{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T18:50:32Z","timestamp":1773687032081,"version":"3.50.1"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Penile inversion vaginoplasty (PIV) is a commonly performed gender-affirming procedure that requires postoperative dilation to maintain vaginal canal patency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To characterize patient-reported dilation experiences and evaluate temporal trends in postoperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive patients undergoing primary PIV at a single center were prospectively surveyed at 1, 3, 6, 9, and 12\u00a0months postoperatively. Surveys were author-developed based on clinical experience and clinical review. Surveys assessed dilation frequency, session duration, depth achieved, and challenges encountered. Univariate analyzes were used to evaluate changes over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>The primary outcome was the proportion of patients reporting any dilation-related challenge over time. Secondary outcomes included adherence metrics (frequency, days\/week, session duration), depth achieved, and specific challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventeen of 27 patients completed all survey time points (63% response rate). On average, participants dilated 6.6\u2009\u00b1\u20091.4\u00a0days\/week and 2.4\u2009\u00b1\u20090.9 times\/day; sessions lasted 38.3\u2009\u00b1\u200916\u00a0minutes. Mean depth achieved was 4.05\u2009\u00b1\u20091.32 (13\u00a0cm standardized dilator set), with no significant decline over time. All patients reported at least one difficulty, most commonly tightness (71%), bleeding (71%), pain (65%), discharge (47%), and logistical barriers (24%). The prevalence of reported challenges declined significantly after six months (P\u2009&amp;lt;\u2009.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>Early dilation-related difficulties are nearly universal and should be anticipated with proactive counseling and structured postoperative support, though symptoms improve over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths and Limitations<\/jats:title>\n                    <jats:p>This is the first prospective, longitudinal study of dilation following PIV, using an author-developed survey instrument to capture patient-reported outcomes. Limitations include modest sample size, potential response bias, and lack of assessment of challenge severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reported dilation adherence following PIV is high, but most patients experience early challenges that diminish over time, highlighting the need for anticipatory counseling and individualized, symptom-responsive dilation protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdag068","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T12:44:27Z","timestamp":1772023467000},"source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal patient-reported outcomes of vaginal dilation after penile inversion vaginoplasty"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7818-3546","authenticated-orcid":false,"given":"Diego A","family":"Gomez","sequence":"first","affiliation":[{"name":"Mayo Clinic Alix School of Medicine, Mayo Clinic , Phoenix, AZ 85054, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makenna","family":"Ley","sequence":"additional","affiliation":[{"name":"University of Arizona College of Medicine , Tucson, AZ 85724, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison C","family":"Hu","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine , Palo Alto, CA 94304, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9628-5896","authenticated-orcid":false,"given":"Danny A","family":"Young-Afat","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Amsterdam University Medical Center , 1105 AZ Amsterdam ,","place":["The Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anandev","family":"Gurjala","sequence":"additional","affiliation":[{"name":"Align Surgical Associates , San Francisco, CA 94115, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Satterwhite","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine , Palo Alto, CA 94304, United States"},{"name":"Align Surgical Associates , San Francisco, CA 94115, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John Henry","family":"Pang","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine , Palo Alto, CA 94304, United States"},{"name":"Align Surgical Associates , San Francisco, CA 94115, United States"},{"name":"Center for Transgender Medicine and Surgery, Mount Sinai Health System and Icahn School of Medicine at Mount Sinai , New York, NY 10029, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"issue":"5","key":"2026031613533687900_ref1","doi-asserted-by":"publisher","first-page":"999","DOI":"10.1097\/PRS.0000000000002684","article-title":"Surgical outcome after penile inversion vaginoplasty: a retrospective study of 475 transgender women","volume":"138","author":"Buncamper","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"6","key":"2026031613533687900_ref2","doi-asserted-by":"publisher","first-page":"911e","DOI":"10.1097\/PRS.0000000000004427","article-title":"Predictors of patient satisfaction and postoperative complications in penile inversion vaginoplasty","volume":"141","author":"Massie","year":"2018","journal-title":"Plast Reconstr Surg"},{"issue":"5","key":"2026031613533687900_ref3","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1038\/s41585-022-00705-y","article-title":"Principles and outcomes of gender-affirming vaginoplasty","volume":"20","author":"Morrison","year":"2023","journal-title":"Nat Rev Urol"},{"issue":"7","key":"2026031613533687900_ref4","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.1111\/jsm.12914","article-title":"Aesthetic and functional outcomes of Neovaginoplasty using penile skin in male-to-female transsexuals","volume":"12","author":"Buncamper","year":"2015","journal-title":"J Sex Med"},{"issue":"3","key":"2026031613533687900_ref5","doi-asserted-by":"publisher","first-page":"416e","DOI":"10.1097\/PRS.0000000000008300","article-title":"Fifteen-year experience with the Ghent technique of penile inversion vaginoplasty","volume":"148","author":"Opsomer","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"3","key":"2026031613533687900_ref6","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1093\/jsxmed\/qdae194","article-title":"Impact of vaginoplasty on sexual health and satisfaction in transgender women","volume":"22","author":"Kitic","year":"2025","journal-title":"J Sex Med"},{"key":"2026031613533687900_ref7","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.bjps.2024.11.019","article-title":"A review of major reconstructive and gender-affirming surgical techniques in genital surgery and care for the transgender patient population","volume":"100","author":"Pope","year":"2025","journal-title":"J Plast Reconstr Aesthetic Surg JPRAS"},{"issue":"7","key":"2026031613533687900_ref8","doi-asserted-by":"publisher","first-page":"726","DOI":"10.1038\/s41443-021-00470-3","article-title":"Vaginoplasty in male to female transgenders: single center experience and a narrative review","volume":"33","author":"Ongaro","year":"2020","journal-title":"Int J Impot Res"},{"key":"2026031613533687900_ref9","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1016\/j.urology.2024.02.005","article-title":"Vaginal stenosis after gender-affirming vaginoplasty: a systematic review","volume":"186","author":"De Rosa","year":"2024","journal-title":"Urology."