A Dutch surgeon has developed a new technique to create erotic sensations in trans women’s vaginas.
The author operated on 50 trans women (born male) between August 2009 and May 2014. He created a a sensate vagina pedicled-spot and a neo-clitoris during primary penile skin inversion vaginoplasty. Part of the corona glandis of the penis is “pedicled on the dorsal penile neurovascular bundles” and put into the neo-vagina.
The goal of the operation is to increase sexual sensitivity for trans women.
“One of the goals of sex reassignment surgery is to create tactile and erogenous sensitivity in the reconstructed genitals. A neo-clitoroplasty performed during primary gender-confirming surgery for male-to-female transsexuals, is a procedure which has been considered state of the art for over 40 years, gives sexual functionality to the neo-female genitalia. This goal falls short due to the inner neo-vagina’s lack of erogenous sensitivity, having instead only tactile sensitivity of the skin and prostate. This shortcoming persists despite the refinements to the vaginoplasty throughout the years.
To improve the sexual functionality, I have innovated a technique that creates a sexual sensate vagina pedicled-spot in the male-to-female transsexuals, which could be compared with the G-spot, in combination with neo-clitoroplasty.”
At 15 weeks, 82% of the patients had sexual feelings in the clitoris and 62% had sexual feelings in the sensate pedicled spot within the vagina. However, the study also says that erogeneous sensibility recurred in all the patients; so perhaps some patients developed sensitivity after 15 weeks.
The study does not discuss orgasms or patient satisfaction. There is no information on whether or not the trans women were having active sex lives. Future studies should look at these issues.
Future research should also look at whether there are any differences between neo-clitorises created with this procedure and other neo-clitorises. Does it affect the clitoris if part of the corona glandis is used to create the sensate pedicled spot within the vagina?
This is an exciting first study, however. Creating sexual arousal and pleasure is an important part of gender reassignment surgery.
What about safety?
The technique added 15 minutes to the time of the operation. This might increase the risk of blood clots, although they did not report any.
Complications included:
6% per-operative rectal lesions which were directly closed
2% post-operative bleeding
34% one or more aesthetic corrections involving the introitus, labia majora, or clitoral region,
4% infections treated with antibiotics
10% post-operative bladder retention which resolved spontaneously after 1 week
20% had meatoplasty to enlarge the opening for peeing
It is difficult to evaluate the relative rate of complications. The rate of bleeding in this series compares well to rates reported in this 2010 German study (6%) and this 2011 overview from the United Kingdom (10%). On the other hand, their rate for problems with narrowing of the urethra is much higher than in the other two studies (none and 3-4% respectively). In this review of studies, a 2001 German study had higher rates of complications. None of the other studies discuss aesthetic corrections.
We need studies that compare the relative safety and rates of complications of different surgical procedures, including this one.
More Details on the Study:
40% of the patients felt sensations in the clitoris an average of 11 weeks before the sensate pedicled spot, 40% felt sensations in both at the same time, 4% felt sensations in the sensate pedicled spot first, and 12% were unclear on the timing.
Erogenous feelings in the clitoris recurred after 7.6 weeks on average in 46 patients, with a range of 5 days to 48 weeks. Erogenous feelings in the sensate pedicled spot recurred after 12.6 weeks on average in 44 patients, again with a range of 5 days to 48 weeks.
For one patient, “the sensate pedicled-spot was lost due to pressure but remarkably the sensate potency was not lost in this case.”
“Hypersensibility occurred in two patients of the sensate pedicled-spot along with hypersensibility of the clitoris.”
The average age of the patients was 38.4 years (range 19–65 years).
Follow-up ranged from 17 to 73 months (mean 46.7 months) and is still ongoing.
You can read details of the surgical technique used below.
Original source (contains graphic photos of surgery):
Technique described in this study:
“For the vaginoplasty, I employ a modification of the abdominally pedicled penile skin inversion technique enhanced by a dorsal rectangular scrotal skin flap. For this, the penile skin tube with the fascia penis superficialis (dartos fascia) and superficial dorsal cutaneous veins adherent to it are dissected from the erectile corpora, leaving the dorsal neurovascular bundles unharmed and covered by Buck’s deep penile fascia. Subsequently, two longitudinal incisions through Buck’s fascia, but not through the tunica albuginea, are made bilateral to the dorsal neurovascular bundles. By blunt and sharp dissection, the intermediate fascia, including both dorsal neurovascular bundles, is raised from the tunica albuginea all the way from the base of the glans to the urogenital diaphragm. After undermining part of the glans, two small parts of its corona and a part of the preputium is left attached to this pedicle which will be divided. One part will serve as a vascularized sensate neoclitoris with its preputial hood and the other part will be the sensate pedicled-spot. The sensate pedicled-spot will be attached to the anterior wall of the vagina in the ostium region and invisible in frontal view.”
TRANS RESEARCH 