Skip to main content

Advertisement

SpringerLink
Log in

Sexual Function After Gender-Affirming Genital Reconstruction

  • Male and Female Surgical Interventions (C Carson & P Selph, Section Editors)
  • Published:
Current Sexual Health Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This nonsystematic review aims to discuss the contemporary literature about sexual (dys)function in transgender population from the biopsychosocial model point of view, focusing on those patients who underwent gender-affirming genital reconstruction (GAGR).

Recent Findings

We analyzed the questionnaires and diagnostic tools that have been used to evaluate sexual health-related issues, including the non-specific ones and the ones specifically designed for transgender individuals. All aspects of sexual function including desire, arousal, orgasm, and pain have been shown to be influenced by GAGR.

Summary

Literature regarding sexual activity in trans women are diverse, showing increase, decrease, and no changes after genital surgery, while sexual satisfaction was shown to be highly related to self-image and self-esteem. Metoidioplasty and flap-based phalloplasty in trans men are successful in treating gender dysphoria, and improving quality of life which commonly lead to high satisfaction rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Steensma TD. Gender identity development in adolescence. Horm Behav. 2013;64:288–97.

    PubMed  Google Scholar 

  2. Winter S. Transgender people: health at the margins of society. Lancet. 2016;388:390–400.

    PubMed  Google Scholar 

  3. Fraser L, Knudson G. Past and future challenges associated with standards of care for gender transitioning Clients. Psychiatr Clin North Am. 2017;40(1):15–27.

    PubMed  Google Scholar 

  4. Richards C, Bouman WP, Seal L, Barker MJ, Nieder TO, Tsjoen G. Non-binary or genderqueer genders. Int Rev Psychiatry. 2016;28(1):95–102.

    PubMed  Google Scholar 

  5. Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13(4):165–232.

  6. Witcomb GL, Bouman WP, Arcelus J. The transgender handbook: a guide for transgender people, their families, and professionals. Int J Transgenderism. 2017;18(3):360.

    Google Scholar 

  7. Scheim AI, Bauer GR. Sex and gender diversity among transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. J Sex Res. 2015;52(1):1–14.

    PubMed  Google Scholar 

  8. Arcelus J, Bouman WP, Van Den Noortgate W, Claes L, Witcomb G, Fernandez-Aranda F. Systematic review and meta-analysis of prevalence studies in transsexualism. European Psychiatry. 2015;30(6):807–15.

    PubMed  CAS  Google Scholar 

  9. Gómez-Gil E, Zubiaurre-Elorza L, Esteva I, Guillamon A, Godás T, Cruz Almaraz M, et al. Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology. 2012;37(5):662–70.

  10. Collin L, Reisner SL, Tangpricha V, Goodman M. Prevalence of transgender depends on the ‘case’ definition: a systematic review. J Sex Med. 2016;13(4):613–26.

    PubMed  PubMed Central  Google Scholar 

  11. Wiepjes CM, Nota NM, de Blok CJM, Klaver M, de Vries ALC, Wensing-Kruger SA, et al. The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): trends in prevalence, treatment, and regrets. J Sex Med. 2018;15(4):582–90.

  12. Hage JJ, Karim RB. Ought GIDNOS get nought? Treatment options for nontranssexual gender dysphoria. Plast Reconstr Surg. 2000;105(3):1222–7.

    PubMed  CAS  Google Scholar 

  13. Klein C, Gorzalka BB. Sexual functioning in transsexuals following hormone therapy and genital surgery: a review. J Sex Med. 2009;6(11):2922–39.

    PubMed  Google Scholar 

  14. De Cuypere G, et al. Sexual and physical health after sex reassignment surgery. Arch Sex Behav. 2005;34(6):679–90.

    PubMed  Google Scholar 

  15. Gijs L, Brewaeys A. Surgical treatment of gender dysphoria in adults and adolescents: recent developments, effectiveness, and challenges. Annu Rev Sex Res. 2007;18:178–84.

    Google Scholar 

  16. Hage JJ, Karim RB. Abdominoplastic secondary full-thickness skin graft vaginoplasty for male-to-female transsexuals. Plast Reconstr Surg. 1998;101(6):1512–5.

