Attempted suicide rates among people who identified as transgender more than doubled after receiving a vaginoplasty, according to a peer-reviewed study published in The Journal of Urology.
The study analyzed the rates of psychiatric emergencies before and after gender-altering surgery among 869 males who underwent vaginoplasty and 357 females who underwent phalloplasty in California from 2012 to 2018.
Researchers found the rates of psychiatric emergencies were high both before and after gender-altering surgery, with similar overall rates in both groups. However, suicide attempts were markedly higher in those who received vaginoplasties.
“In fact, our observed rate of suicide attempts in the phalloplasty group is actually similar to the general population, while the vaginoplasty group’s rate is more than double that of the general population,” the study authors wrote.
Among the 869 patients who underwent vaginoplasty, 38 patients attempted suicide—with nine attempts before surgery, 25 after surgery, and four attempts before and after surgery. Researchers found a 1.5 percent overall risk of suicide before vaginoplasty and a 3.3 percent risk of suicide after the procedure. Almost 3 percent of those who attempted suicide after undergoing vaginoplasty did not present with a risk of suicide prior to surgery.
Among the 357 biologically female patients who underwent phalloplasty, there were six suicide attempts with a 0.8 percent risk of suicide before and after surgery.
Overall, the proportion of those who experienced an emergency room and inpatient psychiatric encounter outside of suicide attempts was similar between the vaginoplasty and phalloplasty groups. Approximately 22.2 percent and 20.7 percent of patients, respectively, experienced at least one psychiatric encounter.
The study found a 33.9 percent chance that a biological man undergoing vaginoplasty would experience a psychiatric encounter post-surgery compared with a 26.5 percent chance for biological women who underwent phalloplasty, if an episode had occurred before surgery. The authors stressed the importance of counseling biological males undergoing a feminizing transition with a history of prior psychiatric emergencies.
Suicide Rate 19-Fold Higher
In an interview with The Epoch Times, Dr. Alfonso Oliva, a board-certified plastic and reconstructive surgeon, said research into the psychiatric outcomes and long-term follow-up of those who have sex-reassignment surgery is lacking, but an important paper is worth mentioning. In a 2011 paper published in PLOS ONE, researchers found that people who underwent sex reassignment surgery had substantially higher rates of overall mortality, suicidal behavior, and psychiatric morbidity compared with the general population.“It’s hard to refute this paper because it’s a longitudinal study,” Dr. Oliva said. “In Sweden, everyone is in a database, and through diagnosis codes, they’re able to follow what happens to every citizen in terms of their medical history. They waited more than 10 years after people had surgery and found that death by suicide had an adjusted hazard ratio of 19.1.”
You can “quibble” about emergency room encounters, but this study shows that for patients who had transgender surgery, their suicide rate after 10 years was 19-fold higher than the general population, Dr. Oliva said. Additionally, the study excluded people with psychiatric illnesses, so these are individuals thought to have no psychiatric illness outside of dysphoria.
Surgical Procedures
A phalloplasty is a multistep process undertaken by a biological female who wants to transition to a male, where a penis is created using tissues from the genitals and forearm or thigh. The external genitals, such as the labia or outer labia, are used to create a scrotum, and testicular implants are inserted months later along with an implant that will cause erections.Vaginoplasty is the most commonly performed gender-reassignment surgery for those with gender dysphoria, with more than 3,000 procedures performed annually. According to Johns Hopkins Medicine, vaginoplasty is a surgical procedure that involves removing the penis, testicles, and scrotum to create a vulva and functional vagina. Surgeons typically create a vaginal canal using the skin surrounding the existing penis and scrotum or by using a skin graft from the abdomen or thigh.
A penial inversion is the most commonly performed procedure where the skin is removed from the penis and inverted to form a pouch that is inserted into the vaginal cavity created between the urethra and the rectum. Surgeons then partially remove, shorten, and reposition the urethra and create a labia majora, labia minora, and clitoris.
Another surgical method involves using a robotic system that enables surgeons to reach into the body through a small incision in the belly button to create a vaginal canal. The type of vaginoplasty performed varies among patients. For example, younger patients who have never experienced puberty may have insufficient penile skin to do a standard penile inversion.
“When you take a child who’s about to undergo puberty—and they suggest giving puberty blockers to stop puberty at age 10 to 11 1/2—and when you do that for little boys, they aren’t able to get tissue from the penis and scrotum, so creating a vagina is very difficult,” Dr. Oliva told The Epoch Times. “You have to use tissue from other areas of the body, such as the peritoneum or the colon. Some researchers in Brazil are actually looking into using tilapia fish,” he added.
After a vaginoplasty is performed, the recovery process is extensive and vaginal dilation must be performed at varying intervals throughout the patient’s life.
Vaginoplasty Associated With Serious Risks
In addition to an increased risk of suicide, vaginoplasty is associated with numerous physical complications, including wound separation, vaginal stenosis, hematoma, rectovaginal fistulas, granulation tissue, bleeding, infection, skin or clitoral necrosis, suture line dehiscence (when the surgical incision opens), urinary retention or vaginal prolapse.According to a 2021 paper in the International Brazilian Journal of Urology, a rectovaginal fistula is the “most devastating complication” of a vaginoplasty that can occur “despite careful technique” and without obvious injury to the rectum.
A rectovaginal fistula is an abnormal connection between the rectum and vagina that can cause fecal incontinence, hygiene issues, vaginal or anal irritation, and potentially life-threatening abscesses and fistula recurrence.
A 2021 review in Andrology found that rates of complications following penile inversion vaginoplasty ranged from 20 to 70 percent, with most of the complications occurring during the first four months following the procedure.
In a 2018 Clinical Anatomy review and meta-analysis, researchers reviewed 125 articles to assess neovaginal complications following surgery. After selecting 13 studies that included 1,684 patients, they found a complication rate of 32 percent, with a reoperation rate of 22 percent for non-esthetic reasons.
“For cosmetic surgery, if the complication rate was more than 2 percent to 3 percent, you wouldn’t have any patients,” Dr. Oliva told The Epoch Times. “These are very high percentage rates that we just accept.”
Dr. Oliva said complications with these surgical procedures are very high and he thinks this is why suicide rates are so high.
“People think this is going to solve the problem and it doesn’t,” he said.
A June 2018 paper on postoperative outcomes of 117 patients who underwent vaginoplasty published in the Journal of the American Society of Plastic Surgeons found that 26 percent of patients experienced granulation tissue, 20 percent had intravaginal scarring, and 20 percent experienced prolonged pain.
In a 2017 paper published in The Journal of Urology, researchers followed patients who underwent penile inversion vaginoplasty. Of 330 patients, 95 (29 percent), presented with postoperative complications. Three of those patients developed a rectoneovaginal fistula, and 30 patients required a second operation.
In a 2016 study published in Urology, researchers retrospectively reviewed clinical records of 69 patients who underwent vaginoplasty from January 2005 to January 2015. Although complications during surgery were not reported, 22 percent of patients experienced major postoperative complications.
“We’ve been transitioning adults in the United States since 2007, but where’s the data from gender identity clinics? Why is nothing published in the United States about long-term function? Why do we have nothing published on sexual function? We should be able to follow that and should be studying it and we’re not,” Dr. Oliva told The Epoch Times.
