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ROBERT R. POLLARD MD DIRECTOR, GYN MIS FPMRS METROHEALTH MEDICAL CENTER CLEVELAND, OH Transgender Hysterectomy

Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

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Page 1: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

R O B E R T R . P O L L A R D M DD I R E C T O R , G Y N M I S

F P M R SM E T R O H E A L T H M E D I C A L C E N T E R

C L E V E L A N D , O H

Transgender Hysterectomy

Page 2: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Objective

Indications for Hysterectomy Criteria for surgery Counseling Review Routes for surgery Review Peri-operative Care

Page 3: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction
Page 4: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction
Page 5: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction
Page 6: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Make No Assumptions

Page 7: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Importance

Transgender health more in the fore-front More patients seeking care Risk of inadequate Care Gyn’s in position to care for these issues

Page 8: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Indications

Gender Affirmation-Incongruence Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction Decrease Testosterone Dose

Page 9: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Incongruence

58% underwent surgery b/c of incongruent organs

Page 10: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Gyn Complaints

AUB Dysmenorrhea Pelvic Pain

Page 11: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Cancer Risk Reduction

Risk of Testosterone Pap Smears Ovarian Cancer

Page 12: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction
Page 13: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

WPATH Criteria

Age of Majority (18yo) Persistent, well documented gender dysphoria Capacity to make informed decision and consent for

treatment 12 continuous months of Testosterone therapy Two letters from qualified mental health

professionals

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Letters

Diagnosis and psychological assessment Duration and type of therapy from provider Criteria for surgery have been met Rational for support of surgery

Page 15: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Criteria

What about for Gyn etiologies of surgery?

Page 16: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Environment

Page 17: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Counseling for Surgery

Reasons for surgery History and ?PE Concomitant surgery Plans for future surgery Fertility BSO Sexuality

Page 18: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Fertility

Page 19: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Pre-op

Pap? EMB? US? Labs Antibiotics DVT prophylaxis Testosterone

Page 20: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Surgery

Route of Surgery Shaving Vaginal Access- Uterine manipulator Ports Cuff Closure Unexpected findings? Vaginectomy Mastectomy

Page 21: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Post-OP

23 hour stay Same Day Discharge Pelvic Rest? Vaginal Spotting Communication/Education Follow up

Page 22: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Long Term Results/Patient Experience

QOL Psychological Well-Being Sexual Testosterone Dose Risk of Regret

Page 23: Transgender Hysterectomy - PFD Week · Transgender Hysterectomy. ... Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction

Summary Getting Started

Open access to care Work with Endocrinologists or Plastic surgeons Follow the WPATH criteria Treat any associated pathology at surgery Patient satisfaction high Very appreciative group of patients