title: Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study.
abstract: OBJECTIVE
  Total phalloplasty is rarely performed today in males with severe penile deficiency, despite its successful use in the transgender population. Can phalloplasty replicate the complexity of penile anatomy and function on the long term?
  
  
  METHODS
  Sexual quality of life (QoL) was assessed in 10 men (aged 20-43 years) at least 1 year after phalloplasty in a single institution (80 % radial forearm flap and 20 % anterolateral thigh flap). In all but one, an erectile prosthesis was implanted on average 1 year after phallic reconstruction. Sexual QoL outcomes were compared to those of men with hypospadias repair (n = 73) and control men (n = 50).
  
  
  RESULTS
  After phalloplasty (mean 36.9 months, 14-92 months), all men were sexually active (80 % intercourse and 100 % masturbation with orgasm and ejaculation). However, 75 % indicated to be inhibited in seeking sexual contacts, compared to 40 % of hypospadias patients (p < 0.05) and 11 % of controls (p < 0.01). Although 90 % were satisfied with the final surgical result, dissatisfaction with some aspects of genital appearance was present in 50 %. Erogenous neophallus sensitivity was said to be less than previously hoped for. Six men developed urinary complications (urethral stricture and/or fistula), and one man underwent revision of the erectile implant because of dysfunction. Nevertheless, all indicated they would choose again for phalloplasty if necessary.
  
  
  CONCLUSIONS
  Total phalloplasty opens new horizons for the treatment of men with penile deficiency, but limitations of the technique should be emphasized prior to surgery. An exploration of patient expectations and continued follow-up including psychological support is important for optimizing psychosexual comfort.
authors.affiliation: Department of Pediatric Endocrinology, Ghent University and University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium.
authors.forename: Nina
authors.initials: N
authors.lastname: Callens
authors.forename: Griet
authors.initials: G
authors.lastname: De Cuypere
authors.forename: Guy
authors.initials: G
authors.lastname: T'Sjoen
authors.forename: Stan
authors.initials: S
authors.lastname: Monstrey
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Lumen
authors.forename: Erik
authors.initials: E
authors.lastname: Van Laecke
authors.forename: Piet
authors.initials: P
authors.lastname: Hoebeke
authors.forename: Martine
authors.initials: M
authors.lastname: Cools
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004542:Ejaculation; D005832:Genital Diseases, Male / Q000523:psychology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009948:Orgasm; D017060:Patient Satisfaction; D010413:Penis / Q000002:abnormalities* / Q000601:surgery; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D012725:Sexual Behavior; D013524:Surgical Flaps; D016896:Treatment Outcome; D055815:Young Adult