From the Guidelines
Male-to-female (MTF) transgender individuals who have undergone vaginoplasty are at risk of experiencing vaginal candidiasis (yeast infection), and treatment typically involves antifungal medications such as fluconazole 150mg as a single oral dose or topical treatments like clotrimazole or miconazole creams applied to the neovaginal canal for 7 days, as recommended by the 2021 Centers for Disease Control and Prevention (CDC) guidelines 1.
Diagnosis and Treatment
The diagnosis of vulvovaginal candidiasis (VVC) can be challenging, and microscopy and clinical suspicion have been used for decades, but culture remains the gold standard for diagnosis of vaginal fungal infections 1. However, molecular testing, such as polymerase chain reaction (PCR), has shown high clinical accuracy for diagnosing VVC, with sensitivity and specificity of 90.9% and 94.1%, respectively 1.
Prevention Strategies
Prevention strategies for vaginal yeast infections in MTF transgender individuals who have undergone vaginoplasty include proper hygiene, avoiding douching, wearing breathable underwear, and maintaining dilation practices as recommended by healthcare providers.
- Proper hygiene practices, such as gentle cleaning of the neovaginal canal with mild soap and water, can help prevent yeast infections.
- Avoiding douching, which can disrupt the natural balance of microorganisms in the neovagina, is also recommended.
- Wearing breathable underwear, such as cotton, can help keep the neovaginal area dry and reduce the risk of yeast overgrowth.
- Maintaining dilation practices, as recommended by healthcare providers, can help prevent stenosis and promote healthy tissue growth in the neovagina.
Important Considerations
It is essential to note that the neovagina is typically lined with skin grafts rather than mucosa, creating a different environment than a natal vagina, but one that still supports various microorganisms, including Candida species that can cause yeast infections when overgrowth occurs. Therefore, MTF transgender individuals who have undergone vaginoplasty should be aware of the risk of vaginal yeast infections and take preventive measures to maintain good hygiene and prevent yeast overgrowth.
From the Research
Vaginal Candidiasis in MTF Transgender Individuals
- There is limited research on vaginal health after vaginoplasty, including the incidence of vaginal candidiasis (yeast infection) in male-to-female (MTF) transgender individuals 2.
- A study on gynecological concerns and vaginal practices among transfeminine individuals who have undergone vaginoplasty found that participants reported various gynecological concerns, including urinary tract infections and internal hair regrowth, but did not specifically mention vaginal candidiasis 2.
- Other studies have focused on the surgical techniques and complications of vaginoplasty, such as flap necrosis, rectal and urethral injuries, and vaginal stenosis, but have not addressed vaginal candidiasis specifically 3, 4, 5, 6.
- Overall, there is a lack of research on the incidence and management of vaginal candidiasis in MTF transgender individuals who have undergone vaginoplasty.
Gynecological Concerns and Vaginal Practices
- A study on transfeminine individuals who have undergone vaginoplasty found that participants reported a range of gynecological concerns, including urinary tract infections, internal hair regrowth, and vaginal symptoms such as malodor and bleeding 2.
- The study also found that participants engaged in various vaginal practices, including dilating and douching, but did not provide information on the incidence of vaginal candidiasis 2.
- Other studies have reported on the outcomes of vaginoplasty, including patient satisfaction, functional outcomes, and aesthetic outcomes, but have not addressed vaginal candidiasis specifically 5, 6.
Need for Further Research
- There is a need for further research on the incidence and management of vaginal candidiasis in MTF transgender individuals who have undergone vaginoplasty 2.
- Studies should investigate the prevalence of vaginal candidiasis in this population, as well as the effectiveness of different treatment options and prevention strategies.
- Additionally, research should focus on developing evidence-based guidelines for vaginal care and health in MTF transgender individuals who have undergone vaginoplasty 2.