Advertisement

Genital Sensory Detection Thresholds and Patient Satisfaction With Vaginoplasty in Male-to-Female Transgender Women

      Abstract

      Introduction

      Gender-affirming surgery is common for the treatment of gender dysphoria, but its effect on genital sensitivity is not well known.

      Aims

      To investigate genital sensory detection thresholds in male-to-female transgender women postoperatively and their relation to psychological well-being and variables of satisfaction.

      Methods

      Prospective study on 28 transgender women at least 18 years old operated on at least 3 months before the study by a single surgeon (N.M.J.).

      Main Outcome Measures

      Medical complications; sensory detection thresholds for light touch, pressure, and vibration; and questionnaires on general and sexual satisfaction, sexual function, depression, and psychological well-being.

      Results

      Sensory detection thresholds ranged from 0.07 to 2.82 g for light touch, with the neck being most sensitive; from 20.23 to 34.64 g for pressure, with similar results for the neck and clitoris; and from 0.0052 to 0.0111 V for vibration, with similar findings for all stimulation points. Satisfaction with the appearance of the labia, vulva, clitoris, and sexual function was good to very good. Frequency of sexual activities increased significantly postoperatively for orogenital stimulation and decreased significantly for frequency of fantasies (t = −4.81; P < .0001). Orgasmic function was reported by 80% of participants. Psychological adjustment was good to very good, with low depression scores. Sexual satisfaction was statistically and positively correlated with vaginal function and depth, clitoral sensation, appearance of the vulva and labia minora, and natural lubrication and negatively correlated with depression scores.

      Conclusion

      Gender-affirming surgery yields good results for satisfaction with appearance and function. Genital sensitivity showed the best results with pressure and vibration.

