Gender-affirming surgery is available to support transgender individuals in aligning their physical characteristics with their gender identity and alleviating gender dysphoria. Gender dysphoria occurs when an individual feels distressed by a disconnect from their own body due to their gender identity not aligning with their sex assigned at birth. For transgender women, gender-affirming surgery may consist of breast implants, facial feminization surgery, or vaginoplasty, and often all of them together.

The most common vaginoplasty for transgender women consists of orchiectomy, clitoroplasty, vulvoplasty, and the construction of a vaginal canal, often using a penile skin inversion technique. Essentially, surgeons are constructing a vulva, functioning and sensitized clitoris, and vaginal canal using existing skin and nerves from the penis and scrotum, as well as removing both testicles.

To evaluate the impact of vaginoplasty (using penile skin inversion technique) on sexual health and satisfaction in transgender women, researchers surveyed 56 French transgender women with an average age of 35 between 2019 and 2023. All participants had the same surgeon and had received hormonal treatment for an average of 3 years prior to surgery.

Sexual Health and Satisfaction

Using the Google Survey tool, participants were asked questions based on the Female Sexual Function Index (FSFI) and the Female Genital Self-Image Scale (FGSIS), which are designed for cisgender women. Also included was a survey designed for transgender women and created by researchers (not validated) to assess sexual health and satisfaction.

On the FSFI scale, a total score of less than 26.55 indicates that the woman may be experiencing sexual dysfunction. In this study, 54% of patients scored lower than this number, therefore exhibiting sexual dysfunction. However, researchers believe this may be due to a lack of sexual activity prior to follow-up questioning that may have influenced responses from participants, as 88% reported partaking in sexual activity.

In this section of survey, pain scored the lowest (2.9), meaning it was a prominent sexual dysfunction-related issue, and arousal scored the highest (4.2), leading to the assumption that while arousal was enjoyable following vaginoplasty, pain may interfere with sexual satisfaction.

The FGSIS revealed a high genital self-image following the vaginoplasty with an average score of around 22.8 and with all questions scoring at least a 3 or higher, except for the genital odor-related question (2.8). Generally, higher FGSIS scores indicate a positive genital self-image. The question, “I am positive about my genitals” scored the highest (3.6), suggesting that vaginoplasty as gender-affirming surgery might improve feelings of gender dysphoria related to genitalia.

Researchers suggest any low FSFI and FGSIS scores might be related to vaginal dryness and intravaginal hair. Although the seminal vesicles, prostate, and Cowper’s gland remain intact and can secrete seminal fluid, the vaginal walls are not lined with mucosa like those of cisgender women and are instead lined with skin. This may account for the lower FSFI score related to lack of lubrication. Additionally, because the reconstruction uses skin from the scrotum and pubic area, intravaginal hair growth can occur, especially if laser hair removal is not attempted prior to surgery. This may be the cause of the low FGSIS score related to genital odor.

Patients were evaluated on overall sexual health and satisfaction on a 5-point Likert scale (very satisfied to very dissatisfied) and with regard to each anatomical area. Although researchers do not mention the high and low thresholds of each erogenous zone included, clitoral sensitivity was rated highest, and 79% of patients felt “very satisfied” with it, while vaginal and vulvar sensitivity had an average response of “neutral.” Clitoral stimulation was also the most common method to achieve maximal sexual pleasure following vaginoplasty.

On a scale of 1-10, satisfaction with exterior genital appearance and post-operative self-confidence was rated over 7 by about 70% of patients, which is in line with average FGSIS scores. Additionally, 89% of patients reported no or slight discomfort with intravaginal hairiness.

In general, sexual health and satisfaction appear to have improved post-operatively, which researchers say reflects a shift toward prioritizing sexual pleasure for gender-affirming care and emphasizes the need for neoclitoral sensitivity.

Conclusion

Researchers say this study reflects a positive impact of penile skin inversion vaginoplasty on sexual health, satisfaction and functionality of genitalia in transgender women. Overall, patients reported higher genital self-confidence and satisfaction with neoclitoral sensitivity post-operatively, suggesting that vaginoplasty can significantly influence the sexual health of transitioning patients.

Despite limitations such as the lack of validated, transgender-specific sexual functioning and satisfaction assessment tools, as well as the self-report design, Researchers believe that results reveal the importance of vaginoplasty within the transition process for transgender women.

Resources

• Kitic, A., Pozzo, V., Kitic, N., Atlan, M., & Rausky, J. (2025). Impact of vaginoplasty on sexual health and satisfaction in transgender women. The Journal of Sexual Medicine, 22(3), 536–542. https://doi.org/10.1093/jsxmed/qdae194