Sexual satisfaction, sexual function, and orgasm after gender-affirming vaginoplasty and vulvoplasty.

Abstract

To examine sexual satisfaction, function, and orgasm following genital gender-affirming surgeries (GGAS) among transgender and gender-diverse (TGD) patients; we used the GENDER-Q, a validated instrument for TGD individuals seeking gender-affirming care that enables a more comprehensive evaluation of sexual experience. Our cross-sectional survey was distributed via e-mail to patients; surveys were completed in May 2025. The primary outcome was sexual satisfaction measured by the GENDER-Q Sexual Well-Being scale. Secondary outcomes measured the relationship between ability to orgasm and orgasm changes pre- and postoperatively with identity, sexual wellness, social acceptance, body image, mental health, and surgical outcomes. Of 765 eligible individuals, 295 (39%) responded; 103 (35%) underwent vulvoplasty and 192 (65%) underwent vaginoplasty. In all, 89% were transgender women, and 80% were at least 1-year postoperative. Sexual satisfaction did not differ by age, surgery type, race/ethnicity, revision history, timing of first postoperative orgasm, or anxiety symptomology. Higher sexual satisfaction was associated with postoperative orgasm and absence of orgasm-related pain and correlated positively with higher scores on the GENDER-Q Orgasm, Social Acceptance, Surgery Outcome, and Body Image scales. In all, 80% of participants able to orgasm preoperatively reported postoperative orgasm, while 29% who did not experience orgasm preoperatively achieved orgasm postoperatively. Inability to orgasm postoperatively was associated with older age and lower Sexual Well-Being and Surgery Outcome scores. These findings underscore the multifactorial nature of sexual well-being after GGAS and highlight the value of assessing sexual function before and after surgery. Longitudinal studies are needed to further characterize sexual health trajectories following GGAS.