Psychiatric comorbidities in gender dysphoria subjects after MtF Sex Reassignment Surgery: post surgery outcome

In according with other authors, we regard the gender Dysphoria (GD) as a nosological entity and we think that psychiatric coexisting problems, when present, are a consequence of the persistent gender dysphoria and of the... [ view full abstract ]

In according with other authors, we regard the gender Dysphoria (GD) as a nosological entity and we think that psychiatric coexisting problems, when present, are a consequence of the persistent gender dysphoria and of the concomitant psychosocial distress. In a previous study, we investigated the presence of psychiatric issues in subjects attending the programme for Sex Reassignment Surgery, at the C.I.D.I.Ge.M – a Public Health Service for GD people in Turin, Italy. In this sample, considering the period from January 2005 to October 2015, we found a higher levels of coexisting psychiatric disorders than the general population. Specifically, in according to literature, our data confirm the significant presence of anxiety, depression and personality disorders. Despite being recognized as an important prognostic factor for the outcome in gender dysphoria subjects, the coexistence of psychiatric disorders has rarely been assessed by means of standardized diagnostic instruments (Hepp, Kraemer, Schnyder, N., & Delsignore, 2005). Therefore, our study aims to increase the knowledge about this subject, starting from the CIDIGeM’s data, collected in ten years’s work.

This study focuses on understanding how psychiatric coexisting disorders can change after sex reassignment surgery (SRS) in Transgender women. It is also intended to discover how psychiatric issues can affect sex life,... [ view full abstract ]

This study focuses on understanding how psychiatric coexisting disorders can change after sex reassignment surgery (SRS) in Transgender women. It is also intended to discover how psychiatric issues can affect sex life, relationships, patients’ quality of life and postoperative complications.

The sample examined was composed by 71 Transgender women. All the subjects met the diagnostic criteria for gender dysphoria according to DSM-IV-TR and DSM 5, and had undergone SRS surgery at the CIDIGeM in a period from Janury... [ view full abstract ]

The sample examined was composed by 71 Transgender women. All the subjects met the diagnostic criteria for gender dysphoria according to DSM-IV-TR and DSM 5, and had undergone SRS surgery at the CIDIGeM in a period from Janury 2005 to October 2015. 33 out of 71 subjects decided to participate in the study giving their informed consent. The psychiatric evaluation consisted of two phases: in the first phase a structured clinical interview was conducted by a medical staff member, then participants were asked to rate themselves on psychology questionnaires. The interview included : demographic characteristics, subject’s medical history, family and relationship situation, psychosexual development and postoperative complications. The questionnaires used were: Body Uneasiness Test A (BUT-A), Body Uneasiness Test B (BUT-B), SCL-90-R, Beck Depression Inventory-II, Visual Analog Gender Dysphoria Scale, SF-36, Visual Analog General Satisfaction Scale, Liebowitz Social Anxiety Scale Test, Humiliation Inventory, Visual Analog Sexual Orientation Scale, Relationship, Visual Analog Sexual Satisfaction Scale, Female Sexual Distress Scale Revised (FDSD-R),Female Sexual Function Index (FSFI).

For the assessment of postoperative outcomes, all the following factors were considered: changes in psychiatric comorbidities after SRS, incidence of post surgical complications, hormonal therapy compliance, subjective... [ view full abstract ]

For the assessment of postoperative outcomes, all the following factors were considered: changes in psychiatric comorbidities after SRS, incidence of post surgical complications, hormonal therapy compliance, subjective improvement in gender dysphoria, sex and relationship life and patients’ quality of life.

The study showed a lower rate of Axis I disorders after the surgery: before MtF SRS, 19 people suffered from anxiety (n=7), depression (n=4), anxiety associated with depression (n=5) and more diagnosis (n=2) but after MtF SRS,... [ view full abstract ]

The study showed a lower rate of Axis I disorders after the surgery: before MtF SRS, 19 people suffered from anxiety (n=7), depression (n=4), anxiety associated with depression (n=5) and more diagnosis (n=2) but after MtF SRS, only 12 people suffer from anxiety (n=3), depression (n=5) and anxiety associated with depression (n=4). The co-existence of psychiatric disorders persists in about 30% of subjects (p<0,06) but it doesn’t seem to be associated with an increased risk of postoperative complications (p<0,4). According to the data, no statistically significant difference has been found between subjects with and without psychiatric disorders.

According to our results, GD is a clinical condition not associated with a severe psycopathology and it can be considered independent. For us, the co-existence of psychiatric disorders is often a psycological reaction to GD... [ view full abstract ]

According to our results, GD is a clinical condition not associated with a severe psycopathology and it can be considered independent. For us, the co-existence of psychiatric disorders is often a psycological reaction to GD condition, and rarely a problem for SRS’ success if the patient is under a good psychopathological control. This is also confirmed by the guidelines of WPATH International Standards of Care which state: “when mental health concerns are present, they must be well controlled before hormone and surgery therapy”. The presence of past mental health concerns did not adversely affect postoperative outcomes in 33 gender dysphoria subjects who underwent MtF SRS surgery at the CIDIGeM in a period from January 2005 to October 2015. However these coexisting conditions should be optimally managed prior to, or concurrent with, treatment of gender dysphoria. Obviously sample size is the main shortcoming of the study, nevertheless this has been a significant opportunity to assess postoperative outcomes and the importance of long-term psychiatric and somatic care after MtF SRS surgery. Our sample does not represent all transsexual persons, but only the GD subjects seeking for professional treatment, according to standards of care.