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Page 2 of 18 Billings et al. Plast Aesthet Res. 2025;12:27 https://dx.doi.org/10.20517/2347-9264.2025.52

INTRODUCTION
Sexual health is a vital component of overall health and well-being, encompassing physical and psychosocial
[1]
health, freedom from violence and coercion, and access to competent healthcare . Although transgender
and gender diverse (TGD) individuals share many of the same sexual health needs as the general
population, they also face unique clinical considerations - particularly in the context of gender-affirming
[2-4]
care (GAC) .
Broadly, GAC includes hormone therapy, mental health care, social and legal support, primary care, voice
[4]
therapy, sexual health counseling, and surgical interventions . Although all aspects of GAC contribute to
overall well-being, gender-affirming surgeries (GASs) play a particularly significant role for many TGD
individuals. For those who pursue them, GAS can help achieve embodiment goals, alleviate gender
dysphoria, improve psychosocial and mental health outcomes, and enhance QOL .
[3-7]

Accurately estimating the size of the global transgender population remains difficult due to gaps in data
collection and variations in sociolegal contexts. Nevertheless, available evidence suggests that prevalence
ranges from a fraction of a percent to several percentage points . In the United States, recent
[4]
epidemiological data suggest that the transgender population is increasing, especially among younger age
groups - a trend attributed to greater social acceptance and improved survey methods . Current estimates
[8]
suggest that more than one million transgender individuals live in the U.S.

Data from the 2022 United States Transgender Survey (USTS) show that 56% of transgender individuals had
received hormone therapy (although 88% expressed a desire for it), and 29% had at least one GAS (with 84%
expressing interest in at least one surgery; see Table 1 for a breakdown by procedure) . Similarly, findings
[9]
from the 2019 Fundamental Rights Agency (FRA) Survey in the European Union indicated that 48% of
transgender respondents in the Netherlands, 46% in Germany, 36% in Sweden, and 33% in Denmark had
undergone GAS, compared with an EU average of 27% (see FRA 2023 for full data) . Although surgical
[10]
data from low- and middle-income countries remain limited, available evidence highlights a consistent and
growing global demand for gender-affirming surgical care .
[11]

Common GASs include masculinizing chest surgery, feminizing breast augmentation, phalloplasty,
metoidioplasty, vaginoplasty, and vulvoplasty. While these surgeries can enhance body congruence and
relieve gender dysphoria - often with positive effects on sexual functioning - they may also pose anatomical,
neurological, and psychosocial challenges. These considerations underscore the need for careful
management and realistic preoperative counseling. This review synthesizes the current literature on both
positive and negative sexual health outcomes following GAS, identifies gaps in knowledge, and highlights
areas for future research aimed at optimizing care for TGD individuals. For the purposes of this paper,
sexual health outcomes are defined as outcomes directly affecting the sexual experiences of TGD
individuals, including changes in gender dysphoria, factors influencing sexual self-esteem and comfort with
intimacy, changes in sensation, and functional changes that affect sexual activity (e.g., the ability to engage
in penetrative sex in new ways).

METHODS
This was a narrative review constructed around an outline developed by the two authors, drawing on the
senior author’s expertise as a certified sexuality educator and social worker working with patients seeking
GAS, as well as her years of experience providing clinical education on TGD sexuality. The literature on
each topic was reviewed by both authors using PubMed (primary source) and Google Scholar (secondary
source) to identify relevant publications. Where systematic reviews were available, they were considered
alongside the primary literature.