(065) ANATOMY OF THE TRANSFEMININE PELVIC FLOOR FOLLOWING GENDER AFFIRMING VAGINOPLASTY - A PROPOSAL FOR EDUCATIONAL MODELS
Bibliographic record
Abstract
Abstract Introduction Gender affirming vaginoplasty is a feminizing surgery that involves the creation of vulvar and vaginal structures from existing penile and scrotal tissues. Post-operative evaluation often includes clinical assessment of the pelvic floor function – specifically in regard to the patency of the neo-vaginal canal and intravaginal dilations, urinary and bowel function, sexual function and sensation, pelvic pain and more. The current landscape of educational models devoted to post - Vaginoplasty pelvic anatomy is extremely limited. This gap in resources poses a clinical challenge for care providers in the evaluation and diagnosis of pelvic floor related issues following vaginoplasty surgery. Objective To develop a clinical manual illustrating intraoperative reconstructive steps and post-operative transfeminine pelvic anatomy, including the relation between pelvic organs, key musculoskeletal structures, and neuro-vascular pathways. Methods This proposal is the product of a meaningful collaboration between multidisciplinary specialists including urology, gynaecology, nursing and pelvic floor physiotherapy. All providers involved in this research have expertise in transgender health and work in a high-volume gender affirming surgical centre. This manual draws on available anatomical references of preoperative pelvic anatomy, with the incorporation of intraoperative illustrations of different steps of pelvic reconstruction implementing the Penile Inversion Vaginoplasty technique. Post operative transfeminine models illustrate the neo- vulvar and neo-vaginal structures in relation to various surrounding layers; including connective tissues, ligaments and muscles with demonstration of the different compartments and organs left in situ (prostate, bladder and rectum). Results Constructed transfeminine pelvic anatomy is presented through out various stages of a penile inversion vaginoplasty (Fig. 1) with post operative illustrations of the different compartments in the pelvis. (Figure 2). Fig. 1 – Intraoperative transverse cut illustration in lithotomy position during a Penile Inversion Vaginoplasty. Neo-Clitoris (Glans) is constructed from the penile glans. Clitoral hood and labia minora are derived from distal foreskin of the penis. The urethra is spatulated and reconstructed to create a new urethral meatus (catheter in place), adjacent and anterior to the perineal body and the Neo-vaginal introitus (excluded from this image). Fig. 2 – a 3D illustration of the transfeminine pelvis in lithotomy position. On the patient’s right side the superficial layers are shown – The neo-clitoris and Labia Minora in relation to the pubis, neo-urethra and neo-vagina. Bulbospongiosus muscle has been surgically removed excluding the insertion to the perineal body. Ischiocavernosus muscle has been surgically removed excluding the insertion to the Ischium. On the patient’s left side the deeper layers showing the prostatic urethra are shown, the Levator Ani muscles are presented in relation to the neo-vagina. Conclusions This proposal for educational models of transfeminine pelvic anatomy following gender-affirming vaginoplasty holds significant clinical value for multidisciplinary healthcare providers, aiming to enhance understanding and management of pelvic health issues and post-operative care for patients. Disclosure No.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.035 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".