Postsurgical Pain, Psychosocial Functioning, and Cannabis Use Among Adolescents and Young Adults Undergoing Gender-Affirming Surgery

PURPOSE: Little is known about transgender and gender expansive (TGE) adolescents' and young adults' (AYAs') pain and psychosocial experiences in the acute postsurgical period following gender-affirming surgery (GAS). This study describes pain symptomatology and psychosocial functioning within 1 month after GAS among TGE AYAs, examines immediate postsurgical associations of cannabis use with pain symptomatology, pain catastrophizing, and psychosocial functioning, and explores pain persistence, cannabis use, and psychosocial functioning in a subgroup of individuals 6 months after surgery.

METHODS: AYAs (N = 64) underwent GAS at a large academic medical center in the Pacific Northwest between March 2019 and June 2023. Participants reported on pain intensity, pain interference, pain catastrophizing, anxiety, depression, and cannabis use. Independent and paired-samples t-tests examined differences by age, past 30-day cannabis use, and from the postsurgical period to 6-month follow-up.

RESULTS: Participants reported acute and persistent pain following GAS. Younger age was associated with improved pain interference in the postoperative stage. Reports of past 30-day cannabis use were high in this sample, and cannabis use was associated with higher pain interference, anxiety, and depression.

CONCLUSION: This study is the first to assess AYA pain functioning, mental health, and cannabis use following GAS within 1 month of surgery and at 6 months. Findings suggest that 6 months after GAS is a postsurgical adjustment phase, necessitating more supportive perioperative and psychosocial resources, including attention to substance use, during this crucial window.