Coming Soon: Ability to Orgasm After Gender Affirming Vaginoplasty

Abstract

Background Many patients have goals related to sexual health when seeking gender-affirming vaginoplasty, and previous investigations have only studied the ability to orgasm at cross-sectional timepoints. Aim Our aim is to quantify the time to orgasm postoperative gender-affirming vaginoplasty and describe potential correlative factors, including preoperative orgasm, to improve preoperative counseling. Methods A retrospective chart review was utilized to extract factors thought to influence pre and postoperative orgasm in patients undergoing robotic peritoneal flap vaginoplasty. Mean days to orgasm plus one standard deviation above that mean was used to define the time at which patients would be considered anorgasmic. Outcomes Orgasm was documented as a categorical variable on the basis of surgeon interviews during pre and postoperative appointments while time to orgasm was measured as days from surgery to first date documented as orgasmic in the medical record. Results A total of 199 patients underwent surgery from September 2017 to August 2020. The median time to orgasm was 180 days. 178 patients had completed 1 year or greater of follow-up, and of these patients, 153 (86%) were orgasmic and 25 patients (14%) were not. Difficulty in preoperative orgasm was correlated only with older age (median age 45.9 years vs 31.7, P = .03). Postoperative orgasm was not significantly correlated with preoperative orgasm. The only factor related to postoperative orgasm was smoking history: 12 of 55 patients (21.8%) who had a positive smoking history and sufficient follow-up reported anorgasmia (P-value .046). Interventions for anorgasmic patients include testosterone replacement, pelvic floor physical therapy, and psychotherapy. Clinical Implications Preoperative difficulty with orgasm improves with gender-affirming robotic peritoneal flap vaginoplasty, while smoking had a negative impact on postoperative orgasm recovery despite negative cotinine test prior to surgery. Strengths & Limitations This investigation is the first effort to determine a timeline for the return of orgasmic function after gender-affirming vaginoplasty. It is limited by retrospective review methodology and lack of long-term follow-up. The association of smoking with postoperative orgasm despite universal nicotine cessation prior to surgery may indicate prolonged smoking cessation improves orgasmic outcomes or that underlying, unmeasured exposures correlated with smoking may be the factor inhibiting recovery of orgasm. Conclusion The majority of patients were orgasmic at their 6-month follow-up appointments, however, patients continued to become newly orgasmic in appreciable numbers more than 1 year after surgery.

Vaginoplasty for Gender Dysphoria and Mayer-Rokitansky-Küster-Hauser Syndrome: A Systematic Review and Meta-analysis

“…Satisfaction with sexual function (overall, orgasmic function or vagina depth) amongst sexually active (or married 76 ) patients was also reported by diverse 10-point, 69 5-point, 46,60 3-point, 68,71,85 2point 14,41,87,43,55,61,65,66,75,79,86 and self-made questionnaires (Figures S6E/F). Sexual dysfunction associated with inadequate depth, 45 lubrication issues, sexual discomfort, sporadic ejaculation and clitoral erection (after Penile-inversion-surgery) 25 and excessive secretion, dyspareunia 25,61,79 and vaginal stenosis.…”

Peritoneal Vaginoplasty in Gender Diverse Patients

“…Peritoneal flaps were able to augment neovaginal depth by 5 cm beyond the length of a skin graft or flap, especially in settings with limited natal skin [9]. Most patients (80-86%) report ability to achieve adequate orgasm, experience neovaginal wetness or increased wetness with sexual arousal (70%) and are able to have receptive intercourse (50%) [11,13].…”

Sexual health in transgender and gender diverse people

“…achieve orgasm by 1 year after vaginoplasty, with a median recovery time of 6 months and a history of smoking found to be independently associated with postoperative orgasmic dysfunction [17]. While the authors proposed several potential treatments for postoperative anorgasmia, the efficacy of these remains to be determined.…”