwent sigmoid colon vaginoplasty, 3 patients underwent zero-depth vaginoplasty (ZDV), and 3 patients underwent vaginoplasty using skin flap (penile or scrotum). Postoperative follow-up showed that for sigmoid colon neo-vagina, vaginal length can reach 10-15 cm, with a width of about 2 fingers. For skin flap neo-vagina, the long-term vaginal length can maintain at around 8-10 cm, with a width of about 2 fingers. AHPFS-W outcome shows that patients undergoing sigmoid colon vaginoplasty and ZDV have relatively better pelvic floor muscle function. Patients undergoing skin flap vaginoplasty scored higher on the FGSIS, indicating a higher level of self-acceptance toward reconstructed genitalia.

Discussion: Factors like anatomical characteristics, sexual customs and cultural backgrounds may alter the choice of GAS techniques for Chinese transgender females. The GAS surgical experience specialized to Chinese transgender females is necessary to share.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Chinese population; Genital gender-affirming surgery; Surgical outcomes; Transgender female.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no conflict of interest. Ethical Approval: Our experiments were in accordance with the ethical standards formulated in the Helsinki Declaration. The research procedures were approved by the Medical Science Research Ethics Committee of the Third Hospital of Peking University. Informed Consent: Informed consent was obtained from the participants responding to the follow-up surveys.

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