Advertisement

Long-Term Sensitivity and Patient-Reported Functionality of the Neoclitoris After Gender Reassignment Surgery

Published:January 10, 2017DOI:https://doi.org/10.1016/j.jsxm.2016.12.003

      Abstract

      Introduction

      A cornerstone of treating gender dysphoria for transgender women is gender reassignment surgery (GRS) encompassing vaginoplasty and clitoroplasty. The neoclitoris is harvested as a flap with a neurovascular pedicle from the proximal dorsal part of the glans penis. Few long-term follow-ups exist on postoperative sensation and patient-reported sexual functionality of the neoclitoris.

      Aim

      To examine the sensitivity of the neoclitoris and its relation to orgasm and sexual function at least 1 year after GRS.

      Methods

      Twenty-two patients were included, with a mean follow-up of 37 months (range = 12–63) after initial surgery. Tactile and vibratory sensitivities were measured with Semmes-Weinstein monofilaments and the Bio-Thesiometer vibratory measurement device, respectively. A questionnaire was provided to the patients, as were interview questions about body image, orgasm, pain, and general satisfaction with the surgery.

      Main Outcome Measures

      Tactile and vibratory sensitivities of the neoclitoris and questionnaire on satisfaction with orgasm, sexual function, and general satisfaction.

      Results

      The average tactile threshold for the clitoris was 12.5 g/mm2 and the average vibratory threshold was 0.3 μm. Most participants (86%) experienced orgasm after surgery, had no or little pain, and were satisfied with the surgery. No statistical correlation was found between better or worse objective pressure and vibratory thresholds and patient answers to questions about the clitoris in the Body Image Scale for Transsexuals questionnaire.

      Conclusion

      The neoclitoris derived from the glans penis in GRS provides long-term clitoral sensation that is erogenous. Overall, the vast majority of patients who undergo male-to female GRS experience orgasm and are satisfied with the surgery.

      Key Words

      To read this article in full you will need to make a payment
      ISSM Member Login
      Login with your ISSM username and password.
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders (DSM-5).
        (Available at:)
        • World Health Organization
        International classification of diseases, tenth revision.
        (Available at:)
        • Wallen K.
        • Lloyd E.A.
        Female sexual arousal: genital anatomy and orgasm in intercourse.
        Horm Behav. 2011; 59: 780-792
        • Brown J.
        Creation of a functional clitoris and aesthetically pleasing introitus in sex conversion.
        in: Marchac D. Hueston J.T. Transactions of the Sixth International Congress of Plastic and Reconstructive Surgery. Masson, Paris1976: 654-655
        • Wesser D.R.
        A single stage operative technique for castration, vaginal construction and perineoplasty in transsexuals.
        Arch Sex Behav. 1978; 7: 309-323
        • Selvaggi G.
        • Monstrey S.
        • Ceulemans P.
        • et al.
        Genital sensitivity after sex reassignment surgery in transsexual patients.
        Ann Plast Surg. 2007; 58: 427-433
        • von Szalay L.
        [Construction of a neo-clitoris in male-to-female transsexuals].
        Handchir Mikrochir Plast Chir. 1990; 22 ([in German]): 277-278
        • Fang R.H.
        • Chen C.F.
        • Ma S.
        A new method for clitoroplasty in male-to-female sex reassignment surgery.
        Plast Reconstr Surg. 1992; 89 (discussion 683): 679-682
        • Eldh J.
        Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals.
        Plast Reconstr Surg. 1993; 91 (discussion 901-903): 895-900
        • Rubin S.O.
        Sex-reassignment surgery male-to-female. Review, own results and report of a new technique using the glans penis as a pseudoclitoris.
        Scand J Urol Nephrol Suppl. 1993; 154: 1-28
        • Rehman J.
        • Melman A.
        Formation of neoclitoris from glans penis by reduction glansplasty with preservation of neurovascular bundle in male-to-female gender surgery: functional and cosmetic outcome.
        J Urol. 1999; 161: 200-206
        • Hage J.J.
        • Karim R.B.
        Sensate pedicled neoclitoroplasty for male transsexuals: Amsterdam experience in the first 60 patients.
        Ann Plast Surg. 1996; 36: 621-624
        • Hess J.
        • Hess-Busch Y.
        • Kronier J.
        • et al.
        Modified preparation of the neurovascular bundle in male to female transgender patients.
        Urol Int. 2016; 96: 354-359
        • Lindgren T.W.
        • Pauly I.B.
        A body image scale for evaluating transsexuals.
        Arch Sex Behav. 1975; 4: 639-656
        • Kuiper B.
        • Cohen-Kettenis P.
        Sex reassignment surgery: a study of 141 Dutch transsexuals.
        Arch Sex Behav. 1988; 17: 439-457
        • van de Grift T.C.
        • Cohen-Kettenis P.T.
        • Elaut E.
        • et al.
        A network analysis of body satisfaction of people with gender dysphoria.
        Body Image. 2016; 17: 184-190
        • van de Grift T.C.
        • Kreukels B.P.
        • Elfering L.
        • et al.
        Body image in transmen: multidimensional measurement and the effects of mastectomy.
        J Sex Med. 2016; 13: 1778-1786
        • Bell-Krotoski J.A.
        • Fess E.E.
        • Figarola J.H.
        • et al.
        Threshold detection and Semmes-Weinstein monofilaments.
        J Hand Ther. 1995; 8: 155-162
        • Chong P.S.
        • Cros D.P.
        Technology literature review: quantitative sensory testing.
        Muscle Nerve. 2004; 29: 734-747
        • Horbach S.E.
        • Bouman M.B.
        • Smit J.M.
        • et al.
        Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques.
        J Sex Med. 2015; 12: 1499-1512
        • Gilbert D.A.
        • Williams M.W.
        • Horton C.E.
        • et al.
        Phallic reinnervation via the pudendal nerve.
        J Urol. 1988; 140: 295-299
        • Bleustein C.B.
        • Arezzo J.C.
        • Eckholdt H.
        • et al.
        The neuropathy of erectile dysfunction.
        Int J Impot Res. 2002; 14: 433-439
        • Bleustein C.B.
        • Eckholdt H.
        • Arezzo J.C.
        • et al.
        Quantitative somatosensory testing of the penis: optimizing the clinical neurological examination.
        J Urol. 2003; 169: 2266-2269
        • Cordeau D.
        • Belanger M.
        • Beaulieu-Prevost D.
        • et al.
        The assessment of sensory detection thresholds on the perineum and breast compared with control body sites.
        J Sex Med. 2014; 11: 1741-1748