Caring for Transgender Patients: Complications of Gender-Affirming Genital Surgeries

      Patients who undergo gender-affirming genital surgeries may present to the emergency department for their postsurgical complications. In this paper, we briefly describe the transfeminine and transmasculine genital procedures, review the diagnosis and management of both common and potentially life-threatening complications, and discuss the criteria for hospitalization and time frame for surgical consultation and referral.
      To read this article in full you will need to make a payment
      ACEP Member Login
      ACEP Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Canner J.K.
        • Harfouch O.
        • Kodadek L.M.
        • et al.
        Temporal trends in gender-affirming surgery among transgender patients in the United States.
        JAMA Surg. 2018; 153: 609-616
        • Lane M.
        • Ives G.C.
        • Sluiter E.C.
        • et al.
        Trends in gender-affirming surgery in insured patients in the United States.
        Plast Reconstr Surg Glob Open. 2018; 6: e1738
        • Moll J.
        • Krieger P.
        • Moreno-Walton L.
        • et al.
        The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: what do we know?.
        Acad Emerg Med. 2014; 21: 608-611
        • Rosendale N.
        • Goldman S.
        • Ortiz G.M.
        • et al.
        Acute clinical care for transgender patients: a review.
        JAMA Intern Med. 2018; 178: 1535-1543
        • Middleton I.
        • Holden F.A.
        Urological issues following gender reassignment surgery.
        Br J Nurs. 2017; 26: S28-S33
        • Suchak T.
        • Hussey J.
        • Takhar M.
        • et al.
        Postoperative trans women in sexual health clinics: managing common problems after vaginoplasty.
        J Fam Plann Reprod Health Care. 2015; 41: 245-247
        • Glossary of terms - transgender
        GLAAD Media Reference Guide - Transgender. 2019.
        • Deutsch M.
        Guidelines for the primary and gender-affirming care of transgender and gender binary people. 2016.
        • Bouman M.B.
        • van Zeijl M.C.
        • Buncamper M.E.
        • et al.
        Intestinal vaginoplasty revisited: a review of surgical techniques, complications, and sexual function.
        J Sex Med. 2014; 11: 1835-1847
        • Dreher P.C.
        • Edwards D.
        • Hager S.
        • et al.
        Complications of the neovagina in male-to-female transgender surgery: a systematic review and meta-analysis with discussion of management.
        Clin Anat. 2018; 31: 191-199
        • Papadopulos N.A.
        • Zavlin D.
        • Lelle J.D.
        • et al.
        Combined vaginoplasty technique for male-to-female sex reassignment surgery: operative approach and outcomes.
        J Plast Reconstr Aesthet Surg. 2017; 70: 1483-1492
        • Horbach S.E.
        • Bouman M.B.
        • Smit J.M.
        • et al.
        Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques.
        J Sex Med. 2015; 12: 1499-1512
        • Kuhn A.
        • Hiltebrand R.
        • Birkhauser M.
        Do transsexuals have micturition disorders?.
        Eur J Obstet Gynecol Reprod Biol. 2007; 131: 226-230
        • Neto R.R.
        • Hintz F.
        • Krege S.
        • et al.
        Gender reassignment surery - a 13 year review of surgical outcomes.
        Int Braz J Urol. 2012; 38: 97-107
        • Buncamper M.E.
        • van der Sluis W.B.
        • van der Pas R.S.D.
        • et al.
        Surgical outcome after penile inversion vaginoplasty: a retrospective study of 475 transgender women.
        Plast Reconstr Surg. 2016; 138: 999-1007
        • Cristofari S.
        • Bertrand B.
        • Leuzzi S.
        • et al.
        Postoperative complications of male to female sex reassignment surgery: a 10-year French retrospective study.
        Ann Chir Plast Esthet. 2019; 64: 24-32
        • Bertolotto M.
        • Liguori G.
        • Bucci S.
        • et al.
        MR imaging in patients with male-to-female sex reassignment surgery: postoperative anatomy and complications.
        Br J Radiol. 2017; 90: 20170062
        • Amies Oelschlager A.M.
        • Kirby A.
        • Breech L.
        Evaluation and management of vaginoplasty complications.
        Curr Opin Obstet Gynecol. 2017; 29: 316-321
        • Workowski K.A.
        • Bolan G.A.
        • Centers for Disease Control and Prevention
        Sexually transmitted diseases treatment guidelines, 2015.
        MMWR Recomm Rep. 2015; 64: 1-137
        • Thewjitcharoen Y.
        • Srikummoon T.
        • Srivajana N.
        • et al.
        Hemorrhagic necrosis of small bowel following small bowel obstruction as a late complication of sex reassignment surgery-a gap in transgender care.
        J Surg Case Rep. 2018; 2018: rjy314
        • Ferrando C.A.
        Vaginoplasty complications.
        Clin Plast Surg. 2018; 45: 361-368
        • Aghayev A.
        • Ozbayrak M.
        • Tatli S.
        Treatment of neovaginal variceal bleeding after transgender surgery with transjugular intrahepatic portosystemic shunt.
        J Vasc Interv Radiol. 2015; 26: 762-763
        • Heller D.S.
        Lesions of the neovagina—a review.
        J Low Genit Tract Dis. 2015; 19: 267-270
        • Hage J.J.
        • van Turnhout A.A.
        Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals.
        Ann Plast Surg. 2006; 57: 312-316
        • Morrison S.D.
        • Shakir A.
        • Vyas K.S.
        • et al.
        Phalloplasty: a review of techniques and outcomes.
        Plast Reconstr Surg. 2016; 138: 594-615
        • Nikolavsky D.
        • Yamaguchi Y.
        • Levine J.P.
        • et al.
        Urologic sequelae following phalloplasty in transgendered patients.
        Urol Clin North Am. 2017; 44: 113-125
        • Santucci R.A.
        Urethral complications after transgender phalloplasty: strategies to treat them and minimize their occurrence.
        Clin Anat. 2018; 31: 187-190
        • Esmonde N.
        • Bluebond-Langner R.
        • Berli J.U.
        Phalloplasty flap-related complication.
        Clin Plast Surg. 2018; 45: 415-424
        • Yao A.
        • Ingargiola M.J.
        • Lopez C.D.
        • et al.
        Total penile reconstruction: a systematic review.
        J Plast Reconstr Aesthet Surg. 2018; 71: 788-806
        • Falcone M.
        • Garaffa G.
        • Gillo A.
        • et al.
        Outcomes of inflatable penile prosthesis insertion in 247 patients completing female to male gender reassignment surgery.
        BJU Int. 2018; 121: 139-144