    PubMed  CAS  Google Scholar 

  17. Bizic MR, Stojanovic B, Djordjevic ML. Genital reconstruction for the transgendered individual. J Pediatr Urol. 2017;13(5):446–52.

    PubMed  Google Scholar 

  18. Dhejne C, Arver S, Landén M. An analysis of all applications for sex reassignment surgery in Sweden. Arch Sex Behav. 1960;43(8):1535–45.

    Google Scholar 

  19. Fisk NM. Editorial: gender dysphoria syndrome--the conceptualization that liberalizes indications for total gender reorientation and implies a broadly based multi-dimensional rehabilitative regimen. West J Med. 1974;120(5):386–91.

    PubMed  PubMed Central  CAS  Google Scholar 

  20. Garcia MM, Ralph DL (2017) Update Series (2017) Lesson 5: Genital Gender Affirming Surgery for Transgender Patients | AUA University. https://auau.auanet.org/content/update-series-2017-lesson-5-genital-gender-affirming-surgery-transgender-patients. Accessed: 06-Oct-2019.

  21. Schechter LS. Surgical management of the transgender patient. 1st ed: Elsevier Inc; 2016.

  22. • Garcia MM. Sexual function after shallow and full-depth vaginoplasty: challenges, clinical findings, and treatment strategies— urologic perspectives. Clin Plast Surg. 2018;45(3):437–46. Described the most important risk factors for anorgasmia after GAGR in trans women.

  23. Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol. 2011;8(5):274–82.

    PubMed  Google Scholar 

  24. Colebunders B, Brondeel S, D’Arpa S, Hoebeke P, Monstrey S. An update on the surgical treatment for transgender patients. Sex Med Rev. 2017;5(1):103–9.

    PubMed  Google Scholar 

  25. Kim S, Dennis M, Holland M, Terrell M, Loukas M, Schober J. The anatomy of forearm free flap phalloplasty for transgender surgery. Clin Anat. 2018;31(2):145–51.

    PubMed  CAS  Google Scholar 

  26. Trombetta C, Mazzon G, Ramella V, Arnež ZM. Surgical therapy: forearm free flap phalloplasty. In: Management of gender dysphoria. Milan: Springer; 2015. p. 249–56.

    Google Scholar 

  27. Stojanovic B, Djordjevic ML. Anatomy of the clitoris and its impact on neophalloplasty (metoidioplasty) in female transgenders. Clin Anat. 2015;28(3):368–75.

    PubMed  Google Scholar 

  28. McCabe MP, et al. Definitions of sexual dysfunctions in women and men: a consensus statement from the Fourth International Consultation on Sexual Medicine 2015. J Sex Med. 2016;13(2):135–43.

    PubMed  Google Scholar 

  29. Basson R, et al. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol. 2000;163(3):888–93.

    PubMed  CAS  Google Scholar 

  30. Bitzer J, Giraldi A, Pfaus J. Sexual desire and hypoactive sexual desire disorder in women. Introduction and overview. Standard operating procedure (SOP part 1). J Sex Med. 2013;10(1):36–49.

    PubMed  Google Scholar 

  31. Kerckhof ME, et al. Prevalence of sexual dysfunctions in transgender persons: results from the ENIGI follow-up study. J Sex Med. 2019:1–12.

  32. Hatzichristou D, Kirana PS, Banner L, Althof SE, Lonnee-Hoffmann RAM, Dennerstein L, et al. Diagnosing sexual dysfunction in men and women: sexual history taking and the role of symptom scales and questionnaires. J Sex Med. 2016;13(8):1166–82.

  33. Whitlock BL, Duda ES, Elson MJ, Schwab PP, Uner OE, Wen S, et al. Primary care in transgender persons. Endocrinol Metab Clin N Am. 2019;48(2):377–90.

  34. •• Jones BA, Bouman WP, Haycraft E, Arcelus J. The gender congruence and life satisfaction scale (GCLS): development and validation of a scale to measure outcomes from transgender health services. Int J Transgenderism. 2019;20(1):63–80. Developed and validated one of the first and most important questionnaires specifically designed for those who identify their genders in a binary system or out of the binary system. It evaluates gender congruence, well-being and general life satisfaction throughout the course of GAT, divided into 7 subscales: psychological functioning, genitalia, social gender role recognition, physical and emotional intimacy, chest and other secondary sex characteristics and life satisfaction.

