Sexual satisfaction and function (SatisFunction) survey post-vaginoplasty for transgender and gender diverse individuals: preliminary development and content validity for future clinical use.

Background: Transgender and gender diverse individuals (TGDIs) are people whose gender identity is not in line with their sex assigned at birth, but current surveys used for cisgender patients addressing sexual satisfaction and function (SFS) do not fit the needs of this unique population. Aim: The authors of this project sought to create and validate a new comprehensive survey in North American English that differs from the current options for TGDI post-vaginoplasty. Materials and methods: Using the current literature on SFS as a foundation, a 26-item survey was created and distributed to 16 TGDI at least 3 months post-vaginoplasty. Feedback and review for content validity took place in the forms of interviews with the 16 TGDI, an expert panel, and the creation of a community advisory board. Outcomes: Feedback was incorporated to transform the original 26-item questionnaire into a 32-question survey with eight domains, named the SatisFunction Survey Post-Vaginoplasty, which represents the preliminary development and content validity of the survey, with its clinical use not recommended until further validation steps are completed. Results: Feedback focused on improving the clarity of questions to address sexual vs non-sexual behaviors, providing definitions of terms in the question stems for improved user understanding, including more questions on specific anatomic locations, addressing gender dysphoria as it relates to genital self-image, specifying type of vaginoplasty and only including questions relevant to those with or without a vaginal canal. Clinical implications: The authors foresee clinical use of the survey for recurrent assessment in the postoperative period as well as post-revision. Strength and limitations: Community-based research is essential in developing an assessment tool tailored to the unique needs of a specific population. This study presents the findings of preliminary content validation but requires further validation before clinical use, and is limited by a small sample size from a single-site institution. Conclusion: Future directions involve completing the validation process for the survey with distribution to a larger TGDI population with other validated surveys with a subsequent cohort interview to address construct and divergent validity as well as reliability.