Gynecologic outcomes and satisfaction among transgender women and gender diverse individuals following penile inversion or peritoneal augmented vaginoplasty

Gender-affirming vaginoplasty (GAVP) is a critical intervention for many transgender women and gender diverse individuals. While penile inversion vaginoplasty (PIV) is the most common technique, peritoneal augmented vaginoplasty (PAV) has emerged as an alternative. However, limited data exist comparing post-surgical sexual health, gynecologic experiences, and satisfaction between these approaches. This study aimed to describe gynecologic experiences, exposures, and satisfaction among transgender women and gender diverse (TWGD) individuals following penile inversion vaginoplasty (PIV) or peritoneal augmented vaginoplasty (PAV) at a single-site institution. This quantitative study was done between November 2023 and February 2025. Adults who had undergone PIV or PAV at least three months prior completed a questionnaire assessing sexual practices, sexually transmitted infection (STI) history, dilation and douching, vaginal symptoms, complications, and satisfaction. Fisher’s exact tests were used to assess group differences. Thirty-seven TWGD individuals were included (8 PIV; 29 PAV). Mean age at time of vaginoplasty was 36.8 years, and mean time since surgery was 601.5 days. Overall, 74.3% (26 of 35) of participants reported being satisfied or very satisfied with their surgical outcomes. Dissatisfaction was significantly higher in the PIV group (50%, 4 of 8) compared to the PAV group (3.7%, 1 of 27; p = 0.006). Rates of reoperation for aesthetic or depth concerns and the prevalence of vaginal symptoms or sexual practices were similar between groups, with no statistically significant differences. While gynecologic experiences varied widely, satisfaction differed significantly by surgical approach. Patients who had undergone PAV reported higher satisfaction than those who had undergone PIV, despite comparable complication rates. Further research is needed to explore factors contributing to dissatisfaction and to establish validated, inclusive tools for assessing outcomes post-vaginoplasty.