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Table 1. Prevalence of suicidal ideation across various medical conditions, diagnosis, and social populations
Description Suicidal ideation
Obesity 3.2%-4.3% [17]
[18]
Schizophrenia 34.5%
[19]
Cancer 0.27%-53.3%
[20]
Anxiety disorders 10%-53%
[21]
Burn injuries 1%-43%
Chronic pain 7.9%-40.9% [22]
[23]
Homeless people 41.6%
Transgender people US 48% [16]
[16]
General population US 4%
Transgender people SWE 36% *[12]
[12]
General population SWE 3%
*
Thought about or attempted suicide during the 12 months preceding the survey. US: United States of America; SWE: Sweden.

risk . In particular, transgender individuals face higher risks of anxiety, depression, and substance abuse
[26]
due to discrimination, stigma, and a lack of healthcare access [27,28] . Affective disorders, such as post-
traumatic stress disorder, are more common than psychotic disorders among the transgender
population [29,30] . Moreover, autism rates are higher among people with GD, and they experience significantly
more social anxiety and depressive symptoms . Consequently, transgender individuals, who often
[31]
experience multiple concurrent risk factors, face an enhanced overall risk of suicide and suicidal thoughts.

Improvements in mental health and quality of life (QoL) in transgender patients following vaginoplasty are
well-documented [32-36] . Studies have suggested that GAS, such as vaginoplasty, can significantly enhance the
mental well-being and overall QoL of transgender individuals .
[9]

METHODS
Study design and participants
This retrospective survey was conducted at the Sahlgrenska University Hospital and included patients who
underwent gender-affirming surgeries between 2011 and 2021. This study formed part of a larger data
collection initiative that focuses on transgender women who have undergone GAS. Of the 108 patients
living in Sweden who were initially considered, 102 met the inclusion criteria of having at least 1 year of
follow-up post-surgery.

Data collection
Of the 102 recruited participants, four were lost to follow-up due to missing or outdated addresses and were
thus excluded from the study, leaving 98 patients who received the survey questionnaire via post mail. Since
all the patients who were assigned to the male gender at birth and who underwent genital GAS were
followed up by a network of psychologists in Sweden, we are aware that none of the recruited participants
had committed suicide by the time of submission of this manuscript.

Of the 98 patients who received the questionnaire, 50 patients returned a completed questionnaire between
October 2020 and November 2022. Among the completed questionnaires, some questions were left
unanswered in some instances. Table 2 illustrates the flow of participants throughout the study. Table 3
details the questionnaires used.