Genital sensitivity after sex reassignment surgery in transsexual patients.
BACKGROUND
Tactile and erogenous sensitivity in reconstructed genitals is one of the goals in sex reassignment surgery. Since November 1993 until April 2003, a total of 105 phalloplasties with the radial forearm free flap and 127 vaginoclitoridoplasties with the inverted penoscrotal skin flap and the dorsal glans pedicled flap have been performed at Ghent University Hospital. The specific surgical tricks used to preserve genital and tactile sensitivity are presented. In phalloplasty, the dorsal hood of the clitoris is incorporated into the neoscrotum; the clitoris is transposed, buried, and fixed directly below the reconstructed phallic shaft; and the medial and lateral antebrachial nerves are coapted to the inguinal nerve and to one of the 2 dorsal nerves of the clitoris. In vaginoplasty, the clitoris is reconstructed from a part of the glans penis inclusive of a part of the corona, the inner side of the prepuce is used to reconstruct the labia minora, and the penile shaft is inverted to line the vaginal cavity.


METHODS
A long-term sensitivity evaluation (performed by the Semmes-Weinstein monofilament and the Vibration tests) of 27 reconstructed phalli and 30 clitorises has been performed.


RESULTS
The average pressure and vibratory thresholds values for the phallus tip were, respectively, 11.1 g/mm and 3 microm. These values have been compared with the ones of the forearm (donor site). The average pressure and vibratory thresholds values for the clitoris were, respectively, 11.1 g/mm and 0.5 microm. These values have been compared with the ones of the normal male glans, taken from the literature. We also asked the examined patients if they experienced orgasm after surgery, during any sexual practice (ie, we considered only patients who attempted to have orgasm): all female-to-male and 85% of the male-to-female patients reported orgasm.


CONCLUSIONS
With our techniques, the reconstructed genitalia obtain tactile and erogenous sensitivity. To obtain a good tactile sensitivity in the reconstructed phallus, we believe that the coaptation of the cutaneous nerves of the flap with the ilioinguinalis nerve and with one of the 2 nerves of the clitoris is essential in obtaining this result. To obtain orgasm after phalloplasty, we believe that preservation of the clitoris beneath the reconstructed phallus and some preservation of the clitoris hood are essential. To obtain orgasm after a vaginoplasty, the reconstruction of the clitoris from the neurovascular pedicled glans flap is essential.
Selvaggi
Gennaro
G
Department of Plastic Surgery, Ghent University Hospital, Gent, Belgium. selvaggigennaro@yahoo.it
Monstrey
Stan
S
Ceulemans
Peter
P
T'Sjoen
Guy
G
De Cuypere
Griet
G
Hoebeke
Piet
P
D002987:Clitoris / Q000294:innervation* / Q000601:surgery*; D005260:Female; D005542:Forearm; D006801:Humans; D008297:Male; D009948:Orgasm; D017060:Patient Satisfaction; D010413:Penis / Q000294:innervation* / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012677:Sensation; D013524:Surgical Flaps; D014189:Transsexualism / Q000601:surgery*; D016896:Treatment Outcome; D014732:Vibration