transgender hysterectomy - pfd week · transgender hysterectomy. ... abnormal uterine bleeding...
TRANSCRIPT
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R O B E R T R . P O L L A R D M DD I R E C T O R , G Y N M I S
F P M R SM E T R O H E A L T H M E D I C A L C E N T E R
C L E V E L A N D , O H
Transgender Hysterectomy
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Objective
Indications for Hysterectomy Criteria for surgery Counseling Review Routes for surgery Review Peri-operative Care
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Make No Assumptions
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Importance
Transgender health more in the fore-front More patients seeking care Risk of inadequate Care Gyn’s in position to care for these issues
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Indications
Gender Affirmation-Incongruence Abnormal Uterine Bleeding Pelvic Pain Dysmenorrhea Avoid future Gyn visits Cancer Risk Reduction Decrease Testosterone Dose
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Incongruence
58% underwent surgery b/c of incongruent organs
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Gyn Complaints
AUB Dysmenorrhea Pelvic Pain
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Cancer Risk Reduction
Risk of Testosterone Pap Smears Ovarian Cancer
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WPATH Criteria
Age of Majority (18yo) Persistent, well documented gender dysphoria Capacity to make informed decision and consent for
treatment 12 continuous months of Testosterone therapy Two letters from qualified mental health
professionals
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Letters
Diagnosis and psychological assessment Duration and type of therapy from provider Criteria for surgery have been met Rational for support of surgery
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Criteria
What about for Gyn etiologies of surgery?
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Environment
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Counseling for Surgery
Reasons for surgery History and ?PE Concomitant surgery Plans for future surgery Fertility BSO Sexuality
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Fertility
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Pre-op
Pap? EMB? US? Labs Antibiotics DVT prophylaxis Testosterone
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Surgery
Route of Surgery Shaving Vaginal Access- Uterine manipulator Ports Cuff Closure Unexpected findings? Vaginectomy Mastectomy
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Post-OP
23 hour stay Same Day Discharge Pelvic Rest? Vaginal Spotting Communication/Education Follow up
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Long Term Results/Patient Experience
QOL Psychological Well-Being Sexual Testosterone Dose Risk of Regret
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Summary Getting Started
Open access to care Work with Endocrinologists or Plastic surgeons Follow the WPATH criteria Treat any associated pathology at surgery Patient satisfaction high Very appreciative group of patients