},{"issue":"3","key":"2026031613533687900_ref10","doi-asserted-by":"publisher","first-page":"649e","DOI":"10.1097\/PRS.0000000000003108","article-title":"Penile inversion vaginoplasty with or without additional full-thickness skin graft: to graft or not to graft?","volume":"139","author":"Buncamper","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"2026031613533687900_ref11","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.bjps.2024.11.042","article-title":"Predictors of dilation difficulty in gender-affirming vaginoplasty","volume":"101","author":"Shamamian","year":"2025","journal-title":"J Plast Reconstr Aesthetic Surg JPRAS"},{"key":"2026031613533687900_ref12","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1016\/j.urology.2019.03.043","article-title":"Male-to-female gender reassignment surgery: an institutional analysis of outcomes, short-term complications, and risk factors for 240 patients undergoing penile-inversion vaginoplasty","volume":"131","author":"Levy","year":"2019","journal-title":"Urology."},{"issue":"Suppl 1","key":"2026031613533687900_ref13","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1080\/26895269.2022.2100644","article-title":"Standards of Care for the Health of transgender and gender diverse people, version 8","volume":"23","author":"Coleman","year":"2022","journal-title":"Int J Transgender Health"},{"issue":"7624","key":"2026031613533687900_ref14","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"von Elm","year":"2007","journal-title":"BMJ."},{"key":"2026031613533687900_ref15","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000012514","article-title":"Body mass index as a predictor of surgical outcomes in gender-affirming vaginoplasty: a Nationwide analysis","author":"Manasyan","year":"2021","journal-title":"Plast Reconstr Surg"},{"issue":"6","key":"2026031613533687900_ref16","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1111\/andr.13030","article-title":"Penile inversion vaginoplasty outcomes: complications and satisfaction","volume":"9","author":"Hontscharuk","year":"2021","journal-title":"Andrology."},{"issue":"5","key":"2026031613533687900_ref17","doi-asserted-by":"publisher","first-page":"e5033","DOI":"10.1097\/GOX.0000000000005033","article-title":"Gender-affirming vaginoplasty: a comparison of algorithms, surgical techniques and management practices across 17 high-volume Centers in North America and Europe","volume":"11","author":"Coon","year":"2023","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"1","key":"2026031613533687900_ref18","doi-asserted-by":"publisher","first-page":"102801","DOI":"10.1016\/j.ijgc.2025.102801","article-title":"Current challenges in the assessment and management of radiotherapy-induced vaginal stenosis","volume":"36","author":"Torigoe","year":"2026","journal-title":"Int J Gynecol Cancer Off J Int Gynecol Cancer Soc"},{"issue":"5","key":"2026031613533687900_ref19","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1016\/j.eururo.2020.06.040","article-title":"Outcomes of gender affirming peritoneal flap vaginoplasty using the Da Vinci single port versus xi robotic systems","volume":"79","author":"Dy","year":"2021","journal-title":"Eur Urol"},{"issue":"4","key":"2026031613533687900_ref20","doi-asserted-by":"publisher","first-page":"614e","DOI":"10.1097\/PRS.0000000000002549","article-title":"Primary Total laparoscopic sigmoid vaginoplasty in transgender women with penoscrotal hypoplasia: a prospective cohort study of surgical outcomes and follow-up of 42 patients","volume":"138","author":"Bouman","year":"2016","journal-title":"Plast Reconstr Surg"},{"issue":"4","key":"2026031613533687900_ref21","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1097\/JU.0000000000001516","article-title":"Neovaginal Canal dissection in gender-affirming vaginoplasty","volume":"205","author":"Shoureshi","year":"2021","journal-title":"J Urol"},{"issue":"3","key":"2026031613533687900_ref22","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1016\/j.juro.2017.10.013","article-title":"Postoperative complications following primary penile inversion vaginoplasty among 330 male-to-female transgender patients","volume":"199","author":"Gaither","year":"2018","journal-title":"J Urol"},{"issue":"3","key":"2026031613533687900_ref23","doi-asserted-by":"publisher","first-page":"e2097","DOI":"10.1097\/GOX.0000000000002097","article-title":"Evaluation of BMI as a risk factor for complications following gender-affirming penile inversion vaginoplasty","volume":"7","author":"Ives","year":"2019","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"2","key":"2026031613533687900_ref24","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1002\/nau.25132","article-title":"Patient reported symptoms and adverse outcomes seen in Canada\u2019s first vaginoplasty postoperative care clinic","volume":"42","author":"Potter","year":"2023","journal-title":"Neurourol Urodyn"},{"issue":"1","key":"2026031613533687900_ref25","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1097\/SAP.0000000000004542","article-title":"The addition of betamethasone suppositories to silver nitrate treatment for Hypergranulation tissue following penile inversion vaginoplasty: a matched cohort study","volume":"96","author":"Gharavi","year":"2026","journal-title":"Ann Plast Surg"},{"issue":"5","key":"2026031613533687900_ref26","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1097\/AOG.0000000000003236","article-title":"Implementation of a pelvic floor physical therapy program for transgender women undergoing gender-affirming vaginoplasty","volume":"133","author":"Jiang","year":"2019","journal-title":"Obstet Gynecol"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/4\/qdag068\/67371339\/qdag068.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/4\/qdag068\/67371339\/qdag068.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T17:53:41Z","timestamp":1773683621000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/doi\/10.1093\/jsxmed\/qdag068\/8524996"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":26,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,3,9]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdag068","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,9]]},"article-number":"qdag068"}}