Strategies for innervation of the neophallus

Abstract

A fundamental goal of phalloplasty includes the construction of a sensate neophallus. Both tactile and erogenous sensation are important for protective sensation (including retention of implantable penile prosthesis) as well as sexual satisfaction. This article will describe the sensory innervation of flaps commonly used for phalloplasty including the radial forearm flap, anterolateral thigh flap, and musculocutaneous latissimus dorsi flap. The sensory innervation of the perineum and external genitalia will be reviewed as a basis for selecting recipient nerves. Additionally, surgical techniques, such as neurorrhaphy, will be discussed. Finally, outcome data, although limited, will be assessed.

Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol

“…It is clear that sensory outcomes are improved when direct nerve coaptation is performed; however, little granularity in current data is available beyond the presence or absence of sensation and ability to achieve orgasm, making quantification of sensory outcomes difficult. 6 , 7 A recent study reported results that often did not match patient expectations. 2 Other studies have demonstrated a range of sensory outcomes, with some patients reporting increased erogenous sensation and orgasmic intensity with hypersensitivity, and others reporting decreases in these same outcome measures.…”

“… 5 , 6 Current strategies reported in the literature to optimize sensation following phalloplasty address mainly the peripheral components of sensation, focusing on the peripheral nerve coaptations that are performed during surgery. 7 …”

“…5,6 Current strategies reported in the literature to optimize sensation following phalloplasty address mainly the peripheral components of sensation, focusing on the peripheral nerve coaptations that are performed during surgery. 7 In order to best optimize outcomes, a comprehensive and systematic approach that targets all components contributing to the sensory experience following phalloplasty is ideal. 8 There are several variables contributing to sensation following phalloplasty that can likely be optimized: choice of donor and recipient nerves for coaptation, nerve regeneration, and the role of the central nervous system.…”