The role of the behavioral health provider in supporting patients undergoing gender-affirming genital reconstructive surgery

As gender-affirming surgery becomes more widely available, the demand for such procedures has increased accordingly. Where once genital reconstructive surgeries, such as vulvovaginoplasty, metoidioplasty, and phalloplasty, were accessible only to a select few individuals in a limited number of facilities, they are now offered to a broader cross-section of prospective patients. The life experiences, social environments, and support available to these patients vary widely, and many can benefit from the support of behavioral health professionals. While this is true for many types of reconstructive surgery, gender-affirming genital surgeries have the potential to dramatically reshape how individuals relate to their bodies across numerous domains - affecting not just gender congruence, but also sexuality and daily activities such as toileting. Behavioral health providers play a crucial role in supporting patients through the preparation and recovery processes for these surgeries. This includes helping to identify areas of a patient’s life that may complicate recovery and working with them to develop appropriate healing strategies. While the role of behavioral health providers is sometimes complicated by their parallel responsibilities in regulating access to care through the letter-writing process, they are well-positioned to support patients across the perioperative period when their expertise is used to facilitate patient readiness and recovery. This review article explores how behavioral health professionals can support the well-being of individuals undergoing gender-affirming genital surgery, from the presurgical period through long-term recovery. It is also intended to raise surgeons’ awareness of the impact of mental health and social determinants of health on the perioperative experience and to facilitate the provision of trauma-informed care and support.