Outcomes and Experience of Gender-Confirming Vulvoplasty: A Systematic Review

Genital gender-affirming surgery, or bottom surgery, is a medically necessary treatment for some transgender and gender diverse (TGD) individuals. Techniques and outcomes of penile inversion vaginoplasty are the most well-documented type of feminizing bottom surgery in the literature. The outcomes of vulvoplasty, in which no vaginal canal is created, are less clear. The aim of this study was to systematically review the literature on outcomes and experience of vulvoplasty. Embase, PubMed, CINAHL, and SCOPUS were searched from inception to October 22, 2022. Three search concepts were applied covering (1) population: TGD individuals assigned male at birth, (2) intervention: vulvoplasty, and (3) outcomes: surgical outcomes, patient-reported outcomes, and surgeons' assessment of advantages and disadvantages of the procedure. Only publications in Danish or English were included with no other restrictions imposed. Data were pooled when feasible. The search generated 1713 titles after the removal of duplicates. Five studies were included for data analysis. The studies were of low quality and with small sample sizes, and analyses were limited by methodological heterogeneity. Thus, reliable conclusions could not be made. The scarce literature, however, suggests promising outcomes and satisfaction following vulvoplasty, and further, vulvoplasty is described as having some distinct advantages and disadvantages. Further investigation using larger study populations is needed.