Function, Satisfaction, and Sexual Activity of Trans Women After Vulvovaginoplasty: Results of a Multicenter Study

Abstract

Purpose:

This study aimed to analyze the functional outcomes after vulvovaginoplasty for trans women with a comprehensive analysis, including sexual function, satisfaction, and esthetic results.

Methods:

A prospective, observational, multicenter study of trans women who underwent vulvovaginoplasty between 2007 and 2019 was conducted at three different centers in France. Data collection was achieved through an online questionnaire. Participants were asked to complete a questionnaire that included the Female Sexual Function Index (FSFI), the Female Genital Self-Image Scale (FGSIS), the Body Image Scale (BIS), and nonvalidated questions to explore sexual practices, related orgasm, genital sensitivity, and specific postsurgical satisfaction.

Results:

A total of 158 women were included. Highest scores of the FSFI were obtained for the satisfaction domain, lubrication was scored the lowest. Two-thirds (64%, 89/138) of sexually active women had an FSFI score <26.5 (cutoff suggested for sexual dysfunction); the total mean±standard deviation (SD) FSFI score was 21.2±9.5. Self-image was favorable overall; the mean±SD BIS score was 4.5±5.2 and the mean±SD FGSIS score of 22.1±4.3. Masturbation was the most frequent sexual activity and the only one that led to a positive mean orgasm frequency score. The clitoris was the area women most frequently reported as having “sufficient sensitivity” (67.7%).

Conclusion:

This multi-institutional study of functional outcomes after vulvovaginoplasty found positive esthetic outcomes and high satisfaction. More than 85% of trans women were sexually active, and sexuality was rich and common despite mixed functional results. These results enlighten the postoperative outcomes and thereby the points to discuss with women considering vulvovaginoplasty.

Introduction

Genital gender-affirming surgery (GGAS) is an important step for some trans women during their transgender path¹ and may include orchiectomy, vulvoplasty with clitoroplasty, and/or creation of a neovaginal cavity. The surgical technique has been noticeably standardized over the past 30 years² and the penile inversion technique is currently considered as the vulvovaginoplasty of choice.³ The surgical outcomes of this procedure have been widely reported^4–6; however, the functional aspects remain scarcely described and their evaluation is complex as they include sexual function,⁷ vaginal functionality, and esthetic results.⁸

In addition, considering the biopsychosocial nature of sexuality and its impact by social and individual factors (expectations, social determinants),⁹ a more comprehensive analysis on larger cohort are required to obtain meaningful results. Furthermore, it seems important to evaluate functional aspects considering the important influence of sexuality on gender construction¹⁰ and the aim of overall sexual health improvement after GGAS.

The aim of the present study was therefore to analyze through a large multicenter study the functional outcomes after vulvovaginoplasty for trans women with a comprehensive analysis, including sexual function, satisfaction, and esthetic results.

Materials and Methods

Population

This was a prospective, observational, multicenter study of trans women who underwent vulvovaginoplasty between January 2007 and December 2019 at three different centers in France. Two centers had a more recent history of performing GGAS for trans women (starting from 2012 to 2015).

Eligible women were identified using electronic medical files of each center and met the inclusion criteria defined as follows: ≥18 years of age, ≥1 year follow-up since surgery, having received vulvovaginoplasty during the inclusion period, and an email address registered in the medical file. An information note was sent by email and presented the aim and the characteristics of the survey with a link to a questionnaire available through LimeSurvey (GNU GPL, licensed provided by Lyon 1 faculty). A dunning email was sent 15 days after the first contact. Only patients providing a complete questionnaire, defined as those with at least 75% of the items were fulfilled, were included.

Surgical technique

F.M. (Lille) and X.P. (Limoges) were initially tutored by N.M.-J. (Lyon) for GGAS. The preferred technique is penile flap inversion with addition of a scrotal skin graft for vaginal cavity.¹¹ When penile and scrotal skin are insufficient for the vulvovaginoplasty, additional total skin graft is performed. In these rare cases, the skin can be harvested from the lower abdomen or the thigh. In some specific cases, and according to patient preference, a penile inversion vulvoplasty with intestinal vaginoplasty can be performed. A vaginal stent is left for 6 days; it is then removed, and dilatation initiated. Our dilatation protocol is rather demanding and begins with four dilatations per day. It is advised to perform ≥1 dilatation per week permanently. A postoperative sexologist evaluation or a pelvic floor reeducation were not systematically performed but could be offered according to individual needs.

