Gender-Affirming Surgery: A Visual Resource for Patients, Relatives, and Healthcare Providers

Gender dysphoria occurs when an individual’s psychological identity as a male or female conflicts with their biological sexual characteristics, resulting in anxiety, depression, and distress. Transgender individuals often face harassment, discrimination, and stigmatization. Discrimination and transphobic experiences in clinical settings can erode trust in the healthcare system by the transgender community, and by extension, negatively affect the health of the transgender patient. Gender-affirming surgeries are being performed with increasing frequency. In 2014, the Affordable Care Act banned discrimination based on gender identity, and Medicare coverage was extended to include transgender surgical treatment. The number of transgender individuals seeking gender-affirming surgery is expected to rise. Gender-affirming bottom and facial surgeries are complex, difficult to conceptualize procedures and require the patient to make decisions about permanently changing two intimate parts of the body: the pelvic anatomy and face. Failure of the patient to understand resulting anatomical changes and the implications those changes have for post-operative function and upkeep can lead to low post-operative satisfaction and patient outcomes. Patient-doctor communication is crucial for effective decision making by the patient. It is also important to educate potential downstream healthcare providers who may be unfamiliar with these procedures and the new anatomy of post-surgical patients. Existing visual resources on gender-affirming surgery are limited; they often lack clarity, are inconsistent, or are not designed for patient education. Videos and photographs may be graphic and impractical for teaching purposes. A full color, gender and racially sensitive patient education resource was created with input from professionals at the Johns Hopkins Center for Transgender Health. It includes nine male to female vaginoplasty images, six female to male phalloplasty images, and four donor site images. Several images employ an innovative color-coding system to describe tissue repositioning. A ten-image facial feminization surgery interactive module was designed to educate patients on realistic post-surgical outcomes of six procedures that modify facial structure. The images, rich in detail and aesthetically pleasing, will facilitate doctor-patient communication, aid patient decision-making, and improve health outcomes and trust in the healthcare system for the transgender community