Trauma-Informed Care for Genital Skin Diseases in Transgender Patients

Conclusions

• Sex and gender should be understood as multidimensional constructs rather than simple binary categories, especially when evaluating genital anatomy and skin disease in transgender and gender-diverse patients.
• Transgender and gender-diverse patients often avoid discussing genital concerns because of stigma, so clinicians need to proactively invite these conversations and normalize them in routine care.
• A trauma-informed, consent-based, patient-led approach is essential for genital history-taking and examination, because many transgender patients have significant prior experiences of assault, discrimination, and medical mistreatment.
• Dermatology visits for transgender patients should prioritize affirming language, visible positioning, explanation before touch, options for chaperones or support people, and immediate stopping if discomfort arises.
• Gender-affirming surgeries create unique postoperative anatomies that require clinicians to know the reconstructive techniques in order to recognize normal anatomy versus pathology.
• Common genital dermatoses after gender-affirming surgery include inflammatory conditions, contact dermatitis, lichen sclerosus, infections, warts, and neoplastic disease.
• HPV-related disease appears to be a frequent and clinically important problem in post-vaginoplasty patients and can present as condyloma that responds to therapies such as imiquimod or cryotherapy.
• Rare but serious complications such as fistula, ulceration, and squamous cell carcinoma can occur in reconstructed genital tissue, particularly when access to ongoing gynecologic surveillance is limited.
• Colonic vaginoplasty can improve lubrication through mucus production, but excessive secretion may also cause irritant dermatitis that can sometimes be helped by reducing secretions pharmacologically.
• In phalloplasty, inadequate or persistent hair in the neourethra can lead to stricture, infection, granuloma, and repeated surgery, making durable preoperative hair removal critical.
• Dermatologists can play an important preventive role in gender-affirming surgery by coordinating effective permanent hair removal and postoperative skin care with surgical teams.
• Overall, better outcomes for transgender patients depend on clinicians speaking comfortably and respectfully about genital anatomy, sexual health, and gender identity while providing inclusive, individualized care.