Study Objective
This study aimed to characterize the incidence and management of postoperative vaginal
bleeding concerns experienced by transgender adolescents and young adults (AYA) on
testosterone hormone therapy after gender-affirming hysterectomy (GAH).
Methods
This was a retrospective cohort of transgender AYA, 18 years and older, using testosterone
therapy who underwent a GAH between July 2020 and September 2021 at a tertiary care
children's hospital. The incidence of patient-reported postoperative vaginal bleeding
concerns and management of bleeding are described.
Results
Patient ages ranged between 18 and 33 years. Among 25 patients who met the inclusion
criteria, 13 (52.0%) reported vaginal bleeding concerns. No modifiable patient or
operative characteristics reached statistical significance in association with postoperative
bleeding concerns. Among patients with bleeding concerns, 10 (76.9%) experienced such
concerns during the first 2 weeks after surgery, and 6 (46.2%) had resolution of bleeding
without intervention. Among 11 patients who underwent an exam for evaluation of bleeding,
findings included granulation tissue (n = 5, 45.5%), vaginal atrophy (n = 4, 36.4%), bleeding vessel (n = 1, 9.1%), mucosal separation (n = 1, 9.1%), or no cause of bleeding identified (n = 4, 36.4%).
Conclusions
Over half of transgender AYA on testosterone therapy in this cohort reported postoperative
vaginal bleeding concerns that were most often secondary to atrophy and granulation
tissue, suggesting possible susceptibility to vaginal tissue trauma at the time of
GAH and granulation-susceptible healing in patients on testosterone. As vaginal bleeding
could worsen gender dysphoria, these findings support the need for patient counseling
on postoperative bleeding expectations and identification of interventions to reduce
vaginal bleeding after GAH.
Key Words
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Article info
Publication history
Published online: September 07, 2022
Accepted:
September 2,
2022
Received in revised form:
August 5,
2022
Received:
June 3,
2022
Footnotes
Conflict of interest statement: The authors report no conflicts of interest.
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
