背景:阴道自润滑对于接受性别确认阴道成形术(GAV)的患者的性满意度和健康的泌尿生殖功能至关重要。不同的新阴道内衬组织的分泌能力在文献中有不同的描述,他们在提供功能自润滑新阴道方面的成功几乎没有基于证据的共识。我们回顾了现有的新阴道润滑数据和解剖结构,组织学,阴茎和阴囊皮肤的生理学,结肠,和腹膜,以更好地表征其在用作新阴道衬里时功能自润滑的能力。
目的:该研究试图回顾和比较阴茎和阴囊皮肤移植的优点,尿道穿孔,结肠,和腹膜皮瓣产生类似于GAV设置中的出生阴道的功能润滑。
方法:我们遵循PRISMA(系统评价和荟萃分析的首选报告项目)指南进行了系统评价。Medline,EMBASE,ClinicalTrials.gov,并在CochraneLibrary数据库中搜索了2022年12月12日之前发表的同行评审研究,(1)包括特定于跨女性个体的数据;(2)是全文随机对照研究,病例报告,案例系列,回顾性队列研究,前瞻性队列研究,定性研究,和横断面研究;(3)包括对利用阴茎皮肤GAV后阴道润滑或液体分泌的具体讨论,结肠组织,或者腹膜.
结果:我们确定了580项研究,其中28人符合我们的纳入标准。新阴道润滑的数据仅限于定性的临床观察,患者报告的结果,和满意度措施。没有针对任何GAV移植物或皮瓣技术确定定量新阴道分泌物的研究。解剖学上,阴茎和阴囊皮肤没有自润滑的潜力,尽管阴茎倒置阴道成形术可能会在合并尿道组织并保留润滑泌尿生殖腺时产生一些性反应性分泌液。结肠和腹膜组织都有分泌能力,但是这些组织产生的液体是连续的,对性唤起没有反应,体积可能不合适,因此可能无法满足某些患者的需求或期望。尚未记录手术组织易位对其先天分泌功能的影响。
结论:没有阴茎/阴囊皮肤,结肠,或腹膜提供与成人出生阴道相当的功能性新阴道润滑。每个组织都有局限性,特别是关于分泌物的不适当的体积和/或慢性性。现有证据不支持基于润滑结果推荐一种GAV技术。最后,难以区分生理性和病理性新阴道液分泌可能混淆新阴道自润滑的评估,因为新阴道的许多病理表现为有症状的放电。
Vaginal self-
lubrication is central to the sexual satisfaction and healthy genitourinary function of patients who have undergone gender-affirming vaginoplasty (GAV). Secretory capacities of different neovaginal lining tissues have been variably described in the literature, with little evidence-based consensus on their success in providing a functionally self-lubricating neovagina. We
review the existing neovaginal
lubrication data and the anatomy, histology, and physiology of penile and scrotal skin, colon, and peritoneum to better characterize their capacity to be functionally self-lubricating when used as neovaginal lining.
The study sought to
review and compare the merits of penile and scrotal skin grafts, spatulated urethra, colon, and peritoneal flaps to produce functional
lubrication analogous to that of the natal vagina in the setting of GAV.
We conducted a systematic
review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Medline, EMBASE, ClinicalTrials.gov, and the Cochrane Library databases were searched for peer-reviewed studies published prior to December 12, 2022, that (1) included data specific to transfeminine individuals; (2) were full-text randomized controlled studies, case reports, case series, retrospective cohort studies, prospective cohort studies, qualitative studies, and cross-sectional studies; and (3) included specific discussion of vaginal lubrication or fluid secretion following GAV utilizing penile skin, colonic tissue, or peritoneum.
We identified 580 studies, of which 28 met our inclusion criteria. Data on neovaginal lubrication were limited to qualitative clinician observations, patient-reported outcomes, and satisfaction measures. No studies quantifying neovaginal secretions were identified for any GAV graft or flap technique. Anatomically, penile and scrotal skin have no self-lubricating potential, though penile inversion vaginoplasty may produce some sexually responsive secretory fluid when urethral tissue is incorporated and lubricating genitourinary accessory glands are retained. Colonic and peritoneal tissues both have secretory capacity, but fluid production by these tissues is continuous, nonresponsive to sexual arousal, and likely inappropriate in volume, and so may not meet the needs or expectations of some patients. The impact of surgical tissue translocation on their innate secretory function has not been documented.
None of penile/scrotal skin, colon, or peritoneum provides functional neovaginal lubrication comparable to that of the adult natal vagina. Each tissue has limitations, particularly with respect to inappropriate volume and/or chronicity of secretions. The existing evidence does not support recommending one GAV technique over others based on lubrication outcomes. Finally, difficulty distinguishing between physiologic and pathologic neovaginal fluid secretion may confound the assessment of neovaginal self-lubrication, as many pathologies of the neovagina present with symptomatic discharge.