Project 452201

Transgender and gender diverse (TGD) people have been largely excluded from sexual health research, though as many as 1/200 adults are TGD. Many transfeminine (tF) individuals choose to undergo the gender-affirming surgery of vaginoplasty, defined as the surgical creation of a neovagina (typically using penile skin). However, post-vaginoplasty complications such as hypertrophic granulation tissue and discharge occur after almost two-thirds of vaginoplasties, and tF frequently express concerns around neovaginal malodor and discharge in the post-healing period. The pathogenesis of post-vaginoplasty neovaginal concerns are poorly understood, and as such evidence-based clinical guidelines for their prevention and treatment are completely lacking. The genital microbiome is a critical determinant of health in cisgender males and females. Bacterial dysbiosis causes inflammation and symptoms such as discharge and pain and renders the genital mucosa more susceptible to sexually transmitted infections. The composition of the neovaginal microbiome is almost completely uncharacterized. Bacteria may also contribute to delayed wound healing and hypertrophic granulation tissue post-surgically. This proposal aims to characterize the neovaginal microbiome, identify what constitutes an optimal, low-inflammation microbiome, and to define what factors in the perioperative period contribute to the establishment of an optimal neovaginal microbiome. This research has the capacity to immediately improve the health of tF in Canada who choose to undergo vaginoplasty.