NEW YORK (Reuters Health) - Years after transgender surgery, transsexuals can suffer from vaginal prolapse, where muscles around the vagina weaken and neighboring organs bulge in, a Swiss study says.
The condition affects as many as half of women older than 50 who’ve given birth, but it also occurred in 4 of the 55 transsexuals who participated in the study, according to the paper in Fertility and Sterility.
“Professionals who look after transsexual patients should well be aware that this health problem involving bladder, bowel and sexual function as well as quality of life may trouble their patients,” co-author Dr. Annette Kuhn, a gynecologist at the University of Berne, told Reuters Health by email.
There have been very few studies on the risks of transsexual surgery, the researchers say. This is the first on prolapse in transsexuals.
“If you think of the vagina like a sock, (prolapse is) like the toe of the sock coming down through the opening,” said Dr. Tyler Muffly, who’s completing a fellowship in obstetrics and gynecology at the Cleveland Clinic in Cleveland Ohio.
Women are at risk for prolapse if they “have done heavy lifting or have a constipation issue,” Muffly, who did not work on the study, told Reuters Health. “Also, childbirth is a major risk factor.”
The researchers had 55 transsexual patients fill out a survey on urinary and bowel symptoms that have to do with vaginal prolapse. They also performed pelvic examinations on all the patients. The average age of the patients in the study was 57, and the average amount of time since their sex reassignment surgery was 16 years.
Four of them had vaginal prolapse.
Fifty-two of the 55 patients were male to female transsexuals, but three had transitioned from female to male. These individuals tend to retain at least part of their vaginas, so they remain at risk for the condition as well. And in fact, one of the four patients with vaginal prolapse was a female-to-male transsexual.
Two patients with vaginal prolapse needed surgery to correct it. Typically, the vagina is surgically reinforced by making “a sandwich” out of it, Muffly said. “We put mesh on back wall and on front wall and suspend it to the tail bone,” he said.
Transgendered women may be susceptible to vaginal prolapse because the walls of the new vagina are thinner than in average women, said Dr. Marci Bowers, a gynecologist who performs transgender surgeries in San Mateo, California.
Nearly half the patients in the study also reported problems with bladder difficulties. About 25 of the 52 had problems urinating, while 13 had leaky bladders when coughing or sneezing and 9 had the urge to urinate often.
This could be due to the nature of the surgery, in which a new vagina is inserted between the bladder and the rectum, the researchers say. The surgery might disturb the nerves, the sphincter, and the pelvic floor muscles.
In the U.S., about 1 in 10,000 people have had male-to-female surgery, and about 1 in 25,000 people are transgendered female-to-male, according to Bowers.
Sex change surgery can run anywhere from $8,000 to nearly $40,000, depending on the location, Bowers, who was not involved in the study, told Reuters Health. About 40 percent of their patients’ surgeries are covered by insurance, up from virtually no coverage 5 years ago, she added.
The surgery usually involves using both penile and scrotal skin to create the new vagina, which is held in place by scar tissue, she said. The patients in this study had an average vaginal length of only 2 and a half inches, whereas a natural vagina is usually about 4 and a half to 5 inches long. This is another reason it might prolapse, Bowers said.
It doesn’t have much surface area to be scarred into place, she said, so “the length of the attachment is not as great.”
Bowers said that surgeries done more recently than the ones in the study usually create longer vaginas. She’s been doing sex reassignment surgeries since 2003, and has only seen two cases of prolapse.
However, techniques used by surgeons in the U.S. have not spread to Europe and the rest of the world, “so far as I know so (prolapse) may continue to be a problem for some,” Bowers said.
Kuhn pointed out that in this study, the vaginal prolapse problems developed years after the transgender surgery, and not immediately after.
Not a great deal can be done to avoid vaginal prolapse, Bowers said. Kegel exercises, where a woman squeezes her pelvic muscles, can help tone the area, she added.
Even so, this paper is valuable because “not a lot of attention is paid to the long-term health of the transsexual individual,” she said.
SOURCE: bit.ly/ecRcti Fertility and Sterility, online April 2, 2011.