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. 2025 Jul 10;13(3):qfaf045.
doi: 10.1093/sexmed/qfaf045. eCollection 2025 Jun.

Analysis of surgical complications and risk factors in genital feminization surgery: a retrospective cohort study of 407 transgender women

Fériel Ferchichi  1 , Nicolas Morel-Journel  1   2 , Damien Carnicelli  1 , Lucas Freton  3 , Lucie Jurek  4 , Alain Ruffion  1   5 , François-Xavier Madec  6 , Paul Neuville  1   5
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Analysis of surgical complications and risk factors in genital feminization surgery: a retrospective cohort study of 407 transgender women

Fériel Ferchichi et al. Sex Med. .

Abstract

Background: Penile inversion vulvo-vaginoplasty with addition of a scrotal skin graft is a widely used technique in genital feminizing surgery for trans women.

Aim: To identify the types and frequencies of complications following genital feminizing surgery and assess associated risk factors.

Methods: A retrospective review was conducted on all trans women who underwent primary genital feminizing surgery at Lyon Sud University Hospital between 2008 and 2022. Inclusion criteria were age over 18 and a minimum follow-up of 1 year. Data were collected from electronic medical records and included demographic and clinical characteristics, surgical details, intraoperative events, postoperative complications, and revision procedures.

Outcomes: The study focused on the incidence of intraoperative, early, and late postoperative complications, as well as the frequency and types of surgical revisions.

Results: Among 407 patients (mean (SD) age of 38.6 (12.7) years, mean (SD) BMI of 24.7), intra-operative rectal injury occurred in 5 patients (1.2%). Early graft failure requiring revision was seen in 1%, and 23.1% underwent secondary revisions. Late complications included recto-neovaginal fistula (0.5%) and vaginal stenosis requiring revision (3.4%). Labiaplasty was the most frequent revision procedure (n = 68). Younger age was associated with increased early revisions, while BMI and smoking were not.

Clinical implications: Clear, individualized preoperative counseling is essential to prepare patients for the potential need for revision surgery.

Strengths & limitations: This study benefits from a large sample size and long follow-up but is limited by its retrospective design and reliance on electronic records.

Conclusion: Penile inversion vulvo-vaginoplasty with scrotal skin graft is a generally safe procedure; detailed knowledge of complications supports better patient counseling and informed decision-making.

Keywords: genital feminizing surgery; genital reassignment; genital reconstruction; transwoman; vulvo-vaginoplasty.

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Conflict of interest statement

No conflicts of interest to declare by the authors.

Figures

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Figure 1
Age diagram distribution.
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