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1. Introduction
2. Terminology, Definitions, and Background
2.1. Terminology related to genital anatomy
2.2 Insensitive terminology
3. Epidemiology
4. Transgender health disparities
5. Cultural competence: How do we provide affirming care for transgender and gender diverse patients in our institutions?
6. Interdisciplinary Care Model
7. Gender transition and treatment of gender dysphoria
8. Treatment: Gender-affirming Hormone Therapy
9. Treatment with gender affirming surgery: Criteria and Patient Selection
10. Genital gender affirming surgery
10.1 Genital gender affirming surgery categories
10.2 Feminizing genital gender affirming surgeries
10.3 Masculinizing genital gender affirming surgeries for transgender men and gender diverse individuals
10.3.1 Hysterectomy and oophorectomy
10.3.2 Masculinizing genital surgery options
10.3.3 Masculinizing gGAS techniques
10.3.4 Surgery staging and surgery complications
11. Role of the urologist in the care of transgender patients
12. Additional Resources
13. Illustrations
References
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Genital Gender-Affirming Surgery & Urologic Care Overview

Editors:
Maurice M. Garcia, MD, MAS
Authors:
Christi Butler, MD; Amanda Chi, MD
Last Updated:
Tuesday, February 22, 2022

Keywords:

Transgender; Gender non-conforming; Gender dysphoria; Gender-affirming hormone therapy (GAHT); Gender-affirming genital surgery; Vaginoplasty; Vulvoplasty/Shallow/Zero-depth vaginoplasty; Phalloplasty with urethral lengthening; Phalloplasty without urethral lengthening; Metoidioplasty; Management of patient expectations; Erogenous sensation; Complications

Keypoints:

1. Introduction

Transgender and gender diverse (TGD) people have historically been marginalized by society and the healthcare system. With growing awareness of TGD identities, and expanding coverage of gender-affirming care by private insurers and some State Medicaid plans, urologists will encounter an increasing number of TGD patients for both gender-affirming and general urologic care. The most common complications after genital gender-affirming surgery (gGAS) relate to the lower urinary tract and sexual function. Thus, urologists are likely to see more TGD patients for management of urinary and sexual dysfunction.

This Core Curriculum section introduces the urologist to the transgender patient population to facilitate sensitive care, provide information on the process of gender transition, and provide insight on how gender transition affects the genitourinary system. We recommend that readers also refer to Lesson 5 of the 2017 AUA Updates Series: Genital Gender Affirming Surgery for Transgender Patients and the 2022 AUA Update Series: A Urologist’s Guide to Caring for Transgender Women for additional and more detailed information about gender-affirming surgery.1

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