Study Objective

This study aimed to characterize the incidence and management of postoperative vaginal bleeding concerns experienced by transgender adolescents and young adults (AYA) on testosterone hormone therapy after gender-affirming hysterectomy (GAH).

Methods

This was a retrospective cohort of transgender AYA, 18 years and older, using testosterone therapy who underwent a GAH between July 2020 and September 2021 at a tertiary care children's hospital. The incidence of patient-reported postoperative vaginal bleeding concerns and management of bleeding are described.

Results

Patient ages ranged between 18 and 33 years. Among 25 patients who met the inclusion criteria, 13 (52.0%) reported vaginal bleeding concerns. No modifiable patient or operative characteristics reached statistical significance in association with postoperative bleeding concerns. Among patients with bleeding concerns, 10 (76.9%) experienced such concerns during the first 2 weeks after surgery, and 6 (46.2%) had resolution of bleeding without intervention. Among 11 patients who underwent an exam for evaluation of bleeding, findings included granulation tissue (n = 5, 45.5%), vaginal atrophy (n = 4, 36.4%), bleeding vessel (n = 1, 9.1%), mucosal separation (n = 1, 9.1%), or no cause of bleeding identified (n = 4, 36.4%).

Conclusions

Over half of transgender AYA on testosterone therapy in this cohort reported postoperative vaginal bleeding concerns that were most often secondary to atrophy and granulation tissue, suggesting possible susceptibility to vaginal tissue trauma at the time of GAH and granulation-susceptible healing in patients on testosterone. As vaginal bleeding could worsen gender dysphoria, these findings support the need for patient counseling on postoperative bleeding expectations and identification of interventions to reduce vaginal bleeding after GAH.

中文翻译：

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跨性别青少年和青壮年使用睾酮进行性别确认子宫切除术后阴道出血问题

学习目标

本研究旨在描述跨性别青少年和年轻成人 (AYA) 在性别肯定子宫切除术 (GAH) 后接受睾酮激素治疗后阴道出血问题的发生率和管理。

方法

这是一个回顾性队列，研究对象为 18 岁及以上的跨性别 AYA，他们使用睾酮疗法，于 2020 年 7 月至 2021 年 9 月期间在一家三级儿童医院接受了 GAH。描述了患者报告的术后阴道出血问题的发生率和出血处理。

结果

患者年龄介于 18 至 33 岁之间。在符合纳入标准的 25 名患者中，13 名 (52.0%) 报告有阴道出血问题。没有可修改的患者或手术特征与术后出血问题相关，具有统计学意义。在有出血问题的患者中，10 名 (76.9%) 在手术后的前 2 周内经历过这种担忧，6 名 (46.2%) 在没有干预的情况下解决了出血问题。在 11 名接受出血评估检查的患者中，发现包括肉芽组织（n  = 5, 45.5%）、阴道萎缩（n  = 4, 36.4%）、出血血管（n  = 1, 9.1%）、粘膜分离（n  = 1, 9.1%)，或未确定出血原因 ( n = 4, 36.4%)。

结论

在这个队列中，超过一半接受睾酮治疗的跨性别 AYA 报告了术后阴道出血问题，这些问题最常继发于萎缩和肉芽组织，这表明在接受睾酮治疗的患者中可能易受 GAH 和肉芽敏感愈合时的阴道组织创伤。由于阴道出血可能会加重性别不安，这些发现支持需要就术后出血预期向患者提供咨询，并确定减少 GAH 后阴道出血的干预措施。