Treatment and follow-up of individuals with gender dysphoria: gynaecological aspects

In this thesis the role of the gynaecologist in the treatment and follow-up of transsexual individuals has been explored. Concerning the Female-to-Male transsexual (FTM) we showed that laparoscopic hysterectomy is safe and that it should be the preferred method of hysterectomy in this population. Male-to-Female (MTF)-patients, when compared to the general population, function well on a physical, emotional, psychological and social level. However sexual function in this population is less satisfactory. They appear to suffer from difficulties concerning arousal, lubrication and pain. Vaginal examination and transvaginal ultrasound proved to be feasible and well accepted. Transvaginal palpation of the prostate is of poor clinical value, whereas transvaginal ultrasound allows for proper evaluation of the prostate. Mammography and breast sonography were technically feasible and well accepted in MTF-patients. Since both examinations were almost painless, 98% of patients intended to come back if invited. A mixed microflora of aerobe and anaerobe species usually found either on the skin, in the bowel or in a bacterial vaginosis (BV) microflora is encountered in the neovagina of MTF-patients. Vaginal lactobacilli were lacking, with only one individual having a penile skin-lined neovagina with Lactobacillus casei. Vaginal complaints such as vaginal irritation and discharge were frequent among these patients. Normal vaginal cytology, with superficial, intermediate and parabasal cells as well as Doderlein bacilli, was only found in 4% of transsexual women. Apart from one patient displaying a LSIL (being positive for HR-HPV with koilocytes) and four patients with ASCUS, no HSIL lesions have been found. Low bone mass proved to be highly prevalent. This finding appeared to be largely determined, in comparison to healthy males, by smaller bone size and a strikingly lower muscle mass. The final conclusion should be that there is a substantial role for the gynaecologist, not only in the treatment of FTM transsexuals but also in the follow-up of MTF transsexuals. The gynaecologist has ample experience in all diagnostic examinations concerning female sexual health. Moreover MTF individuals are keen on having an adequate follow-up of their newly created and their remaining original genital organs.