(003) Sexual Satisfaction and Orgasmic Function After Gender-Affirming Vaginoplasty: Initial Results From the Validated SatisFunction Survey

Abstract Introduction Transgender and gender diverse individuals (TGDI) may undergo gender-affirming surgery (GAS) to align their appearance with their gender. Sexual function after gender-affirming vaginoplasty (GAV) is a critical outcome for patients and surgeons. Prior to the development of the SatisFunction Survey, there were limited objective measures available to measure how GAS affected this area of patients’ lives or to stratify techniques, risks, and long-term outcomes. Objective To distribute the SatisFunction survey to patients who had undergone GAV to assess their experience of orgasm post-operatively. Methods This IRB-approved study (STUDY20221324) included transgender women and gender-diverse adults who had undergone GAV at least three months prior and could complete the survey in English. Participants who were recruited through gender-affirming care clinics at a single-site institution and through community outreach provided electronic consent and completed the SatisFunction Survey via REDCap. The 34-item survey, developed through a seven-phase validation process, assessed sexual function domains including desire, arousal, orgasm, satisfaction, distress, and pain, with items scored from –2 to +2 (higher = better function). Demographics, surgical type, and revision data were also collected. Descriptive statistics summarized cohort characteristics. Chi-square tests assessed categorical differences in outcomes between surgical techniques. A simple linear regression was performed to assess the relationship between time since vaginoplasty and orgasm with vaginal penetration; model significance was evaluated using the ANOVA F-test. Analyses were performed using IBM SPSS v31.0.1.0. Results Of those approached for participation, 98 individuals met inclusion criteria for the SatisFunction Survey and were included in analyses. The average age of participants was 39.1 years and the average time from GAV to survey completion was 2.4 years. The most common surgical approaches included peritoneal pull through (57, 58.2%), penile inversion (22, 22.5%), zero depth (6, 6.1%), and shallow depth (5, 5.1%) GAV. About half of patients (46, 47.4%) reported first noticing pleasurable genital sensations by three months post-operatively. Overall, participants were always or almost always able to reach orgasm when they wanted (46, 46.9%) and were satisfied with their orgasm quality (64, 66.0%) post-operatively. Between types of GAV, there were significant differences in participants’ ability to reach orgasm through any kind of sex (p = 0.016), and also through vaginal penetration (p = 0.030), clitoral stimulation (p = 0.004), and anal penetration (p = 0.017). There was no significant difference in individuals’ orgasm quality (p = 0.087) between GAV types. There was also no significant difference in timing to initial pleasurable genital sensations post-operatively between GAV types (p = 0.183). A simple linear regression showed that years since vaginoplasty did not significantly predict whether participants always or almost always had orgasms with vaginal penetration (F(1, 81) = 0.37, p = 0.54). Conclusions The SatisFunction survey provides valuable insight into post-operative experiences among TGDI undergoing GAV. Differences in orgasmic function across GAV techniques highlight the importance of individualized surgical planning and counseling, and the need for further research into optimizing sexual health outcomes for TGDI. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Astellas (speaker); Johnson & Johnson Global Public Health (consultant).