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J Reconstr Microsurg 2019; 35(02): 129-137
DOI: 10.1055/s-0038-1667360
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Genital Sensibility in the Neophallus: Getting a Sense of the Current Literature and Techniques

Shane D. Morrison
1  Division of Plastic Surgery, Department of Surgery, University of Washington, Seattle, Washington
,
Jonathan P. Massie
2  Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
A. Lee Dellon
3  Department of Plastic Surgery, Johns Hopkins University, Baltimore, Maryland
4  Department of Plastic Surgery, University of Maryland, Baltimore, Maryland
› Author Affiliations
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Publication History

20 January 2018

27 June 2018

Publication Date:
05 August 2018 (online)

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Abstract

Introduction Phalloplasty attempts to achieve a functional and aesthetic phallus. Sensation is a key component for sexual pleasure. Sensation is also important for protection in the setting of penile implant insertion. Little data are available on genital sensibility outcomes after phalloplasty, and there are no standardized approaches for assessment of either sensibility or erogenous perception.

Methods A literature search of PubMed, Google Scholar, and MEDLINE databases was conducted with terms related to genital sensibility after phalloplasty. Data on patient demographics, nerves used for coaptation, and measurements of genital sensibility were collected. Pooled event rates were determined for recovered glans sensibility and recovered erogenous sensation using a Freeman–Tukey arcsine transformation.

Results A total of 341 articles were identified of which 26 met the inclusion criteria for final analysis. The dorsal cutaneous branch of the pudendal nerve and ilioinguinal were the most common donor nerves. The lateral and medial antebrachial cutaneous and lateral femoral cutaneous were the most common recipient nerves. Pooled event rates suggest that some recovered glans sensibility occurs in more than 70% of cismale patients and in more than 90% of transmale patients. Recovered “erogenous” sensation occurs in more than 75% of cismale patients and more than 95% of transmale patients. In cismale patients, outcomes of recovered glans sensibility and erogenous sensation may be better for upper extremity recipient nerves than lower extremity recipient nerves.

Conclusions Based on the limited data in current literature on genital sensibility after phalloplasty, it is difficult to draw evidence-based conclusions. Yet data support improved outcomes with innervation. A validated outcome measure of “erogenous sensation” and a standardized approach to measuring cutaneous sensibility are required.

Keywords

phallus - phalloplasty - transgender - sensibility - peripheral nerve

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