Questionnaire

The study questionnaire (Supplementary Appendix SA1) was composed of four validated questionnaires and additional nonvalidated items.

The Female Sexual Function Index (FSFI)—Validated French version¹² is a 19-item self-report measurement, each scored from 0 to 5 points that encompass six subsections: desire, arousal, lubrication, orgasm, satisfaction, and pain.¹³ Higher scores indicate a higher quality of sexuality. A score <26.5 has been reported to indicate sexual dysfunction in a cisgender population.¹⁴

The Female Genital Self-Image Scale (FGSIS) aims to evaluate women's perception of their own genitals. Seven items are scored using a 4-point scale (1=strongly disagree, 4=strongly agree); the total score ranges from 7 to 28, and higher scores express better genital self-image.^15,16

The Body Image Scale (BIS),¹⁷ validated French version,¹⁸ is composed of 10 items, each scored from 0 to 3 points that appraise body image; higher scores express an altered body image.

LeBreton et al.¹⁹ produced a postsurgery sexuality evaluation through frequency of practices (rating scale: “does not apply” [score=0], “less than once a year” [score=1], “less than once a month” [score=2], “once a month” [score=3], “twice per month” [score=4], “once per week” [score=5], “several times a week” [score=6], “once a day” [score=7], “more than once a day” [score=8]) and related frequency of orgasm (5-point Likert scale from “never” [score=−2] to “always” [score=2]).

In addition, 24 nonvalidated items exploring sexuality and satisfaction regarding surgical outcomes (functional and esthetics) were also included.

Statistical analyses

Descriptive variables are expressed as mean±standard deviation (SD) or as count (percentage). Outcomes of the different questionnaires and influence of population characteristics were analyzed with Kruskal–Wallis test, Fisher's exact test, Pearson's correlation coefficient, or Spearman's rank correlation coefficient, as appropriate. A p-value <0.05 was considered for statistical significance. All analyses were conducted using the R software environment (version 4.1.0 released on 2021-05-18; The R Foundation for Statistical Computing).

Ethics

The email sent contained a full note that included study characteristics. Informed consent was collected at the beginning of the online survey. The study was approved by an independent Ethics Committee (CPP Sud-Est IV; IRB00013040) and registered (2021-A01893-38).

Results

We received a total of 195 replies (65% response rate). Among these there were 37 (12.4%) partially completed questionnaires and 158 (52.6%) complete questionnaires (Fig. 1); the latter were included in the present study. The mean±SD age of the 158 women at GGAS was 38.6±12 years and the survey took place a mean 6.1±5.2 years after surgery (Table 1). Women with facial surgery were significantly more likely to have breast surgery (76.2% vs. 52.6%; p=0.003).

FIG. 1.

Study flow chart.

Table 1.

Population Characteristics

	Total population, n=158
Mean age at time of questionnaire, years±SD	45.0±12.5
Mean age at vaginoplasty, years±SD	38.6±12.0
Mean duration of hormonotherapy before surgery, years±SD	5.7±5.2
Facial feminization surgery, n (%)	63 (39.9)
Breast surgery, n (%)	98 (62.0)
Penile inversion vaginoplasty with scrotal skin graft, n (%)	153 (96.8)
Penile inversion vaginoplasty with intestinal vaginoplasty, n (%)	5 (3.2)

SD, standard deviation.

Female Sexual Function Index

A large majority of trans women were sexually active (n=138, 87.3%). The mean±SD FSFI score was 19.6±10.3 (of a maximum 45 points) for the total population, and 21.2±9.5 for the sexually active subgroup; among the latter, 64% (n=89) had a score <26.5 (cutoff for sexual dysfunction). The lowest mean scores were obtained for the lubrication domain (2.9±2.1 for the sexually active group), and the highest scores for the satisfaction domain (4.1±1.7 for the sexually active group; Table 2).

Table 2.

