1. SEXUAL FUNCTIONING IN TRANSWOMEN AFTER SEX REASSIGNMENT SURGERY C.I.D.I.Ge.M. Centro Interdipartimentale Disturbi dell’Identità di Genere Molinette University of Turin Chiara CRESPI, Valentina MINECCIA, Chiara MANIERI, Mariateresa MOLO Carlo Molo Foundation -onlus-

2. AIMS  To compare the quality of sexual life after Sex Reassignment Surgery (S.R.S.) between transwomen and a control group of women  To investigate the sexual functioning in transwomen after SRS  To compare the sexual functioning between transwomen and control women

3. MATERIALS AND METHOD

4. 50% (N=25)‏ N tot =50 50% (N=25)‏ The Sample

5. TOT SAMPLE (N=50)MtF WOMEN Sex 25(50%) AGE, YEARS (  SD)30,51 (  9,89) 31,02(  8,97) EDUCATIONAL LEVEL, YEARS (  SD) 11,55 (  3,28) 12,67(  2,67) MARITAL STATUS, N (%):  Single  Married  Cohabitant 16(64%) 17(68%) 2 (8%) 5 (20%) 7(28%) 3 (12%) STABLE RELATIONSHIP  YES  No 12(48%) 19(76%) 13(52%) 6(24%) SEXUAL ORIENTATION  Eterosexual  Omosexual 24(99%) 1(1%) 1(1%) SOCIAL AND DEMOGRAPHIC CARACTERISTICS

6. Study project The study is based on: Clinical Data World Health Organization Quality of Life Questionnaire ( WHOQOL-100) Female Sexual Function Index (F.S.F.I.) ‏ Almost two years after the SRS

7. CLINICAL DATA  Sexual orientation;  Presence of a stable relationship;  Surgical complications;

8. TRANSWOMEN CONTROL WOMEN STABLE RELATIONSHIP  YES  No 12(48%) 13(52%) 19(76%) 6(24%) SEXUAL ORIENTATION  Eterosexual  Omosexual 24(99%) 1(1%) KIND of SURGERY  Vaginoplasty  Rectosigmoid flap 23(92%) 2(8%) NO surgical complications CLINICAL DATA

9. - Pain - Energy - Sleep - Positive emotions - Reasoning skills - Self-Esteem -Body Image -Negative emotions -Mobility -Daily living activities - Drug addiction - Work ability - Interpersonal relationships - Social support - Sexual activity -Safety -Home environment -Financial resources -Health care - Opportunities for new knowledge -Recreation - Physical environment - Transports - Spirituality WHOQOL-100 QUESTIONNAIRE 24 subscales

10. - Desire - Arousal - Lubrication - Orgasm - Sexual Satisfaction - Pain -Total Score* Female Sexual Function Index (F.S.F.I) * Cut off ≤26,55 : risk for sexual dysfunction (Wieger et al., Journal of Sex & Marital Therapy, 31:1-20, 2005)

11. RESULTS

12. AIMS  To compare the quality of sexual life between transwomen and control women  To investigate the sexual functioning in transwomen after SRS  To compare the sexual functioning between transwomen and control women

13. THE COMPRISON BETWEEN MTF AND CONTROL WOMEN IN THE QUALITY OF SEXUAL LIFE Sample N Mean SD SE ------------------------------------------------------------------------------------------- 1. Data1_QOLSexDIG 25 59.032 21.121 4.2242 2. Data1_QOLSexC 25 61.008 20.66535 4.13307 ------------------------------------------------------------------------------------------- Difference of Means: -1.976 t DoF P Value ------------------------------------------------ -0.33436 48 0.73957 *Two Sample Independent t-Test ------------------------------------------------ *Cut off≥50 *

14. AIMS  To compare the quality of sexual life between transwomen and control women  To investigate the sexual functioning in transwomen after SRS  To compare the sexual functioning between transwomen and control women

15. *Cut off ≤26,55 risk for sexual dysfunction (Wieger et al., Journal of Sex & Marital Therapy, 31:1-20, 2005) Mean ±SD Desire4,31,2 Arousal4,41,0 Lubrication4,41,2 Orgasm4,41,2 Satisfaction4,31,5 Pain3,71,6 TOTAL SCORE* 25,57,7 Transwomen Sexual Functioning Index: FSFI

16.  The sexual DESIRE in terms of frequency and level generally is HIGH;  The AROUSAL (frequency, level, confidence and satisfaction) is HIGH;  The LUBRICATION in terms of frequency, difficulty and frequency in mantaining is in average /with a tendency to lower scores;  The frequency, the difficult and the satisfaction about ORGASM is in average with a tendency to lower scores;  The SATISFACTION is in average  The PAIN in terms of frequency during/following vaginal penetration is generally HIGH;  The Total Score is borderline, close to the risk of sexual dysfunctions TRANSWOMEN

17. AIMS  To compare the quality of sexual life between transwomen and control women  To investigate the sexual functioning in transwomen after SRS  To compare the sexual functioning between transwomen and control women

18. *Cut off ≤26,55 risk for sexual dysfunction (Wieger et al., Journal of Sex & Marital Therapy, 31:1-20, 2005) Sexual functioning : F.S.F.I. Transwomen Control women Mean ±SD Mean

19.  The control womens’ DESIRE in terms of frequency and level is LOWER than Transwomen  The AROUSAL is HIGH in both groups  The LUBRICATION and the ORGASM (frequency, level, difficult, confidence and satisfaction) are HIGH in the control group while they are in an average level in the Trans women sample  The SATISFACTION is in an average level in both groups  The control group’s PAIN in terms of frequency during/following vaginal penetration is LOWER than Transwomen  The TOTAL SCORE is in average; normative cluster (i.e no risk of sexual dysfunctions) CONTROL WOMEN versus TRANSWOMEN

20. CONCLUSIONSCONCLUSIONS 1.After SRS the Quality of Sexual Life is good without statistically differences from control women 1.After SRS the Quality of Sexual Life is good without statistically differences from control women 2. Transwomen showed some difficults in sexual functioning 2. Transwomen showed some difficults in sexual functioning 3. The main problems are concerning Lubrication, orgasm and pain 3. The main problems are concerning Lubrication, orgasm and pain

21. CONCLUSIONSCONCLUSIONS Problems about lubrication are related to the kind of surgery (only two patients made “rectosigmoid flap”) Problems about lubrication are related to the kind of surgery (only two patients made “rectosigmoid flap”) Problems about orgasm and pain are probably related to the difficulty in integrating new genitalia in the Body Image Problems about orgasm and pain are probably related to the difficulty in integrating new genitalia in the Body Image We think that after SRS a specific psychosexual intervention is necessary We think that after SRS a specific psychosexual intervention is necessary