  35. Cohen-Kettenis PT, Van Goozen SHM. Sex reassignment of adolescent transsexuals: a follow-up study. J Am Acad Child Adolesc Psychiatry. 1997;36(2):263–71.

    PubMed  CAS  Google Scholar 

  36. Deogracias JJ, Johnson LL, Meyer-Bahlburg HFL, Kessler SJ, Schober JM, Zucker KJ. The gender identity/gender dysphoria questionnaire for adolescents and adults. J Sex Res. 2007;44(4):370–9.

    PubMed  Google Scholar 

  37. Kozee HB, Tylka TL, Bauerband A. Measuring transgender individuals’ comfort with gender identity and appearance: development and validation of the transgender congruence scale. Psychol Women Q. 2012;36(2):179–96.

  38. • Nikkelen SWC, Kreukels BPC. Sexual experiences in transgender people: the role of desire for gender-confirming interventions, psychological well-being, and body satisfaction. J Sex Marital Ther. 2018;44(4):370–81. Demonstrated that GAGR is not only important for the sexual function, but also in regard to agency, pleasure and esteem. This affects sexual activity and sexual satisfaction in trans people.

  39. Wierckx K, Elaut E, van Hoorde B, Heylens G, de Cuypere G, Monstrey S, et al. Sexual desire in trans persons: associations with sex reassignment treatment. J Sex Med. 2014;11(1):107–18.

  40. Manrique OJ, Adabi K, Huang TCT, Jorge-Martinez J, Meihofer LE, Brassard P, et al. Assessment of pelvic floor anatomy for male-to-female vaginoplasty and the role of physical therapy on functional and patient-reported outcomes. Ann Plast Surg. 2019;82(6):661–6.

  41. • LeBreton M, et al. Genital sensory detection thresholds and patient satisfaction with vaginoplasty in male-to-female transgender women. J Sex Med. 2017;14(2):274–81. Explored genital sensitivity in TW after vaginoplasty. They found out that neoclitoral sensitivity threshold for light touch was lower than that for glans penis in CM, but higher than that reported for clitoris in CW.

  42. Wierckx K, van Caenegem E, Elaut E, Dedecker D, van de Peer F, Toye K, et al. Quality of life and sexual health after sex reassignment surgery in transsexual men. J Sex Med. 2011;8(12):3379–88.

  43. Elaut E, de Cuypere G, de Sutter P, Gijs L, van Trotsenburg M, Heylens G, et al. Hypoactive sexual desire in transsexual women: prevalence and association with testosterone levels. Eur J Endocrinol. 2008;158(3):393–9.

  44. Basson R. Women’s sexual dysfunction: revised and expanded definitions. CMAJ. 2005;172(10):1327–33.

    PubMed  PubMed Central  Google Scholar 

  45. Mate-Kole C, Freschi M, Robin A. A controlled study of psychological and social change after surgical gender reassignment in selected male transsexuals. Br J Psychiatry. 1990;157:261–4.

    PubMed  CAS  Google Scholar 

  46. Lawrence AA, Latty EM, Chivers ML, Bailey JM. Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography. Arch Sex Behav. 2005;34(2):135–45.

    PubMed  Google Scholar 

  47. Oh SK, Kim GW, Yang JC, Kim SK, Kang HK, Jeong GW. Brain activation in response to visually evoked sexual arousal in male-to-female transsexuals: 3.0 tesla functional magnetic resonance imaging. Korean J Radiol. 2012;13(3):257–64.

    PubMed  PubMed Central  Google Scholar 

  48. Sigre-Leirós V, Carvalho J, Nobre PJ. The sexual thoughts questionnaire: psychometric evaluation of a measure to assess self-reported thoughts during exposure to erotica using sexually functional individuals. J Sex Med. 2016;13(5):876–84.

    PubMed  Google Scholar 

  49. Barlow DH, Mills JR, Agras WS, Steinman DL. Comparison of sex-typed motor behavior in male-to-female transsexuals and women. Arch Sex Behav. 1980;9(3):245–53.

    PubMed  CAS  Google Scholar 

  50. Lippa RA. Gender-related traits in transsexuals and nontranssexuals. Arch Sex Behav. 2001;30(6):603–14.

    PubMed  CAS  Google Scholar 

  51. Cohen-Kettenis PT, van Goozen SH, Doorn CD, Gooren LJ. Cognitive ability and cerebral lateralisation in transsexuals. Psychoneuroendocrinology. 1998;23(6):631–41.

