Aesthetic Refinement in the Creation of the Clitoris, Its Preputial Hood, and Labia Minora in Male-to-Female Transsexual Patients

Vázquez, Iván Mañero; García-Senosiain, Oihane; Labanca, Trinidad; Gómez‐Gil, Esther

doi:10.1097/sap.0000000000001532

Cited by 16 publications

(7 citation statements)

References 20 publications

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“…46 studies measured or reported on erogenous sensation of post‐surgical genitalia including the vulva, clitoris, anus, or mons pubis 11,13,18,19,30,33,35,44,45,48,51,66,67,70‐103 . General erogenous sensation ranged from 51.4% to 100% (median 97.7%) in 529 patients 11,13,30,74,80,88,89,91,100,101 . Only De Andrade (2013) reported a qualified scale for genital sensibility, receiving a 9.4/10 among 7 patients 75 .…”

Section: Resultsmentioning

confidence: 99%

Sexual health after vaginoplasty: A systematic review

et al. 2021

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Background: Vaginoplasty is a gender-affirming procedure for transgender and gender diverse (TGD) patients who experience gender incongruence. This procedure reduces mental health concerns and enhances patients' quality of life. A systematic review investigating the sexual health outcomes of vaginoplasty has not been performed. Objectives:To investigate sexual health after gender-affirming vaginoplasty for TGD patients.

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Section: Resultsmentioning

confidence: 99%

Sexual health after vaginoplasty: A systematic review

et al. 2021

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“…Reminding patients that there is no one “standard look” of a vulva may help when setting expectations on cosmetic outcomes. If sexual penetration is not a primary goal for the patient, a vulvoplasty can be a viable alternative for those that are at higher risk, as the procedure is less invasive and has been shown to have low complication rates 25 …”

Section: Discussionmentioning

confidence: 99%

“…If sexual penetration is not a primary goal for the patient, a vulvoplasty can be a viable alternative for those that are at higher risk, as the procedure is less invasive and has been shown to have low complication rates. 25…”

Section: Preoperative Considerationsmentioning

confidence: 99%

Outcomes of penile inversion vaginoplasty and robotic‐assisted peritoneal flap vaginoplasty in obese and nonobese patients

Acar

Alcantar

Millman

et al. 2022

Neurourology and Urodynamics

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Aim: To explore the impact of body mass index (BMI) on the outcomes of gender-affirming vaginoplasty. Methods: A cohort consisting of all gender-affirming vaginoplasties in our practice between September 27th, 2018, and September 1st, 2022 were identified, and data were retrospectively collected. Patients were classified as obese if their BMI was ≥30 kg/m 2 at the time of surgery and nonobese if their BMI was <30 kg/m 2 . Complications were assigned a Clavien-Dindo grade and grouped as Grade ≥2 versus Grade ≤1. Patient-reported functional outcomes of intact erogenous sensation, tactile sensation, ability to achieve penetrative vaginal intercourse, and cosmetic satisfaction were assessed.Results: A total of 58 patients with a mean follow-up time of 6.9 months were included. Seventeen patients (mean BMI = 36.8 kg/m 2 ) were classified as obese and 41 patients (mean BMI = 25.1 kg/m 2 ) were classified as nonobese.No significant differences in outcomes were identified in the obese versus nonobese groups in terms of the incidence of complications. Patient-reported functional outcomes did not differ significantly between the two groups. Conclusions: Similar results can be achieved with gender-affirming vaginoplasty in obese patients when compared to their nonobese counterparts.Eligibility for this procedure should not be restricted based on BMI alone.

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“…7 The construction of the labia minora from preputial tissues in uncircumcised patients and the preservation of the sensitivity of the labia minora are not new ideas. 8 In fact, the sensitive area on the inner surface of the labia minora was named as the "Chonburi flap" by Watanyusakul. Again, Watanyusakul 9,10 stated that an ideal vulva could not be reconstructed aesthetically with penile inversion and explained the necessary aesthetic gains.…”

Section: Introductionmentioning

confidence: 99%

“…To date, there are no exact guidelines describing how to reconstruct the clitoris, clitoral hood, or labia minora; therefore, the preferred technique depends on the surgeon, which may lead to different outcomes 7 . The construction of the labia minora from preputial tissues in uncircumcised patients and the preservation of the sensitivity of the labia minora are not new ideas 8 . In fact, the sensitive area on the inner surface of the labia minora was named as the “Chonburi flap” by Watanyusakul.…”

mentioning

confidence: 99%

Construction of Sensitive Labia Minora–Clitoris–Clitoral Hood Complex in Sex Reassignment Surgery in Circumcised Populations

Balik¹

2023

Ann Plast Surg

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Introduction The construction of the labia minora from preputial tissues in uncircumcised patients and the preservation of the sensitivity of the labia minora are not new ideas. However, evidently, this technique is designed for uncircumcised cases. There is no preputial tissue in the circumcised population. However, this tissue, whose inner and outer layers have different structures and appearances, is critical in the construction of the labia minora. Instead, there is an area of reepithelialization and reinnervation that heals secondarily or is closed primarily, depending on the circumcision. Also, this new skin area is devoid of the natural oily secretions of the prepuce. In addition, the removal of preputial tissue in circumcised individuals may cause uncertainty in terms of vascularity or sensitivity. In this study, we share our clinical experience regarding large labia minora creation (with preserved flap circulation without vaginal reconstruction concerns) and the use of most of the urethra as a mesh graft in the circumcised population. Materials and Methods Between 2010 and 2022, 19 cases were operated on with this technique. All cases were primary interventions for male-to-female sex reassignment. Because this design of the sensitive inner surface of the labia minora, which ensured vascular safety, was not found in the literature, the design was named “butterfly flap” because of its shape. Evaluation of Sensation The area corresponding to both wings of the butterfly flap was evaluated with the Semmes Weinstein Monofilament test, with the patient's eyes closed, in the preoperative period. Likewise, the sensitivity of the inner surface of the labia minora in the first year of 10 patients who were able to attend follow-up clinical examination was evaluated with the same method. Results In our study, a clitoris and a labia minora with sensory innervation were obtained by elevating the superior 180-degree area of the neurovascular bundle surrounding the penis and using the butterfly flap we prepared in the area fed by this bundle. Fourteen cases stated that the sensation of the newly formed labia minora was erogenous and different from the tactile sensation on the body of the penis.

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Aesthetic Refinement in the Creation of the Clitoris, Its Preputial Hood, and Labia Minora in Male-to-Female Transsexual Patients

Abstract: The proposed technique represents an aesthetic refinement of the previously described pedicled glans penis flap by allowing the creation of a sensate neoclitoris, its preputial hood, and labia minora with excellent outcomes in the same surgical stage as the sex reassignment.

Cited by 16 publications

References 20 publications

Sexual health after vaginoplasty: A systematic review

Sexual health after vaginoplasty: A systematic review

Outcomes of penile inversion vaginoplasty and robotic‐assisted peritoneal flap vaginoplasty in obese and nonobese patients

Construction of Sensitive Labia Minora–Clitoris–Clitoral Hood Complex in Sex Reassignment Surgery in Circumcised Populations

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