      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

        • Sohn M.
        • Bosinski H.A.
        Gender identity disorders: diagnostic and surgical aspects.
        J Sex Med. 2007; 4 (quiz 208): 1193-1207
        • Raigosa M.
        • Avvedimento S.
        • Yoon T.S.
        • et al.
        Male-to-female genital reassignment surgery: a retrospective review of surgical technique and complications in 60 patients.
        J Sex Med. 2015; 12: 1837-1845
        • Collin L.
        • Reisner S.L.
        • Tangpricha V.
        • et al.
        Prevalence of transgender depends on the “case” definition: a systematic review.
        J Sex Med. 2016; 13: 613-626
        • Bakker A.
        • van Kesteren P.J.
        • Gooren L.J.
        • et al.
        The prevalence of transsexualism in the Netherlands.
        Acta Psychiatr Scand. 1993; 87: 237-238
        • De Cuypere G.
        • Van Hemelrijck M.
        • Michel A.
        • et al.
        Prevalence and demography of transsexualism in Belgium.
        Eur Psychiatry. 2007; 22: 137-141
        • Masumori N.
        Status of sex reassignment surgery for gender identity disorder in Japan.
        Int J Urol. 2012; 19: 402-414
        • Gomez-Gil E.
        • Esteva de Antonio I.
        • Almaraz M.C.
        • et al.
        [The demand for health care services in the gender identity units of Andalusia and Catalonia during the period of 2000 to 2009].
        Rev Clin Esp. 2011; 211 ([in Spanish]): 233-239
        • Amend B.
        • Seibold J.
        • Toomey P.
        • et al.
        Surgical reconstruction for male-to-female sex reassignment.
        Eur Urol. 2013; 64: 141-149
        • Selvaggi G.
        • Ceulemans P.
        • De Cuypere G.
        • et al.
        Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals.
        Plast Reconstr Surg. 2005; 116: 135e-145e
        • 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
        • Djordjevic M.L.
        • Stanojevic D.S.
        • Bizic M.R.
        Rectosigmoid vaginoplasty: clinical experience and outcomes in 86 cases.
        J Sex Med. 2011; 8: 3487-3494
        • Goddard J.C.
        • Vickery R.M.
        • Qureshi A.
        • et al.
        Feminizing genitoplasty in adult transsexuals: early and long-term surgical results.
        BJU Int. 2007; 100: 607-613
        • Lawrence A.A.
        Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery.
        Arch Sex Behav. 2006; 35: 717-727
        • De Cuypere G.
        • T'Sjoen G.
        • Beerten R.
        • et al.
        Sexual and physical health after sex reassignment surgery.
        Arch Sex Behav. 2005; 34: 679-690
        • Karim R.B.
        • Hage J.J.
        • Mulder J.W.
        Neovaginoplasty in male transsexuals: review of surgical techniques and recommendations regarding eligibility.
        Ann Plast Surg. 1996; 37: 669-675
        • Hage J.J.
        • Karim R.B.
        • Bloem J.J.
        • et al.
        Sculpturing the neoclitoris in vaginoplasty for male-to-female transsexuals.
        Plast Reconstr Surg. 1994; 93 (discussion 365): 358-364
        • 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
        • Szalay L.
        Construction of a neoclitoris in male transsexuals.
        Plast Reconstr Surg. 1995; 95: 425
        • Blanchard R.
        • Legault S.
        • Lindsay W.R.
        Vaginoplasty outcome in male-to-female transsexuals.
        J Sex Marital Ther. 1987; 13: 265-275
        • Perovic S.V.
        • Stanojevic D.S.
        • Djordjevic M.L.
        Vaginoplasty in male transsexuals using penile skin and a urethral flap.
        BJU Int. 2000; 86: 843-850
        • Selvaggi G.
        • Monstrey S.
        • Ceulemans P.
        • et al.
        Genital sensitivity after sex reassignment surgery in transsexual patients.
        Ann Plast Surg. 2007; 58: 427-433
        • Gilbert D.A.
        • Williams M.W.
        • Horton C.E.
        • et al.
        Phallic reinnervation via the pudendal nerve.
        J Urol. 1988; 140: 295-299
        • Karim R.B.
        • Hage J.J.
        • Bouman F.G.
        • et al.
        Refinements of pre-, intra-, and postoperative care to prevent complications of vaginoplasty in male transsexuals.
        Ann Plast Surg. 1995; 35: 279-284
        • 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
        • Lowenstein L.
        • Davis C.
        • Jesse K.
        • et al.
        Comparison between sensory testing modalities for the evaluation of afferent nerve functioning in the genital area.
        Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 83-87
        • Romanzi L.J.
        • Groutz A.
        • Feroz F.
        • et al.
        Evaluation of female external genitalia sensitivity to pressure/touch: a preliminary prospective study using Semmes-Weinstein monofilaments.
        Urology. 2001; 57: 1145-1150
        • Pukall C.F.
        • Young R.A.
        • Roberts M.J.
        • et al.
        The vulvalgesiometer as a device to measure genital pressure-pain threshold.
        Physiol Meas. 2007; 28: 1543-1550
        • Chong P.S.
        • Cros D.P.
        Technology literature review: quantitative sensory testing.
        Muscle Nerve. 2004; 29: 734-747
        • Lothstein L.M.
        • Shinar E.
        Transsexual Postoperative Follow-Up Questionnaire.
        in: Davis C.M. Yarber W.L. Bauserman R. Schreer G. Davis S.L. Handbook of Sexuality-Related Measures. Sages Publications, Londres1998: 576-580
        • Steer R.A.
        • Ball R.
        • Ranieri W.F.
        • et al.
        Dimensions of the Beck Depression Inventory–II in clinically depressed outpatients.
        J Clin Psychol. 1999; 55: 117-128
        • Derogatis L.
        • Clayton A.
        • Lewis-D'Agostino D.
        • et al.
        Validation of the Female Sexual Distress Scale–Revised for assessing distress in women with hypoactive sexual desire disorder.
        J Sex Med. 2008; 5: 357-364
        • 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
        • Bleustein C.B.
        • Arezzo J.C.
        • Eckholdt H.
        • et al.
        The neuropathy of erectile dysfunction.
        Int J Impot Res. 2002; 14: 433-439
        • Clifton J.
        • Seehuus M.
        • Rellini A.H.
        Testing cognitive predictors of individual differences in the sexual psychophysiological responses of sexually functional women.
        Psychophysiology. 2015; 52: 957-968
        • Meston C.M.
        • Rellini A.H.
        • McCall K.
        The sensitivity of continuous laboratory measures of physiological and subjective sexual arousal for diagnosing women with sexual arousal disorder.
        J Sex Med. 2010; 7: 938-950
        • Hess J.
        • Rossi Neto R.
        • Panic L.
        • et al.
        Satisfaction with male-to-female gender reassignment surgery.
        Dtsch Arztebl Int. 2014; 111: 795-801
        • Wagner S.
        • Greco F.
        • Hoda M.R.
        • et al.
        Male-to-female transsexualism: technique, results and 3-year follow-up in 50 patients.
        Urol Int. 2010; 84: 330-333
        • Lief H.I.
        • Hubschman L.
        Orgasm in the postoperative transsexual.
        Arch Sex Behav. 1993; 22: 145-155
        • Basson R.
        Human sex-response cycles.
        J Sex Marital Ther. 2001; 27: 33-43
        • Lawrence A.A.
        Sexuality before and after male-to-female sex reassignment surgery.
        Arch Sex Behav. 2005; 34: 147-166
        • Nuttbrock L.
        • Bockting W.
        • Rosenblum A.
        • et al.
        Gender abuse, depressive symptoms, and HIV and other sexually transmitted infections among male-to-female transgender persons: a three-year prospective study.
        Am J Public Health. 2013; 103: 300-307
        • Heylens G.
        • Verroken C.
        • De Cock S.
        • et al.
        Effects of different steps in gender reassignment therapy on psychopathology: a prospective study of persons with a gender identity disorder.
        J Sex Med. 2014; 11: 119-126
        • Vardi Y.
        • Gruenwald I.
        • Sprecher E.
        • et al.
        Normative values for female genital sensation.
        Urology. 2000; 56: 1035-1040