    PubMed  CAS  Google Scholar 

  52. Garcia MM, Christopher NA, De Luca F, Spilotros M, Ralph DJ. Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: the Institute of Urology, London U.K. experience. Transl Androl Urol. 2014;3(2):156–62.

    PubMed  PubMed Central  Google Scholar 

  53. Raigosa M, Avvedimento S, Yoon TS, Cruz-Gimeno J, Rodriguez G, Fontdevila J. Male-to-female genital reassignment surgery: a retrospective review of surgical technique and complications in 60 patients. J Sex Med. 2015;12(8):1837–45.

    PubMed  Google Scholar 

  54. Horbach SER, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: a systematic review of surgical techniques. J Sex Med. 2015;12(6):1499–512.

    PubMed  Google Scholar 

  55. Lawrence AA. Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Arch Sex Behav. 2006;35(6):717–27.

    PubMed  Google Scholar 

  56. Perovic SV, Stanojevic DS, Djordjevic MLJ. Vaginoplasty in male transsexuals using penile skin and a urethral flap. BJU Int. 2001;86(7):843–50.

    Google Scholar 

  57. Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin N Am. 2009;36(3):707–22.

    Google Scholar 

  58. Kangas R, Morsiani C, Pizza G, Lanzarini C, Aukee P, Kaprio J, et al. Menopause and adipose tissue: miR-19a-3p is sensitive to hormonal replacement. Oncotarget. 2018;9(2):2279–94.

  59. Wasenda EJ, Kamisan Atan I, Subramaniam N, Dietz HP. Pelvic organ prolapse: does hormone therapy use matter? Menopause. 2017;24(10):1185–9.

    PubMed  Google Scholar 

  60. Adams SR, Dessie SG, Dodge LE, Mckinney JL, Hacker MR, Elkadry EA. Pelvic floor physical therapy as primary treatment of pelvic floor disorders with urinary urgency and frequency-predominant symptoms. Female Pelvic Med Reconstr Surg. 2015;21(5):252–6.

    PubMed  Google Scholar 

  61. Pauls RN, Crisp CC, Novicki K, Fellner AN, Kleeman SD. Pelvic floor physical therapy: impact on quality of life 6 months after vaginal reconstructive surgery. Female Pelvic Med Reconstr Surg. 2014;20(6):334–41.

    PubMed  Google Scholar 

  62. Kocjancic E, Jaunarena JH, Schechter L, Acar Ö. Inflatable penile prosthesis implantation after gender affirming phalloplasty with radial forearm free flap. Int J Impot Res. 2019;32:99–106. https://doi.org/10.1038/s41443-019-0153-8.

    Article  PubMed  Google Scholar 

  63. Van de Grift TC, Elaut E, Cerwenka SC, Cohen-Kettenis PT, Kreukels BPC. Surgical satisfaction, quality of life, and their association after gender-affirming surgery: a follow-up study. J Sex Marital Ther. 2018;44(2):138–48.

    PubMed  Google Scholar 

  64. Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Phalloplasty: a review of techniques and outcomes. Plast Reconstr Surg. 2016;138(3):594–615.

    PubMed  CAS  Google Scholar 

  65. Van de Grift TC, et al. A longitudinal study of motivations before and psychosexual outcomes after genital gender-confirming surgery in transmen. J Sex Med. 2017;14(12):1621–8.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Hospital Italiano de Buenos Aires, Perón Tte Gral Juan Domingo 4190, C1199ABB, Buenos Aires, Argentina

    Federico I. Tirapegui

  2. Department of Urology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA

    Ömer Acar & Ervin Kocjancic

Authors
  1. Federico I. Tirapegui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ömer Acar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ervin Kocjancic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Federico I. Tirapegui.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of Topical Collection on Male and Female Surgical Interventions

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tirapegui, F.I., Acar, Ö. & Kocjancic, E. Sexual Function After Gender-Affirming Genital Reconstruction. Curr Sex Health Rep 12, 411–420 (2020). https://doi.org/10.1007/s11930-020-00294-0

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11930-020-00294-0

Keywords

Search

Navigation