Gender incongruence, defined in the International Classification of Diseases as “a marked and persistent incongruence between an individual's experienced gender and the assigned sex,” is now recognized as a sexual health condition and not a mental illness.
Treatment options vary for gender incongruence, and a new analysis in the American Journal of Roentgenology provided radiologists with a “general overview” of three key categories of gender affirmation surgery.
“In the clinical setting, it is important to recognize the presentation of gender spectrums and identify gender dysphoria or incongruence, and radiologists must be trained in parallel to recognize postsurgical variations in gender affirmation surgery and screening guidelines,” wrote lead author Florence X. Doo, MD, Mount Sinai West in New York City, and colleagues.
1. Gender reconstruction
When treating trans females, the authors explained, pelvic MRI is the best modality for evaluating hematomas and fluid collection, two common complications related to vaginoplasty.
The authors also made an important distinction regarding any imaging procedures occurring following gender reconstruction surgery.
“At the end of the procedure, radiopaque vaginal packing is inserted, which should not be mistaken for other foreign bodies on postoperative imaging,” Doo said in a prepared statement.
When evaluating trans males, the team added, retrograde urethrograms lead to stricture overdiagnosis. But they may sometimes still be the right treatment in certain circumstances.
“However, for confirmation of stricture with abnormal function tests and also for evaluation for fistula, a retrograde urethrogram or voiding cystourethrogram can be obtained,” Doo said in the same statement.
2. Body contouring
Trans males should still seek out regular breast cancer screening following subcutaneous mastectomy, the authors noted, because the nipple and areola remain. And trans males are at an increased risk of breast cancer following neoadjuvant hormone replacement therapy, meaning regular screening is recommended for those patients as well.
3. Maxillofacial contouring
Medical imaging often occurs before surgeries to the jaws or face to “assess the anatomical need for frontal eminence reduction.” And when patients receive facial augmentation via neurotoxin injections or illegal silicone injections, the authors added, they can register on imaging examinations.
“Postoperative imaging is not typically obtained because external aesthetic results can be adequately evaluated by the surgeon,” Doo said in the statement.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.