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Preto et al. Plast Aesthet Res. 2025;12:28 https://dx.doi.org/10.20517/2347-9264.2025.26 Page 9 of 17

Neovaginal depth reduction was observed in 4 patients (9.8%) after a median elapsed time of 12 months
post-surgery. Of these, three cases (7.3%) were managed conservatively with self-dilation, as they did not
require surgical intervention or compromise neovaginal function (1-year vaginal depth 10 cm), while one
case (2.1%) necessitated revision surgery to release adhesions and restore depth (pre-revision depth was 8.5
cm). At 1-year follow-up, the median neovaginal depth across the cohort was 12.5 cm (IQR: 10.5-13.0 cm).

Additionally, significant neovaginal bleeding occurred in one patient (2.1%), leading to hemorrhagic shock
and requiring hospitalization and blood transfusions (Clavien IV).

In the multivariate analysis of postoperative complications, none of the analyzed predictors were found to
be statistically significantly correlated. [Table 4].

Functional outcomes
Of the 47 eligible patients, 30 completed and returned the functional outcome questionnaires during the
follow-up period, and the overall response rate was 63.8%. The remaining patients were excluded from the
functional outcomes analysis. All functional data related to questionnaires were reported in Table 5.

oMtFSFI
Sexual function was assessed using the oMtFSFI questionnaire at 3, 6, and 12 months postoperatively. The
proportion of patients achieving a normal score increased progressively, from 33.3% at 3 months to 50% at 6
months, reaching 63.3% at 12 months.

Conversely, the percentage of patients with critical scores showed a marked reduction from 23.4% at 3
months to 13.3% at 6 months, with no cases reported at 12 months. Similarly, borderline scores were
recorded in 13.3% of patients at 3 months and 6.7% at 6 months, but no patients remained in this category
by 12 months.

The proportion of patients with mild-to-moderate scores remained relatively stable over time, reported at
30% at 3 months, 30% at 6 months, and 36.7% at 12 months. [Table 5].

A multivariate analysis was conducted to identify potential predictors of satisfaction, defined as achieving a
normal oMtFSFI score at 12 months. However, no significant risk factors for lower satisfaction rates were
identified. [Table 6].

FSFI
Sexual function was further assessed using the FSFI questionnaire at 3, 6, and 12 months postoperatively.
The results demonstrated a progressive improvement across all domains over time. Sexual desire, arousal,
lubrication, orgasmic function, satisfaction with intimacy, and pain scores all showed a consistent upward
trend, indicating enhanced sexual well-being as the recovery process advanced. Notably, the total FSFI score
increased significantly from 14.9 (IQR 13-19.8) at 3 months to 18.6 (IQR 16.8-22) at 6 months, reaching 22.2
(IQR 20-25.7) at 12 months post-surgery. The detailed scores for each domain are reported in Table 5.

FGSIS
Genital self-image was assessed using the FGSIS questionnaire at 3, 6, and 12 months postoperatively. The
results showed a progressive improvement in patients’ perception of their external genitalia over time. The
median score increased from 22 (IQR 20-24.5) at 3 months to 24 (IQR 20.75-24.75) at 6 months, remaining
stable at 24 (IQR 22-25) at 12 months. [Table 5].