Increased sexual health after restored genital sensation in male patients with spina bifida or a spinal cord injury: the TOMAX procedure.
OBJECTIVE
In this study we prospectively investigated the contribution of restored penile sensation to sexual health in patients with low spinal lesions.


METHODS
In 30 patients (18 with spina bifida, 12 with spinal cord injury, age range 13 to 55 years) with no penile sensation but good groin sensation the new TOMAX (TO MAX-imize sensation, sexuality and quality of life) procedure was performed. This involves microsurgical connection of the sensory ilioinguinal nerve to the dorsal nerve of the penis unilaterally. Extensive preoperative and postoperative neurological and psychological evaluations were made.


RESULTS
A total of 24 patients (80%) gained unilateral glans penis sensation. This was initially felt as groin sensation but transformed into real glans sensation in 11 patients (33%). These patients had better overall sexual function (p = 0.022) and increased satisfaction (p = 0.004). Although 13 patients (43%) maintained groin sensation, their satisfaction with sexuality was only slightly less than that of those with glans sensation. Improved sensations helped them manage urinary incontinence, thereby improving personal hygiene and independence. Most patients felt more complete and less handicapped with their penis now part of their body image. They also reported having more open and meaningful sexual relationships with their partners.


CONCLUSIONS
Tactile and erogenous sensitivity was restored in the glans penis in patients with a low spinal lesion. This new sensation enhanced the quality of sexual functioning and satisfaction. The TOMAX procedure should become standard treatment for such patients.
Department of Plastic, Reconstructive and Hand Surgery, Isala Clinic, Zwolle, The Netherlands. m.l.e.overgoor@isala.nl
M L E
ML
Overgoor
T P V M
TP
de Jong
P T
PT
Cohen-Kettenis
M A
MA
Edens
M
M
Kon
D000293:Adolescent; D000328:Adult; D006801:Humans; D006987:Hypesthesia / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D017060:Patient Satisfaction; D010413:Penis / Q000294:innervation* / Q000502:physiology / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D060728:Reproductive Health; D012677:Sensation; D013119:Spinal Cord Injuries / Q000150:complications*; D016135:Spinal Dysraphism / Q000150:complications*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D055815:Young Adult