Female Sexual Function Index

	Total population (=158) Mean±SD	Sexually active group (n=138)	Total Buncamper et al.5 (n=49 trans women)	Sexually active Buncamper et al.5 (n=36 trans women)	Total Wiegel et al.14 (n=244 cis women)
Desire	3.6±1.4	3.8±1.2	3.2±1.3	3.7±0.9	4.3±1.1
Arousal	3.4±2.1	3.7±2.0	3.3±2.3	4.4±1.4	5.1±1.1
Lubrication	2.7±2.1	2.9±2.1	2.8±2.4	3.9±1.9	5.5±1.1
Orgasm	3.4±2.3	3.7±2.1	3.4±2.5	4.6±1.6	5.1±1.3
Satisfaction	3.9±1.7	4.1±1.7	3.9±1.6	4.2±1.7	5.0±1.2
Comfort	2.7±2.4	3.0±2.4	2.2±2.7	2.8±2.8	5.5±1.3
Total	19.6±10.3	21.2±9.5	18.7±10.8	23.7±7.9	30.8±1.1
Total score <26.5a	—	n =64%	—	n=56%	—

^a Total score <26.5 has been suggested as having sexual dysfunction. Bold values indicate our study results.

Table 2 also presents the FSFI results of the study reported by Buncamper et al.⁵ that included 49 trans women, as well as the study reported by Wiegel et al.¹⁴ that included 244 cis women, which identified the cutoff score.

Female Genital Self-Image Scale

A mean score ≥3 was reached for all items except the item, “I think my genitals smell fine,” which had the lowest mean±SD score (2.8±0.9; of a maximum 28 points). The highest mean score was reached for the item “I feel positively about my genitals” (3.5±0.8). The total FGSIS score was 22.1±4.3 (Table 3).

Table 3.

Female Genital Self-Image Scale

	Mean±SD
	Total population (n=158)	Buncamper et al.5 (n=49 trans women)	Bouman et al.4 (n=31 trans women, sigmoid vaginoplasty)	Herbenick et al.15 (n=2056 cis women)
I feel positively about my genitals	3.5±0.8	3.4±0.6	3.1±0.9	3.1±0.7
I am satisfied with the appearance of my genitals	3.2±0.9	3.2±0.9	3.2±0.8	3.0±0.8
I would feel comfortable letting a sexual partner look at my genitals	3.1±1.0	3.2±0.9	2.7±0.8	3.0±0.8
I think my genitals smell fine	2.8±0.9	3.0±0.9	2.8±0.7	3.0±0.8
I think my genitals work the way they are supposed to work	3.0±0.9	3.1±1.0	2.7±1.1	3.2±0.7
I feel comfortable letting a health care professional examine my genitals	3.4±0.8	3.3±0.8	2.8±0.7	3.0±0.8
I am not embarrassed about my genitals	3.2±0.9	3.4±0.8	3.1±0.7	3.0±0.8
Total	22.1±4.3	22.6±4.1	20.0±4.5	-

Bold values indicate our study results.

Table 3 also presents the FGSIS scores reported by Buncamper et al.,⁵ Bouman et al.⁴ (trans women who had sigmoid vulvovaginoplasty) and Herbenick et al.¹⁵ (large sample of US cis women).

Body Image Scale

The total mean BIS score was 4.5±5.2 (of a maximum 30 points). There were 22 (13.9%) women who reported that they felt less sexually attractive (“quite a bit” or “very much”) because of their condition or their treatment (Table 4). The total BIS score had a statistically significant negative correlation with the total FGSIS score (Pearson's r−0.371; p<0.001).

Table 4.

Body Image Scale (n=158)

	Not at all (scored 0)	A little (scored 1)	Quite a bit (scored 2)	Very much (scored 3)
Have you been feeling self-conscious about your appearance? n (%)	83 (52.5)	48 (30.4)	16 (10.1)	11 (7.0)
Have you felt less physically attractive as a result of your condition or treatment? n (%)	108 (68.4)	29 (18.4)	14 (8.8)	7 (4.4)
Have you been dissatisfied with your appearance when dressed? n (%)	125 (79.1)	23 (14.5)	5 (3.2)	5 (3.2)
Have you been feeling less feminine because of your condition or treatment? n (%)	122 (77.2)	22 (14.0)	9 (5.6)	5 (3.2)
Did you find it difficult to look at yourself naked? n (%)	120 (76.0)	22 (14.0)	4 (2.5)	12 (7.5)
Have you been feeling less sexually attractive because of your condition or treatment? n (%)	100 (63.3)	36 (22.8)	15 (9.5)	7 (4.4)
Did you avoid people because of the way you felt about your appearance? n (%)	102 (64.6)	36 (22.8)	14 (8.8)	6 (3.8)
Have you been feeling the treatment has left your body less whole? n (%)	149 (94.4)	6 (3.8)	2 (1.2)	1 (0.6)
Have you felt dissatisfied with your body? n (%)	99 (62.7)	39 (24.7)	13 (8.2)	7 (4.4)
Have you been dissatisfied with the appearance of your scar? n (%)	101 (63.8)	35 (22.2)	11 (7.0)	11 (7.0)
Total	4.5±5.2

Postoperative sexuality

Persistence of ejaculation during orgasm was reported by 34.8% (n=55) of women, and 20.9% (n=33) expressed being embarrassed by a remnant corpus spongiosum during arousal.

