SEXUAL FUNCTIONING IN TRANSWOMEN AFTER SEX REASSIGNMENT SURGERY

SEXUAL FUNCTIONING IN TRANSWOMEN

AFTER

SEX REASSIGNMENT SURGERY

C.I.D.I.Ge.M.Centro Interdipartimentale

Disturbi dell’Identità di Genere MolinetteUniversity of Turin

Chiara CRESPI, Valentina MINECCIA, Chiara MANIERI, Mariateresa MOLO

Carlo Molo

Foundation

-onlus-

AIMS

To compare the quality of sexual life after Sex Reassignment Surgery (S.R.S.) between transwomen and a control group of women

To investigate the sexual functioning in transwomen after SRS

To compare the sexual functioning between transwomen and control women

MATERIALS AND

METHOD

MtF

CONTROLWOMEN

50%(N=25)

Ntot=50

50% (N=25)

The Sample

TOT SAMPLE (N=50) MtF WOMEN

Sex 25(50%) 25(50%)

AGE, YEARS ( SD) 30,51 (9,89) 31,02(8,97)

EDUCATIONAL LEVEL, YEARS ( SD)

11,55 ( 3,28) 12,67(2,67)

MARITAL STATUS, N (%):

Single Married Cohabitant

16(64%) 17(68%) 2 (8%) 5 (20%) 7(28%) 3 (12%)

STABLE RELATIONSHIP

YES No

12(48%) 19(76%)13(52%) 6(24%)

SEXUAL ORIENTATION Eterosexual Omosexual

24(99%) 24(99%) 1(1%) 1(1%)

SOCIAL AND DEMOGRAPHIC CARACTERISTICS

Study project

The study is based on:

• Clinical Data

• World Health Organization Quality of Life Questionnaire (WHOQOL-100)

• Female Sexual Function Index (F.S.F.I.)

Almost two years after the SRS

CLINICAL DATA

Sexual orientation;

Presence of a stable relationship;

Surgical complications;

TRANSWOMEN CONTROL WOMEN

STABLE RELATIONSHIP

YES No

12(48%) 13(52%) 19(76%) 6(24%)

SEXUAL ORIENTATION Eterosexual Omosexual

24(99%) 24(99%) 1(1%) 1(1%)

KIND of SURGERY Vaginoplasty Rectosigmoid flap

23(92%) 2(8%)

NO surgical complications

CLINICAL DATA

-     Pain

-     Energy

-     Sleep

-     Positive emotions

-     Reasoning skills

-     Self-Esteem

- Body Image

- Negative emotions

- Mobility

- Daily living activities

- Drug addiction    

-    Work ability

- Interpersonal relationships

-    Social support

- Sexual activity

- Safety

- Home environment

- Financial resources

- Health care

- Opportunities for new knowledge

- Recreation

-     Physical environment

-     Transports

-     Spirituality

WHOQOL-100 QUESTIONNAIRE 24 subscales

-     Desire

-     Arousal

-     Lubrication

-     Orgasm

-     Sexual Satisfaction

-     Pain

- Total Score*

Female Sexual Function Index (F.S.F.I)

*Cut off ≤26,55: risk for sexual dysfunction (Wieger et al., Journal of Sex & Marital Therapy, 31:1-20, 2005)

RESULTS

AIMS

To compare the quality of sexual life between transwomen and control women

To investigate the sexual functioning in transwomen after SRS

To compare the sexual functioning between transwomen and control women

THE COMPRISON BETWEEN MTF AND CONTROL WOMEN IN THE QUALITY OF SEXUAL

LIFE

Sample N Mean SD SE ------------------------------------------------------------------------------------------- 1. Data1_QOLSexDIG 25 59.032 21.121 4.2242 2. Data1_QOLSexC 25 61.008 20.66535 4.13307 ------------------------------------------------------------------------------------------- Difference of Means: -1.976  

t DoF P Value ------------------------------------------------ -0.33436 48 0.73957 *Two Sample Independent t-Test ------------------------------------------------

