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Page 10 of 17 Preto et al. Plast Aesthet Res. 2025;12:28 https://dx.doi.org/10.20517/2347-9264.2025.26

Table 4. Multivariate analysis - predictors of complications
Postoperative complications
Coefficient Standard error P value Odds ratio 95%CI for odds ratio
Lower Upper
Age 0.019 0.042 0.645 1.019 0.939 1.106
BMI 0.020 0.107 0.855 1.020 0.827 1.257
Neovaginal length -0.272 0.352 0.440 0.762 0.382 1.519
Age > 35 0.506 0.967 0.601 1.658 0.249 11.038
BMI > 24 0.123 0.765 0.872 1.131 0.253 5.062
Smoke 0.344 0.540 0.524 1.411 0.490 4.067
Graft 0.405 0.833 0.627 1.500 0.293 7.681

BMI: Body mass index.

Table 5. Functional outcomes
Operated male-to-female sexual function index - oMtFSFI
Range 3 months 6 months 12 months
* *
Normal %, n 10/30 (33.3%) 15/30 (50%) 19/30 (63.3%) °
Mild-moderate %, n 9/30 (30.0%) 9/30 (30.0%) 11/30 (36.7%)
Borderline %, n 4/30 (13.3%) 3/30 (6.7%) 0/30 (0.0%)
Critical %, n 7/30 (23.4%) 4/30 (13.3%) 0/30 (0.0%)
Female sexual function index - FSFI scores
Domains Questions Score range 3 months median (IQR) 6 months median (IQR) 12 months median (IQR)
Desire 1, 2 1-5 2.4 (1.5-3) 3 (2.4-3.6) 3 (2.2-3.6)
Arousal 3, 4, 5, 6 0-5 2.4 (1.8-3.6) 3.6 (2.7-3.8) 4 (3.6-4.8)
Lubrication 7, 8, 9, 10 0-5 1.8 (1.5-3.6) 3 (2.2-4.2) 4.2 (3.6-4.5)
Orgasm 11, 12, 13 0-5 2.2 (1.6-3.6) 2.4 (2-2.8) 4 (3.6-4.4)
Satisfaction 14, 15, 16 0-5 3.8 (2.8-4.4) 3.6 (2.8-4.4) 4.4 (3.4-4.8)
Pain 17, 18, 19 0 - 5 3 (2-4.4) 3.6 (3-4) 4 (3.4-4.4)
Total 36 14.9 (13-19.8) 18.6 (16.8-22) 22.2 (20-25.7)
Female genital self-image scale - FGSIS scores
3 months 6 months 12 months
Median (IQR) 22 (20-24.5) 24 (20.75-24.75) 24 (21-26)
*
Linear regression oMtFSFI 3 months - significant improvement; °Linear regression oMtFSFI 6 months - significant improvement. Evaluated
population: 30 patients. IQR: Interquartile range; oMtFSFI: operated male-to-female sexual function index; FSFI: female sexual function index;
FGSIS: female genital self-image scale.

DISCUSSION
Genital GAS is a key step in the transition process for many AMAB individuals [4,19] . It has been associated
with reduced GD, greater body satisfaction, improved social integration, and enhanced quality of life [10,20-23] .
However, current evidence is limited by small sample sizes, retrospective designs, heterogeneous outcomes,
and inconsistent terminology [24-26] . These issues hinder comparisons between techniques and the
development of standardized guidelines. Moreover, most studies rely on tools designed for cisgender
populations, which may not adequately reflect the experiences of transgender individuals.

Our study aimed to provide an objective and reproducible evaluation of both surgical and functional
outcomes following penoscrotal vaginoplasty using validated tools during the follow-up. Regarding surgical