Trans/Non-Binary Awareness

Question 1

What does AFAB stand for?

Answer 1

Assigned female at birth

Question 2

What does AMAB stand for?

Answer 2

Assigned male at birth

Question 3

What is an intersex person?

Answer 3

Someone whose anatomical, hormonal or chromosomal profile does not fit that which is typically ‘male’ or ‘female’.

Question 4

What are the hormonal causes of intersex presentations?

Answer 4

Androgen insensitivity syndrome (AIS)

Congenital adrenal hyperplasia (CAH)

Question 5

What are the chromosomal causes of intersex presentations?

Answer 5

Klinefelter syndrome (XXY)
5-alpha reductase deficiency

Question 6

What are the anatomical causes of intersex presentations?

Answer 6

Aphallia (congenital absence of the penis / clitoris)

Müllerian agenesis

Question 7

What is the prevalence of HIV in trans-women?

Answer 7

19.9% overall (worldwide), higher in more developed countries

Question 8

How should you examin a AMAB person with a neo-vagina?

Answer 8

A proctoscope may be more comfortable than a speculum

Question 9

In what clinical context would knowing the type of vaginal surgery a trans- patient has had be relevant?

Answer 9

If the neo-vagina has been fashioned from colon tissue - colovaginoplasty - vaginal symptoms should be managed as as a possible proctitis. Where infection has been excluded, diversion colitis may be a cause to consider

Question 10

What possible complications can result from genital surgery in AMAB?

Answer 10

1. Vaginal canal stenosis
2. Stenosis of the urethral meatus / urination difficulties
3. Hair growth in the vagina
4. Vaginal discharge
5. Vaginal or vulval pain
6. Vaginal bleeding
7. Vaginal tissue prolapse
8. Sexual function difficulties (e.g. anorgasmia or dyspareunia)

Question 11

What is the complication rate of genital surgery in AMAB?

Answer 11

32.5%, with the re-operation rate being 21.7% for non-cosmetic reasons

Question 12

What are the most common types of genital surgery for AFAB?

Answer 12

1. Hysterectomy ± BSO
2. Colpoplasty/colpoclesis/colpectomy (closure, fusion or removal of the vagina)
3. Scrotoplasty (creation of a scrotum, possibly with testicular implants)
4. Metoidioplasty (creation of a small penis from enlarged clitoral tissue)
5. Phalloplasty (creation of a penis in several stages, typically using a skin graft from the abdomen or forearm)