TransBiota is a collaborative research project that aims to characterize the genital microenvironments of trans people who have received gender-affirming medical care. Participants included transfeminine individuals who had undergone vaginoplasty at least 1 year prior to enrollment and transmasculine individuals who had been on testosterone for at least 1 year and had not undergone vaginectomy. Research is based at the University of Western Ontario Schulich School of Medicine and Dentistry with Dr. Jessica Prodger's group and includes collaborators at the University of Minnesota Institute for Sexual and Gender Health (Dr. Greta Bauer), University of Maryland School of Medicine (Dr. Jacques Ravel), Women's College Hospital Transition Related Surgery Program (Dr. Yonah Krakowsky, Emery Potter, NP), and the University of Toronto Department of Ecology and Evolutionary Biology (Jacy Newfeld).
In addition to microbiota samples, participants also sent in responses to a questionnaire aimed at understanding their demography, gynecological health, and genital practices (e.g. age, gynecological symptoms and concerns, surgical complications, antimicrobial use, dilation and sexual intercourse frequency). Microbiota swabs and questionnaires were completed once per week for three weeks.
Using the demographic, gynecological health, and genital practice data, we performed an epidemiological survey of transfeminine people who have undergone vaginoplasty. While there is extremely low regret of vaginoplasty compared other invasive surgeries (e.g. 1-2% for vaginoplasty vs. 58% for knee arthroplasty), there were some common concerns, including UTIs and bloody discharge. We identified four behavioural clusters based on post-operative care practices: limited exposures, dilating no douching, dilating and douching, and diverse exposures. While gynecological concerns were not significantly correlated with cluster membership, surgical centre was associated with cluster membership. This is likely because Women's College Hospital recommends dilating without douching while some other surgical centres recommend dilating and douching.
We also saw that few transfeminine individuals see gynecologists for health check-ups, and that many felt unseen and unheard by gynecologists, confused about best practices, and hurt by medical professionals. This study underscores the necessity to further investigate post-operative gynecological care for transfeminine people in order to develop effective diagnostics, treatments, and care guidelines to ensure transfeminine people have equal access to safe and effective medical care. Check out our study, Hallarn et al. (2023), J. Sex. Med. for more info!
Glossary
Trans(gender): someone who identifies as a gender that is different from the sex they were assigned at birth. For instance, a woman who was assigned male at birth.
Cis(gender): someone who identifies as a gender that is the same as the sex they were assigned at birth. For instance, a woman who was assigned female at birth.
Gender affirming medical care: medical care that trans people may access to align their physical appearance with their gender. This may include HRT, surgeries, and/or other care practices. Gender affirming medical care is life-saving and necessary medical care.
Hormone Replacement Therapy (HRT): use of external hormones (e.g. estradiol, progesterone, testosterone) to produce physical changes that align with your gender. Trans people may or may not take HRT.
Transfeminine: an individual who was assigned male at birth, but now identifies as another gender proximal to femininity. Transfeminine individuals may access gender affirming medical care to feminize their appearance, such as through feminizing hormone replacement therapy, vaginoplasty, or others.
Transmasculine: an individual who was assigned female at birth, but now identifies as another gender proximal to masculinity. Transmasculine individuals may access gender affirming medical care to masculinize their appearance, such as through masculinizing hormone replacement therapy, vaginectomy, or others.
Vaginoplasty: surgical construction of a vagina typically using penile skin, but may use grafts from elsewhere in the body. Vaginoplasty may be full-depth, shallow-depth, or zero-depth.
Dilation: post-operative practice of using dilators to maintain depth and width of the vagina. This is a necessary part of post-operative care after vaginoplasty.
Neovagina: Surgically constructed vagina resulting from a vaginoplasty. This may be contrasted with a natal vagina.
Natal vagina: vagina with which one is born. This may be contrasted with neovagina.
Vaginectomy: surgical removal of all or part of the vagina. This may occur as a component of another surgery (e.g. phalloplasty) or may be performed alone as a gender affirming surgery.