Masturbation was the most frequent sexual activity; the mean±SD frequency score was 3.5±2.2. The second most common sexual activity was vaginal intercourse (mean score 3.4±2.4). Masturbation was the only sexual activity that led to a positive mean orgasm frequency score (0.4±1.5.; Table 5)

Table 5.

Post-Operative Sexuality

	Mean frequency score±SD a	Frequency score of associated orgasm±SD b	LeBreton et al.19 Mean frequency score ± SDa	LeBreton et al.19 Frequency of associated orgasm±SD b
Masturbation	3.5±2.2	0.4±1.5	3.4±2.7	0.6±1.4
Mutual masturbation	2.4±2.4	−0.8±1.3	4.4±2.7	−0.2±1.3
Vaginal intercourse	3.4±2.4	−0.8±1.4	3.4±2.5	−0.1±1.1
Oral sex (receiving)	2.7±2.4	−1.2±1.2	3.5±2.5	−0.2±1.5
Anal stimulation (receiving)	1.9±2.3	−1.3±1.1	2.5±2.7	−0.4±1.2
Anal intercourse (receiving)	1.1±1.8	−1.4±1.1	2.0±2.5	0.1±1.0
Fantasies	3.9±2.4	—	5.2±3.9	—

Bold values indicate our study results.

^a Rating scale: “does not apply” (score=0), “less than once a year” (score=1), “less than once a month” (score=2), “once a month” (score=3), “twice per month” (score=4), “once per week” (score=5), “several times a week” (score=6), “once a day” (score=7), “more than once a day” (score=8).

^b Frequency of orgasm: 5-point Likert scale from “never” (score=−2) to “always” (score=2).

Esthetic satisfaction

Esthetic satisfaction was the greatest for the vulva (mean±SD score: 7.0±2.7), and it was the lowest for the labia minora (5.8±3.3). Less than a quarter (n=34, 22.2%) of woman who had a scrotal skin graft (n=153) reported vaginal hair growth; the mean associated discomfort score was 5.3±3.0 (Table 6).

Table 6.

Esthetic satisfaction

	Mean score±SD
Satisfaction with vulva esthetics (n=158)a	7.0±2.7
Satisfaction with labia minora esthetics (n=158)a	5.8±3.3
Satisfaction with labia majora esthetics (n=158)a	6.8±2.8
Satisfaction with clitoris esthetics (n=158)a	6.8±2.9
Satisfaction with clitoral hood esthetics (n=158)a	6.2±3.1
Satisfaction with surgery scars esthetics (n=158)a	7.3±2.9
Partner satisfaction with esthetic aspects of your vaginoplasty (n=109)a	7.6±2.3
Partner satisfaction with functional aspects of your vaginoplasty (n=116)a	7.0±2.9
Vaginal hair growth (n=153), n (%)	34 (22.2)
Bother score for vaginal hairb	5.3±3.0

^a 1–10 scale (1=complete lack of satisfaction, 10=extremely satisfied).

^b 1–10 scale (1=lack of concern, 10=extremely bothered).

Sensitivity

Most patients had “sufficient” sensitivity for all areas. The clitoris was the area women most frequently reported as having “sufficient sensitivity” (67.7%), but also the most frequently reported with “too much sensitivity” (10.1%; Table 7).

Table 7.

Sensitivity (n=158)

	Vulva	Vagina	Clitoris
No sensitivity, n (%)	16 (10.1)	23 (14.6)	6 (3.8)
Low sensitivity, n (%)	42 (26.6)	46 (29.1)	22 (14.0)
Sufficient sensitivity, n (%)	93 (58.9)	73 (46.2)	107 (67.7)
Too much sensitivity, n (%)	3 (1.9)	4 (2.5)	16 (10.1)
Painful sensitivity, n (%)	4 (2.5)	12 (7.6)	7 (4.4)

At the time of filling out the questionnaire, 30.4% (n=58) women reported that vaginal depth was insufficient, 57.6% (n=91) that the depth had reduced over time; 33.3% (n=51) woman reported insufficient width, 39.9% (n=63) that this had reduced over time. Just under half (48.1%, n=76) performed autodilatation once a week.

