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Topical Corticosteroid Use on Vaginal Dilators Is Associated with Reduced Stricture Rates Following Gender-Affirming Vaginoplasty
Emma Lascar
*1, Safia Singer
2, Lisa Duan
2, Emily Payne
2, Sheuli Chowdhury
1, Sahil Sharma
1, Patricia Fuentes
1, Rebecca Suydam
1, Peter J. Taub
1, Peter W. Henderson
1, Elan Horesh
11Division of Plastic and Maxillofacial Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; 2Icahn School of Medicine at Mount Sinai, New York, NY
Background: Neovaginal stricture occurs in 12-15% of patients following gender-affirming vaginoplasty and frequently requires revision. Though topical corticosteroids show anti-fibrotic effects in other stricture-prone surgical contexts, their role in neovaginal stricture prevention remains unstudied. This study examined whether prophylactic topical corticosteroids are associated with reduced stricture after primary vaginoplasty.
Methods: A retrospective review of all primary vaginoplasties at a single academic center (2016-2022) was performed. Postoperative topical corticosteroid use (applied to vaginal dilators) and indication were recorded. The primary outcome was neovaginal stricture. Patients prescribed steroids for existing stricture were excluded in sensitivity analysis to mitigate confounding by indication. Multivariable logistic regression adjusted for age, BMI, smoking, diabetes, race, vaginoplasty technique, and keloid/hypertrophic scar history (p<0.05).
Results: Among 235 patients (mean age 33.0 +/- 11.3 years, mean BMI 25.3 +/- 4.4 kg/m
2), 71 (30.2%) received postoperative topical corticosteroids. Overall stricture rate was 19.6%. Stricture occurred in 8.5% of steroid users versus 24.4% of non-users (p=0.003). On multivariable analysis, corticosteroid use was independently associated with reduced stricture odds (adjusted OR 0.38, 95% CI 0.14-1.00, p=0.049). Sensitivity analysis excluding 13 patients treated for existing stricture strengthened this association (adjusted OR 0.21, 95% CI 0.07-0.60, p=0.003).
Conclusion: Prophylactic postoperative topical corticosteroid application to vaginal dilators is independently associated with reduced neovaginal stricture risk following primary vaginoplasty, with a stronger protective effect after excluding patients treated for established stricture. These findings suggest topical corticosteroids may represent a simple, low-cost postoperative adjunct. Prospective studies are warranted to confirm causality and define optimal protocols.
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