Surgical and functional outcomes of penoscrotal vaginoplasty in AMAB transgender patients: a comprehensive analysis of patient satisfaction and postoperative findings

Aim: To evaluate surgical and functional outcomes of assigned male at birth (AMAB) transgender patients who received penoscrotal vaginoplasty at an Italian referral center. Methods: A retrospective analysis included AMAB transgender patients who received penoscrotal vaginoplasty between April 2018 and April 2024. Patient demographic data, surgical outcomes, complications, and functional outcomes were collected and analyzed. Functional outcomes were assessed using validated questionnaires, including the Operated Male-to-Female Sexual Function Index (oMtFSFI), the Female Sexual Function Index (FSFI), and the Female Genital Self-Image Scale (FGSIS). A follow-up period of 12 months was used, with statistical analyses to identify predictors of complications and patient dissatisfaction. Results: The study included 47 AMAB transgender patients, with 30 providing complete functional outcome data. Surgical outcomes showed that the median operative time was 315 min, with a median neovaginal depth of 14 cm. Major complications occurred in 21.2%, including meatal stenosis and one case of rectovaginal fistula. Functional outcomes showed significant improvement, with 63.3% of patients achieving normal oMtFSFI scores at 12 months. FSFI scores also improved across all domains, and genital self-image progressively improved over time. Conclusion: Penoscrotal vaginoplasty demonstrates favorable surgical and functional outcomes in AMAB transgender patients, with high levels of patient satisfaction. Despite the complexity and potential for complications, penoscrotal vaginoplasty represents an effective surgical option for aligning physical appearance with gender identity, with progressive improvements in sexual function and genital self-image observed over the first postoperative year.