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Page 2 of 10 Hart et al. Plast Aesthet Res. 2026;13:3

Results: Among respondents, greater depression symptoms (PHQ-2 ≥ 3) were associated with lower coping
self-efficacy. Lower coping self-efficacy was associated with higher symptoms of anxiety. Higher coping self-efficacy
was associated with higher perceived level of social support.

Conclusions: These findings identify an opportunity for perioperative interventions that address coping self-efficacy
and social support for TGD individuals pursuing GGAS.

INTRODUCTION
Vulvoplasty, a type of genital gender-affirming surgery (GGAS), involves the construction of vulvar anatomy
from penile and scrotal tissue, whereas vaginoplasty additionally includes the creation of an internal vaginal
canal. Vulvoplasty and vaginoplasty are among the most commonly desired GGAS procedures for
transgender and gender diverse (TGD) individuals . However, accessing these surgeries requires navigating
[1,2]
complex insurance authorization processes, assembling a multidisciplinary care team (including surgeons,
hair removal specialists, and mental health providers), and establishing a robust social support network to
support the intensive post-operative recovery period. These requirements may be particularly burdensome
for TGD individuals, who are more likely than their cisgender counterparts to experience isolation and
trauma in healthcare settings and to encounter systemic barriers when seeking care .
[3]

TGD individuals experience stigma, discrimination, and harassment at disproportionately higher rates than
their cisgender peers, leading to significant negative physical and mental health disparities - particularly
elevated rates of anxiety and depression [1,4] . For some, the process of seeking GGAS can intensify the
psychological toll of stigma and isolation. The minority stress model, which links experiences of stigma and
discrimination - referred to as “minority stress” - to increased rates of depression, anxiety, and suicidal
ideation , suggests that strong social support can buffer these effects by fostering resilience and enhancing
[5,6]
coping abilities in marginalized populations . Indeed, adaptive coping strategies and social support have
[7,8]
been associated with better clinical outcomes and quality of life in TGD populations [9-11] . However, few
studies have specifically examined these protective factors in the context of preparing for and recovering
from GGAS.

To address this gap, we conducted a survey to: (1) describe coping self-efficacy, perceived social support, and
mental health among TGD individuals seeking vaginoplasty and vulvoplasty at our institution; and (2) assess
the acceptability of the coping self-efficacy and perceived social support measures in this population.
Findings from this research can inform clinician researchers, surgeons, and gender program administrators
in identifying both risk and protective factors that impact mental health during the GGAS preparation and
recovery process.

METHODS
An online survey was conducted to collect data between November and December 2022. Individuals were
eligible to participate if they were aged 18 years or older and had completed a consultation for
gender-affirming vaginoplasty or vulvoplasty at our institution between November 1, 2019, and October 31,
2022. Eligible participants were recruited via email, which included a description of the study, eligibility
criteria, the anonymous nature of the survey, and the potential risks and benefits of participation. Informed
consent was obtained through a consent statement displayed at the beginning of the questionnaire, and
participants could access the survey only after indicating their agreement to participate. Participants were
invited to provide their email address for a chance to win one of ten $50 gift cards. This study was approved
by the Oregon Health & Science University Institutional Review Board (IRB #: STUDY00025040).