59,03 61

0102030405060708090

100

Quality of life score

MtF

Control Women

*Cut off≥50

*

AIMS

To compare the quality of sexual life between transwomen and control women

To investigate the sexual functioning in transwomen after SRS

To compare the sexual functioning between transwomen and control women

*Cut off ≤26,55 risk for sexual dysfunction (Wieger et al., Journal of Sex & Marital Therapy, 31:1-20, 2005)

Mean ±SD

Desire 4,3 1,2

Arousal 4,4 1,0

Lubrication 4,4 1,2

Orgasm 4,4 1,2

Satisfaction

4,3 1,5

Pain 3,7 1,6

TOTAL SCORE*

25,5 7,7

Transwomen Sexual Functioning Index: FSFI

The sexual DESIRE in terms of frequency and level generally is HIGH;

The AROUSAL (frequency, level, confidence and satisfaction) is HIGH;

The LUBRICATION in terms of frequency, difficulty and frequency in mantaining is in average /with a tendency to lower scores;

The frequency, the difficult and the satisfaction about ORGASM is in average with a tendency to lower scores;

The SATISFACTION is in average

The PAIN in terms of frequency during/following vaginal penetration is generally HIGH;

The Total Score is borderline, close to the risk of sexual dysfunctions

TRANSWOMEN

AIMS

To compare the quality of sexual life between transwomen and control women

To investigate the sexual functioning in transwomen after SRS

To compare the sexual functioning between transwomen and control women

*Cut off ≤26,55 risk for sexual dysfunction (Wieger et al., Journal of Sex & Marital Therapy, 31:1-20, 2005)

Sexual functioning : F.S.F.I.

Transwomen Control women

DESI RE 4,3 1,2 AROUSAL 4,4 1,0 LUBRI CATI ON 4,4 1,2 ORGASM 4,4 1,2 SATI SFACTI ON 4,3 1,5 PAI N 3,7 1,6

TOTAL SCORE 25,78 7,7

DESI RE 3,8 1,1 AROUSAL 4,9 0,7 LUBRI CATI ON 5,1 1,2 ORGASM 5,5 1,1 SATI SFACTI ON 4,3 1,4 PAI N 4,5 1,6

TOTAL SCORE 28,10 7,1

Mean

±SD ±SDMean

The control womens’ DESIRE in terms of frequency and level is LOWER than Transwomen

The AROUSAL is HIGH in both groups

The LUBRICATION and the ORGASM (frequency, level, difficult, confidence and satisfaction) are HIGH in the control group while they are in an average level in the Trans women sample

The SATISFACTION is in an average level in both groups

The control group’s PAIN in terms of frequency during/following vaginal penetration is LOWER than Transwomen

The TOTAL SCORE is in average; normative cluster (i.e no risk of sexual dysfunctions)

CONTROL WOMEN versus TRANSWOMEN

CONCLUSIONSCONCLUSIONSCONCLUSIONSCONCLUSIONS

1.After SRSthe Quality of Sexual Life is good without statistically

differences fromcontrol women

1.After SRSthe Quality of Sexual Life is good without statistically

differences fromcontrol women

2. Transwomenshowed some difficults in

sexual functioning

2. Transwomenshowed some difficults in

sexual functioning

3. The main problemsare concerning

Lubrication, orgasm and pain

3. The main problemsare concerning

Lubrication, orgasm and pain

CONCLUSIONSCONCLUSIONSCONCLUSIONSCONCLUSIONS

Problems about lubrication are related to

the kind of surgery(only two patients made

“rectosigmoid flap”)

Problems about lubrication are related to

the kind of surgery(only two patients made

“rectosigmoid flap”)

Problems about orgasm and pain

are probably related to the difficulty in integrating

new genitalia in the

Body Image

Problems about orgasm and pain

are probably related to the difficulty in integrating

new genitalia in the

Body Image

We think that after SRS a specific

psychosexual intervention is necessary

We think that after SRS a specific

psychosexual intervention is necessary