Patient-reported outcomes of gynaecological gender-affirming surgeries: a prospective cohort study

Background: Research on motivations and impact of gynaecological gender-affirming surgeries (GGS)—such as hysterectomy and oophorectomy—on transmasculine and gender diverse individuals remains limited. Aim: This study aimed to evaluate patient-reported outcomes of GGS, focusing on motivations and the surgeries’ effects on dysphoria and quality of life. Methods: A prospective cohort study was conducted in which transmasculine and gender diverse individuals undergoing GGS were included between August 2022 and February 2024. Preoperative and postoperative (3 and 9 months) data were collected through online questionnaires, including self-constructed and validated measures (Gender Congruence and Life Satisfaction Scale and Short Form-12 Health Survey). Self-constructed measures were used to collect data on general health, motivation for surgery, recovery, and the impact of surgery on various domains (i.e. dysphoria, mental well-being, self-esteem, sexual well-being and overall impact) measured on an 11-point Likert scale (−5 to +5), corresponding with very negative to very positive. A sample size calculation resulted in a sample of 109 participants. Results: The study included 112 participants; 69 (60.7%) underwent hysterectomy, 6 (5.4%) salpingectomy, 32 (28.6%) colpectomy with hysterectomy, and 6 (5.4%) colpectomy alone. Gender dysphoria (95.0%) was the primary motivator. Other motivations included physical complaints (67.0%) and pregnancy prevention (55%) for hysterectomy. For colpectomy, reasons included penetration avoidance (75.8%) and future surgery preparation (97%). Surgery resulted in significant improvement across all domains, with a median of +3 (IQR 1–5) for dysphoria and +3 (IQR 2–5) for overall impact. The majority reported positive effects postoperative, although a small minority experienced no change or a negative impact in various domains. Discussion: Gynaecological gender-affirming surgeries can significantly reduce dysphoria and positively impact transmasculine and gender diverse individuals. At the same time, this study highlights the diversity of experiences, showing that while these procedures have affirming potential, the process of postoperative recovery can be complex and varied.