Patients' Priorities Regarding Female-to-Male Gender Affirmation Surgery of the Genitalia-A Pilot Study of 47 Patients in Sweden.

INTRODUCTION: No surgical technique is reported to be the best option for gender-affirmation surgery (GAS) of the genitalia in transmen. Although patients' preferences are central when choosing a surgical technique, no studies have evaluated this factor.

AIM: To investigate transmen's priorities and preferences regarding GAS of the genitalia.

METHODS: From November 2015 to March 2016, 54 transmen with the diagnosis of gender dysphoria who were referred to Sahlgrenska University Hospital for discussion of therapeutic steps (surgery and hormonal treatments) were asked to complete a questionnaire on different attributes achievable with GAS, such as sexual and urinary function and appearance. Forty-seven patients (87%) completed the questionnaire. Age ranged from 18 to 52 years (mean = 26 years, SD = 7.4 years). At the time of interview, no patient had undergone GAS of the genitalia.

MAIN OUTCOME MEASURES: Answers to completed questionnaires.

RESULTS: Seventy-six percent of patients identified themselves as male, and 24% wrote other terms such as "mostly male," "inter-gender" and "non-binary." Gender identity had a significant impact on patients' preferences for two questions: the importance of vaginal removal and the importance of having a penis that would be passable in places such as male dressing rooms. These items were more important to patients identifying themselves as male. The most important attributes requested were preserved orgasm ability and tactile sensation. The least important attribute was removal of the vagina, followed by having a penis of human material, minimal scarring, and size. The ability to urinate while standing was considered a high priority by some and a low priority by others. All answers ranged from "unimportant" to "imperative."

CONCLUSION: This series of patients demonstrates a considerable heterogeneity among transmen in their gender identity and preferences regarding GAS of the genitalia, which supports the need for several techniques. Patients must be accurately informed on the different techniques and their specific benefits and limitations to make an informed choice. Jacobsson J, Andréasson M, Kölby L, et al. Patients' Priorities Regarding Female-to-Male Gender Affirmation Surgery of the Genitalia-A Pilot Study of 47 Patients in Sweden. J Sex Med 2017;14:857-864.