Andrology. 2021;00:1–12. | 1 wileyonlinelibrary.com/journal/andr 1 | INTRODUCTION Studies estimate that approximately 25 million individuals world- wide, including one million people in the United States, identify as transgender. 1–4 In recent years, more widespread access to surgery and improved insurance coverage have resulted in in- creasing numbers of transgender individuals pursuing surgical interventions. 5 In a 2019 study, 28% of transgender women re- ported undergoing gender-affirming surgical procedures, with 5−13% of these surgeries involving genital surgery. 6 Of the trans- gender women who had not undergone gender-affirming surgery, 45–54% of individuals reported that they hope to do so in the future. 6 For many individuals, gender-affirming surgery helps to al- leviate gender dysphoria and improve quality of life. Gender- affirming surgery is generally safe, effective, and medically necessary. Although complications can occur, many are self- limited and are commensurate with complication rates of com- plex genitourinary reconstruction performed for other diagnoses (ie, oncological and congenital). 7–13 This article will provide a thorough analysis of post-operative outcomes following penile inversion vaginoplasty, including topics related to patient satis- faction and adverse events. 2 | PENILE INVERSION VAGINOPLASTY When reviewing the literature and assessing the data pertain- ing to vaginoplasty, it is important to recognize that surgical techniques vary between surgeons. In addition, terminology used to describe procedures and/or complications and out- comes also differs. Vaginoplasty typically involves penectomy, orchiectomy, clitoroplasty, vulvoplasty, and the construction of a vaginal canal. Most often, the surgical goals include a cosmeti- cally appealing and sensate vulva and clitoris, and a vagina ca- pable of receptive intercourse. Various surgical techniques are used to create the vagina and its lining, with the most common being a skin-lined neovagina. Other methods include pedicled intestinal flaps, skin grafts from other anatomic sites (abdomen, flanks, buttocks, etc.), and/or peritoneal tissue. The penile in- version vaginoplasty is generally favored by most surgeons and involves the use of penile skin flaps often in conjunction with Received: 9 February 2021 | Revised: 8 April 2021 | Accepted: 1 May 2021 DOI: 10.1111/andr.13030 REVIEW ARTICLE Penile inversion vaginoplasty outcomes: Complications and satisfaction Rayisa Hontscharuk | Brandon Alba | Alireza Hamidian Jahromi | Loren Schechter © 2021 American Society of Andrology and European Academy of Andrology Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA Correspondence Loren Schechter, Rush University Medical Center, 1620 West Harrison Street, Chicago, IL, USA. Email: lss@univplastics.com Abstract Penile inversion vaginoplasty helps to alleviate gender dysphoria and improve qual- ity of life in many transgender individuals. Overall, the procedure is associated with high post-operative satisfaction, even when complications occur. Adverse events related to vaginoplasty are commensurate with other genitourinary reconstructive procedures performed for other diagnoses (ie, cancer or congenital issues). Here, we explore the incidence of complications following vaginoplasty, emphasizing the chal- lenges in defining and managing these adverse events. In addition, outcome measures to assess patient satisfaction will be reviewed. KEYWORDS complication, satisfaction, surgical outcome, transgender, vaginoplasty