A minority of women reported vaginal prolapse (7.0%, n=11) or rectal prolapse (4.4%, n=7), and 95.6% (n=151) reported being satisfied of their reflected image as woman since surgery. Nearly all women (n=157, 99.4%) reported that they would undergo vulvovaginoplasty again (the woman who did not explain she would prefer a sigmoid vaginal canal rather than scrotal skin graft).

Discussion

To enlighten the effects of vulvovaginoplasty on sexual wellbeing we conducted a multicenter and multidimensional study that found, overall, favorable sexual function, body and genital self-image, sexuality, and esthetic satisfaction. A large majority (>85%) of trans women were sexually active, consistently with other reports,^4,20 but some sexual outcomes appear to mitigate this favorable result. Mean FSFI scores were lower than those reported by cis women,¹⁴ and the majority of trans woman herein had a mean score lower than 26.5. It is still unclear if this result means that a majority of trans woman can be regarded as having sexual dysfunction in comparison to cis women, or if the FSFI need to be recalibrated for a trans women population. Noticeably, the low FSFI scores are often linked with low lubrication scores, which are reflecting more a technical limitation rather than a dysfunction. As in the study reported by Buncamper et al.,⁵ the lowest FSFI scores were found for the lubrication and the comfort domains. Those two domains of the FSFI are the most linked with the anatomical aspects of genitals, suggesting that sexual function is empowered and satisfying despite some genital limitations.

Lubrication is an inherent issue in the reconstruction of a vaginal canal with skin graft, which can be easily managed with the use of personal lubricants. The use of digestive segments seems to avoid this limitation, even if they are associated with other disadvantages. Lubrication with a digestive reconstructed vaginal canal have only been reported for cis women, but with highest FSFI score (5.1±0.6)²¹ or frequent adequate lubrication (89%).²² Lubrication outcomes following peritoneal vulvovaginoplasty have not yet been reported.²³ Masturbation and vaginal intercourse were the most frequent sexual practices reported. We report less oral sex (receiving), less anal stimulation and intercourse (receiving), and less mutual masturbation than LeBreton et al.¹⁹ despite the similar sample of trans woman (operated on by N.M.J.). The much larger and multicenter sample report herein may explain these differences. However, as in the study reported by LeBreton et al., masturbation had the only positive score for orgasm procurement.¹⁹

The experience of sexual pleasure may be enhanced by a higher genital body satisfaction,²⁴ highlighting the importance of a positive self-image after GGAS. We report herein overall favorable FGSIS scores, consistent with that reported by Buncamper et al.⁵ and by Bouman et al. after sigmoid vulvovaginoplasty.⁴ However, as in the study reported by Buncamper et al., genital smell had the lowest score on the FGSIS domains. Interestingly, we report a higher score for “letting a healthcare professional examine my genitals” than in a large group of cis women,¹⁵ which may be due to being used of genital examination during the postoperative period. The overall favorable genital self-image was also reported at a more global level by a favorable BIS score. BIS and FGSIS were correlated, suggesting some reinforcement between body image and genital self-image. BIS has also been reported to be associated with improvement in sex life after GGAS,²⁵ but we did not test such an association as the absence of preoperative data in the present study precluded measurement of improvement.

We chose to evaluate esthetic satisfaction on the different anatomical parts of genitalia using a 10-point scale as in a study reported by Zavlin et al.²⁶ that included 40 trans woman after GGAS. The results of the present are slightly less favorable, and the lowest score was found for labia minora esthetics, whereas both labia minora and majora had the lowest scores in the study reported by Zavlin et al.²⁶ Labia majora and minora construction are indeed an important issue that may require further surgical correction, some series reporting up to 70% of secondary labiaplasty.²⁰ Still, in the study reported by Zavlin et al., clitoris sensation and clitoris erogenous sensation were evaluated using a 10-point scale of satisfaction, both with reported mean±SD scores of 8.5±2.²⁶ We chose to use a different scale that included “painful sensitivity,” which was reported by a few trans women of our study, who then may have experienced some restriction in sexual activities, although most individuals reported satisfying sensibility for vulva and clitoris.

