Abstract
Gender-affirming vaginoplasty is performed for transwomen desiring surgical alignment of their genitalia with their perceived gender. The commonest technique performed for vaginoplasty is penile skin inversion, which utilises penile and scrotal skin to construct a neovagina and vulva. An uncommon risk is squamous cell carcinoma of the neovagina. A systematic review was performed, which identified 9 cases of neovaginal squamous cell carcinoma following gender-affirming vaginoplasty for transgender women. In addition, the authors also presented a case of their own and their experience of managing such case. Squamous cell carcinoma may present at least 8 years following the initial vaginoplasty, and presenting symptoms include neovaginal bleeding, discharge, pain, urinary or bowel symptoms. Treatment depends on the stage of disease and include radical surgery, neoadjuvant, adjuvant or palliative chemoradiotherapy. Due to the rarity of neovaginal squamous cell carcinoma, it is important that clinicians are familiar with the anatomy and clinical examination of individuals who have had gender-affirming vaginoplasty. In addition, such cases should ideally be managed at an expert centre in a multidisciplinary setting. As squamous cell carcinoma can present decades following vaginoplasty, sexual health education is important as well as long-term sexual transmitted infection and cancer screening.
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Fig. 1: Abdominal-pelvic MRI of the neovaginal mass.
Fig. 2: Intraoperative images of the neovaginal mass excision.
Fig. 3: Histopathological slides of the neovaginal specimen.
Fig. 4
Data availability
All data generated or analysed during this study are included in this published article.
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Acknowledgements
AM acknowledges support from the NIHR Biomedical Research Centre UCLH.
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Authors and Affiliations
Male Genital Cancer Centre, Department of Andrology, University College London Hospitals NHS Foundation Trust, London, UK
Karl H. Pang, Varun Sadhev, Hussain M. Alnajjar, Rowland Rees & Asif Muneer
Division of Surgery and Interventional Sciences, University College London, London, UK
Karl H. Pang, Hussain M. Alnajjar & Asif Muneer
Department of Urology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
Karl H. Pang
Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
Varun Sadhev & Rowland Rees
Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
Aiman Haider
National Institute for Health and Care Research (NIHR) Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
Asif Muneer
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Karl H. Pang
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4. Hussain M. Alnajjar
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Conceived and/or designed the work that led to the submission: KHP, AM; acquired data, and/or played an important role in interpreting the results: VS, AH, RS, HMA, AM. Drafted or revised the manuscript: KHP, VS, AH, RS, HMA, AM. Approved the final version: KHP, VS, AH, RS, HMA, AM. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: KHP, AM.
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Correspondence to Asif Muneer.
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This was a case report and systematic review, and formal ethical approval through our institutional board was not required. The patient consented for photos to be taken and used for publication. The reporting adhered to the PRISMA checklist.
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Pang, K.H., Sadhev, V., Haider, A. et al. Squamous cell carcinoma of the neovagina following transgender woman gender-affirming vaginoplasty: a case report and systematic review. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01048-z
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Received:18 October 2024
Revised:24 February 2025
Accepted:10 March 2025
Published:29 March 2025
DOI:https://doi.org/10.1038/s41443-025-01048-z
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