Results:
Overall, 869 and 357 patients were identified undergoing vaginoplasty and phalloplasty with 193 (22.2%) and 74 (20.7%) having at least one psychiatric encounter (Table 1). Although the overall proportion of those experiencing a psychiatric encounter was similar between the vaginoplasty and phalloplasty groups, suicide attempts were more common in the vaginoplasty group (4.4% vs. 1.7%, p=0.033). The rate of a psychiatric encounter occurring after surgery if an episode prior surgery occurred was 33.9% and 26.5% for the vaginoplasty and phalloplasty groups. The overall rates of suicide attempts doubled (3.3 vs 1.5%, p=0.017) after vaginoplasty (effect not observed after phalloplasty).
Conclusions:
Rates of psychiatric emergencies are high both before and after gender affirming surgery. Although both the phalloplasty and vaginoplasty patients have similar overall rates of psychiatric encounters, suicide attempts are more common in the later. In fact, our observed rate of suicide attempts in the phalloplasty group is actually similar to the general population, while the vaginoplasty group's rate is more than double that of the general population. Patients undergoing GAS with a history of prior psychiatric emergences or feminizing transition are at higher risk and should be counseled appropriately.