A majority of the trans woman included herein reported that vaginal depth had reduced over time, however, less than a third considered it “insufficient.” Such outcomes may appear less favorable than in the study reported by Zavlin et al. (mean±SD satisfaction score of vaginal depth 8.8±1),²⁶ but satisfaction and depth sufficiency are different outcomes. Moreover, we report a mean follow-up ∼2 years longer than the 4 years in the other main series,^5,20,26 which may explain some reduction over time. Otherwise, the study population seems consistent with the other main series^5,20,26 notably the mean age at GGAS around 40 years.

Vaginal hair growth was reported by more than 20% of trans woman included herein, with an associated bother score suggesting low discomfort. We do not advise systematically to perform genital electrolysis, as no significant difference in terms of bothersome vaginal hair have been reported between participants who had or had not undergone genital electrolysis.²⁰

Limitations

Despite the important perspective of sexual wellbeing after female GGAS reported herein, the study presents some limitations, such as the absence of surgical correlation and objective measurements. However, functionality is a self-perceived determinant and the different questionnaires used in the present study gave interesting viewpoints on long-term postoperative outcomes. We report a limited response rate that may affect the representativeness of the herein sample as the study design did not allow us to compare clinical characteristics between responders and nonresponders. Although, our response rate was more than 50%, which appears satisfactory considering the more than 6-year interval between the surgery and the survey, and considering the 32% response rate of the largest series of functional outcomes after GGAS to date.²⁰

The use of nonvalidated questions and questionnaires validated in cis gender populations may also be considered as an important limitation. FSFI and FGSIS were in this way validated for use in cis women having heteronormative sexual intercourse. The FSFI and FGSIS, as the LeBreton scale, have yet already been used^4,5,19 for the analysis of vulvovaginoplasty outcomes and appears relevant for the present study, and also allows comparison with previous studies. Some recent attempts have proposed a specific questionnaire more suitable to GGAS analysis,^24,27 but these were published too late to be used herein, and their validity still needs to be confirmed. Subsequently, the analysis of sexual satisfaction is not complete without an evaluation of the expectations²⁸ that would require a specific qualitative analysis. In addition, a longitudinal evaluation would have certainly been profitable to highlight the evolution of the sexuality of trans women, as the favorable outcomes regarding sexual satisfaction may be considered in the light of the important level of preoperative dissatisfaction,²⁹ and as the postoperative development of a “rediscovered” sexuality may be a lengthy and evolutive process.³⁰

Conclusion

This large multicenter study of functional outcomes after vulvovaginoplasty found positive esthetic outcomes and high satisfaction. Some parts of the vulva were associated with less satisfaction and call for technical improvements. More than 85% of trans women were sexually active, and sexuality was rich and common despite mixed functional results. These results enlighten the postoperative outcomes and thereby the points to discuss with women considering vulvovaginoplasty. A longitudinal and more comprehensive study would be a further step for a better evaluation of GGAS outcomes.

Abbreviations Used

BIS

Body Image Scale

FGSIS

Female Genital Self-Image Scale

FSFI

Female Sexual Function Index

GGAS

genital gender-affirming surgery

SD

standard deviation

Authors' Contributions

Conceptualization: T.D.; N.M.-J.; and P.N. Data curation: T.D.; X.P.; G.D.; and F.M. Formal analysis: N.M.-J. and P.N. Investigation: T.D.; N.M.-J.; X.P.; G.D.; F.M. and P.N. Methodology: T.D.; N.M.-J.; L.J.; and P.N. Project administration: T.D.; X.P.; F.M.; and P.N. Resources: N.M.-J.; L.J.; and D.C. Software: L.J. and D.C. Supervision: N.M.-J. and P.N. Validation: N.M.-J. and D.C. Visualization: N.M.-J. and P.N. Writing––original draft: T.D. and P.N. Writing––reviewing and editing: N.M.-J.; L.J.; and P.N.

Author Disclosure Statement

No competing financial interests exist.

Funding information

No funding was received for this article.

Cite this article as: Duflot T, Morel-Journel N, Jurek L, Plainard X, Delporte G, Carnicelli D, Marcelli F, Neuville P (2023) Function, satisfaction, and sexual activity of trans women after vulvovaginoplasty: results of a multicenter study, Transgender Health 10:2, 185–192, DOI: 10.1089/trgh.2023.0047.