Vaginoplasty in male transsexuals using penile skin and a urethral flap

Sexuality before and after male-to-female sex reassignment surgery

The sexual behaviors and attitudes of male-to-female (MtF) transsexuals have not been investigated systematically. This study presents information about sexuality before and after sex reassignment surgery (SRS), as reported by 232 MtF patients of one surgeon. Data were collected using self-administered questionnaires. The mean age of participants at time of SRS was 44 years (range, 18-70 years). Before SRS, 54% of participants had been predominantly attracted to women and 9% had been predominantly attracted to men. After SRS, these figures were 25% and 34%, respectively.Participants' median numbers of sexual partners before SRS and in the last 12 months after SRS were 6 and 1, respectively. Participants' reported number of sexual partners before SRS was similar to the number of partners reported by male participants in the National Health and Social Life Survey (NHSLS). After SRS, 32% of participants reported no sexual partners in the last 12 months, higher than reported by male or female participants in the NHSLS. Bisexual participants reported more partners before and after SRS than did other participants. 49% of participants reported hundreds of episodes or more of sexual arousal to cross-dressing or cross-gender fantasy (autogynephilia) before SRS; after SRS, only 3% so reported. More frequent autogynephilic arousal after SRS was correlated with more frequent masturbation, a larger number of sexual partners, and more frequent partnered sexual activity. 85% of participants experienced orgasm at least occasionally after SRS and 55% ejaculated with orgasm.

Impact of Sex Reassignment Surgery on Lower Urinary Tract Function

OBJECTIVE

To investigate the effects of sex reassignment surgery (SRS) on lower urinary tract function.

METHODS

A questionnaire concerning voiding habits and lower urinary tract symptoms after sex reassignment surgery, was given to 24 female-to-male transsexuals (FTM) and 31 male-to-female transsexuals (MTF), who respectively underwent phalloplasty and vaginoplasty. For this study only Dutch speaking patients were selected. Also, uro-flowmetry data from 92 FTM transsexuals were reviewed.

RESULTS

In general, no change in voiding patterns was observed. Post-void dribbling was reported by 79% of the FTM transsexuals, and 16% of the MTF group reported some form of incontinence. The uro-flowmetry examination showed a mean, non-significant decrease of 2 ml/s in Q(max) in FTM patients.

CONCLUSION

SRS can cause minor changes in urinary habits. Even if they do not result in patients seeking medical help, transsexuals should be warned about these eventual discomforts pre-operatively.

Abdominal sacral colpopexy for repair of neovaginal prolapse in male-to-female transsexuals

Penectomy, bilateral orchiectomy, and penoscrotal flap vaginoplasty are procedures that increase the psychosocial well-being and enhance body acceptance of male-to-female transsexuals. The incidence of neovaginal prolapse is not known but is believed to be relatively rare. We report 2 cases of neovaginal prolapse that were successfully treated with abdominal sacral colpopexy at our institution.

Anatomic study of vaginal width in male-to-female transsexual surgery

Despite the recent improvement in the design of male-to-female sex reassignment operations to enlarge the vaginal vault and depth, the size of the neovagina remains somewhat limited and the exterior of the neovagina may be compressed by the bony structure of pubic rami. The purpose of this study was to determine by anatomic study the possible cause of this limitation. Eighteen male and 10 female cadavers were dissected to measure the distance between the bilateral bony pubic rami (interramic distance) at a level that corresponds to the same level in the vaginal canal of females. At the same level of the vaginal canal in the female, which corresponds to the lower border of the prostate in the male, empirically 3 cm below the bony symphysis pubis, the mean value of the interramic distance was 3.95 +/- 0.25 cm in the male and 5.20 +/- 0.36 cm in the female (p = 0.000). The interramic distance in the male and female is significantly different. In those who have undergone the male-to-female transsexual operation, the newly structured vagina may be ventrolaterally limited. Several factors cause narrowing of the vaginal orifice in male-to-female transsexuals. On the basis of this study, it seems that the bony structure of the pubic rami compresses the vagina ventrolaterally. This finding may suggest refinements of the structural design of the neovagina and prompt procedural changes in male-to-female sex reassignment operations. Future investigation should be directed toward modifying vaginoplasty so that neovaginal width can be increased to the patient's satisfaction.