From Posts to Perceptions: How Reddit Users Feel About Phalloplasty and Metoidioplasty

BACKGROUND: Gender-affirming surgery, including phalloplasty and metoidioplasty, is an effective and necessary treatment for patients with gender dysphoria.(1-4) This study aims to better describe the needs and priorities of patients undergoing these procedures by using social media as a lens to analyze patient sentiment. METHODS: We utilized Pushshift.io, an archive of Reddit data, to extract all posts and comments from the r/Metoidioplasty and r/Phalloplasty subreddits since their inception. These posts were analyzed using natural language processing and VADER sentiment analysis. Posts with extreme sentiment scores were manually reviewed for theme classification and qualitative analysis. RESULTS: A total of 4,236 r/Metoidioplasty posts, 37,347 r/Metoidioplasty comments, 12,837 r/Phalloplasty posts, and 122,489 r/Phalloplasty comments were analyzed. The number of posts and comments in both subreddits increased significantly over time. The mean sentiment score for r/phalloplasty comments was significantly higher than the mean sentiment score for r/metoidioplasty comments. The average monthly sentiment score for r/Phalloplasty posts and comments has decreased significantly since the subreddit's inception. 1,347 posts (340 from r/Metoidioplasty and 1,007 r/Phalloplasty) with extreme sentiment scores above 0.95 or below -0.95 were identified. A total of 42 overarching themes were identified. The most frequent themes included the healing/recovery process, sensation and sexual function, and preoperative planning and consultation. CONCLUSION: Our findings reveal an increase in online engagement over time within the r/Metoidioplasty and r/Phalloplasty Reddit communities. This suggests a growing interest in these gender-affirming surgeries and the need for increased patient support. The decrease in phalloplasty sentiment scores may reflect rising concerns or negative experiences among patients. Frequent topics of discussion with extreme sentiment scores identify potential target areas for increased education and patient-physician discussion. Ultimately, this study offers valuable insights into the real-time concerns and priorities of patients undergoing gender-affirming surgery. While Reddit offers a rich source of qualitative data, the limitations of using social media, such as selection bias and the potential for extreme viewpoints to dominate discussions, must be acknowledged. Future studies integrating social media data with traditional clinical outcomes and patient reported outcomes could help develop a more comprehensive understanding of patient experiences, improving both surgical practices and support systems for transgender individuals.