XV Harry Benjamin International Gender Dysphoria Association Symposium

The State of Our Art and the State of Our Science

Sexological and psychological outcomes of male-to-female gender reassignment surgery in 17 new women

By Maryann Schroder PhD, Richard A Carroll PhD*
University of Chicago, *Northwestern University Medical School, University of Chicago; 5841 S. Maryland Ave., MC3051, Chicago IL 60637, USA
Abstract

This descriptive research study investigated sexological and psychological outcomes of gender reassignment surgery in 17 postoperative male-to-female transsexuals (new women). A median of 11.17 years (range=1 to 25 years) transpired between the gender reassignment surgery and the date of the research session. Study procedures included: 1) a structured interview and self-report questionnaires (Gender Dysphoria Assessment: Postoperative Questionnaire and Interview; SCL-90-R; MMPI-2; MCMI-2; and Stress Inventory) about the sexological and psychological outcomes, 2) a medical history and physical examination, 3) a detailed gynecological exam using the first author’s unique clinical instrument, the New Woman’s Gynecological Index, 4) medical photographs of the subjects, including the genitalia, taken to visually document the gynecological findings, and 5) baseline neovaginal blood flow assessment by photophlethysmography. The results of descriptive analysis, correlational analysis between medical psychological and sexological variables, discriminant analysis and multiple regression analysis identifying predictors of good sexual functioning are presented. Over 90% of the new women rated the gender reassignment process as successful. Only one individual viewed the gender reassignment surgery as very unsuccessful and was considering a return to her original male gender role. Genital sensitivity and congruence between gender identity and body were shown to be the best predictors of orgasmic potential. The Stress Inventory total score and the genital neurosensory evaluation on the New Woman’s Gynecological Index were shown to be the best predictors of sexual satisfaction. Vaginal depth and vulvar cosmesis were revealed as the best predictors of overall success of gender reassignment. The New Woman’s Gynecological Index provided a standardized assessment tool to evaluate gynecological outcomes in postoperative male-to-female transsexuals. Medical photographs illustrate the New Woman’s Gynecological Index. The study found photophlethysmography monitoring yielding a baseline physiological measure of the new woman’s neovaginal blood flow. To be normal or complete women was the major reason reported for the respondents to have gender reassignment surgery. About half were sexually attracted to males; about one-third were bisexual; and nearly one-fifth were sexually attracted to females. About two-thirds of the new women reported masturbation and being orgasmic from self-pleasuring. About two-thirds engaged in vaginal intercourse. Slightly over half were orgasmic during partnered sex. About half expressed sexual satisfaction; and about one-quarter of the subjects were completely dissatisfied with their sexual lives. High levels of satisfaction with genital appearance, sensitivity and function as well as vaginal depth appeared to correspond with greater sexual satisfaction, more frequent reports of being orgasmic, and overall success of gender reassignment. Subjects reported elevations on several subclasses of the SCL-90-R and other scales of psychological functioning. However, the pattern of results from the SCL-90-R and the MMPI-2 suggests that this group of new women is currently experiencing mild to moderate elevations in psychological distress, especially related to social interactions, but at a level below that of people who seek treatment for mental health problems. The implications of this study for assessment and treatment of individuals with gender identity disorder will be discussed.