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Page 4 of 13 Larshans et al. Plast Aesthet Res. 2025;12:7 https://dx.doi.org/10.20517/2347-9264.2024.154

Table 2. Details of participant engagement and response rates
Description Number
Considered participants 108
Met inclusion criteria 102
Lost to follow-up 4
Questionnaires distributed 98
Respondents 50

Table 3. Overview of the questionnaires used
Code Description
Q1 LiSat-11 - Life Satisfaction Questionnaire
Q2 GCLS - Gender Congruence and Life Satisfaction Scale
Q3 Demographic Health Survey

Participants were surveyed using the Life Satisfaction Questionnaire (LiSat-11) [37,38] , Gender Congruence and
Life Satisfaction Scale (GCLS) , and a general Demographic Health Survey to obtain basic demographic
[39]
information and health data.

Statistical analysis
This cross-sectional analysis focused on a selection of questions from the GCLS, LiSat-11, and Demographic
Health Survey to provide targeted insights into thoughts of self-harm, suicidal ideation, and QoL in
transgender women following GAS. Descriptive statistics were performed using SPSS software (version 29;
IBM Inc., Armonk, NY, USA) to analyze the data collected from the questionnaires.

Ethics and consent
Ethical approval was obtained from the Swedish Ethical Review Authority, application number 2020-03062.
To protect patient anonymity, individuals were assigned codes prior to the questionnaire distribution.
Written informed consent was obtained from all participants to ensure adherence to the ethical standards
for research involving human subjects.

RESULTS
Response rate and participant characteristics
The study achieved a response rate of 51%, with 50 of 98 patients completing the questionnaire
postoperatively. Participants had diverse educational backgrounds and employment statuses [Table 4]. Of
the 50 respondents, 32% had undergone vaginal reoperation. Regarding other diagnoses, 72% had mental
illness, 28% had a neuropsychiatric diagnosis, and 28% reported having no such diagnosis.

At the time of follow-up, all patients had undergone surgery between three and eight years prior, with an
even distribution over this six-year period. The surgical techniques used were either penile inversion
vaginoplasty or vulvoplasty (i.e., without cavity creation). Each patient received the specific procedure they
had requested during the preoperative consultations. Two patients in this series developed rectovaginal
fistulas postoperatively and subsequently underwent revision surgery with bowel vaginoplasty.

Life satisfaction
Responses to the LiSat-11 questionnaire revealed that none of the participants were “very unsatisfied” with
“Life as a whole,” with an average life satisfaction score of 4.5 on a 6-point scale. This finding suggests a