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Page 2 of 17 Preto et al. Plast Aesthet Res. 2025;12:28 https://dx.doi.org/10.20517/2347-9264.2025.26

outcomes showed significant improvement, with 63.3% of patients achieving normal oMtFSFI scores at 12 months.
FSFI scores also improved across all domains, and genital self-image progressively improved over time.

Conclusion: Penoscrotal vaginoplasty demonstrates favorable surgical and functional outcomes in AMAB
transgender patients, with high levels of patient satisfaction. Despite the complexity and potential for
complications, penoscrotal vaginoplasty represents an effective surgical option for aligning physical appearance
with gender identity, with progressive improvements in sexual function and genital self-image observed over the
first postoperative year.

Keywords: Penoscrotal vaginoplasty, AMAB transgender patients, surgical outcomes, functional outcomes, patient
satisfaction

INTRODUCTION
Gender dysphoria (GD) refers to the discomfort or distress experienced by individuals whose gender
[1]
identity differs from their assigned sex at birth . This condition can cause significant psychological
suffering. The true prevalence of GD remains uncertain, mainly due to variation in study methodologies
[1,2]
and diagnostic definitions . Only a minority of individuals with GD seek professional care - one Dutch
study estimated that about 10% pursue medical support, with even fewer reaching specialized centers .
[3]
Once diagnosed, transgender women (assigned male at birth, AMAB) typically begin a multidisciplinary
psycho-endocrinological pathway to align physical traits with gender identity, which may include
psychological support, hormone therapy, and gender-affirming surgery (GAS), such as breast augmentation
[4]
or genital reconstruction .

The gold standard for GAS in AMAB individuals is vaginoplasty, a procedure designed to create a
neovagina that closely resembles a natal vagina in both appearance and function, using the existing
urogenital tissue . Over time, numerous surgical techniques have been developed to improve both
[5,6]
aesthetic and functional outcomes while minimizing complication rates. Generally, GAS has shown high
patient satisfaction and improved quality of life. Vaginoplasty, which typically involves the inversion of
penile skin, remains the gold standard procedure [7-11] .

Although vaginoplasty has been carried out for many years, there are relatively few studies that rigorously
evaluate its aesthetic, functional, and long-term outcomes, particularly regarding patient satisfaction [12,13] .

This study aims to assess the surgical and functional outcomes of transgender women who received
vaginoplasty at an Italian referral center.

METHODS
Study setting and patients
A retrospective analysis was conducted at a single center between April 2018 and April 2024, following
approval from the local Intercompany Ethics Committee of AOU Città della Salute e della Scienza di Torino
(Pratica n. 506/2023). The study included all transgender women who underwent penoscrotal vaginoplasty.
The patients enrolled in this study had all obtained court authorization to undergo GAS surgery based on
their completed psycho-endocrinological assessment. All patients and procedures included in the study
were ruled by the ethical standards of the Helsinki Declaration and the Committee on Publication Ethics
(COPE) guidelines. All subjects provided written informed consent to participate in the study and for the
publication of anonymized data.