Male-to-Female (MtoF) gender affirming surgery: Modified surgical approach for the glans reconfiguration in the neoclitoris (M-shape neoclitorolabioplasty)

Abstract

Purpose: The aim of this article is to describe our modified surgical technique for the reconfiguration of the glans in the clitoris and the labia minora, known as the “M-shape neoclitorolabioplasty”. Methods: The glans with all its neurovascular bundle is isolated from the corpora cavernosa, incised in Y-shape mode and spread in order to obtain an M-shape glandular flap. The “belly” of the M-shape glans will constitute the triangular neoclitoris meanwhile the lateral flaps will constitute the labia minora. The inferior apex of the neoclitoris is fixed to the superior apex of the previously spatulated urethra. The two glans flaps are incised transversally to increase their length and sutured to the sides of the spatulated urethra forming the labia minora. Our technique permits to create an aesthetically pleasing neovagina preserving all the glandular erogenous sensitivity. Results: 94 patients have been treated with our modified technique of male-to-female (MtoF) gender affirming surgery. At median follow-up of 27.57 months, 81 (86.1%) patients reported vaginal intercourse and 78 (82.9%) patients referred presence of erogenous sensitivity during dilatations, intercourse or masturbations. All the glandular tissue is preserved and reconfigured forming the neoclitoris and the labia minora. The M-shape reconfiguration permit to create an aesthetically pleasant neoclitoris. Conclusions: This technique could be applied safely and easily to patients undergoing gender affirming surgery, allowing the creation of a neovagina with the best possible erogenous sensitivity without losing aesthetical results.

Penile-scrotal flap vaginoplasty versus inverted penile skin flap expanded with spatulated urethra: A multidisciplinary single-centre analysis

“…From an aesthetical and functional point of view, it is important to emphasize that imperfections are extremely subjective: women with minor imperfections may suffer from issues in their sexual life to the point of requiring further surgery, whereas other patients with serious blemishes decide not to undergo re-intervention. Clitoral dimensions are inevitably related to original gland size, since the necessity of saving the marginal portion of the gland for vascularization and innervation of the neo-clitoris (20)(21). Moreover, depending on the surgical technique, the morphology of the lower commissure varies: Jones technique results in a u-shaped commissure while the Perovic strategy results in a v-shaped commissure, which has a more natural aspect and can allow hinder penetration (8).…”

Sexual health after vaginoplasty: A systematic review

“…11,13,18,19,30,33,35,44,45,48,51,66,67, General erogenous sensation ranged from 51.4% to 100% (median 97.7%) in 529 patie nts. 11,13,30,74,80,88,89,91,100,101 Only De Andrade (2013) reported a qualified scale for genital sensibility, receiving a 9.4/10 among 7 patients. 75 The clitoris is the most reported area of erogenous sensation.…”

ESSM Position Statement “Sexual Wellbeing After Gender Affirming Surgery”

“…Sixty-one studies reported outcomes on sexual wellbeing following vaginoplasty, available in Table 2. 55 , 79 , 80 , 81 , 84 , 85 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 ...…”

“…et al 2016, WHOQOL-100 93 Follow-up study 4 47 AMAB 16–54 Marital status, sexual activity WHOQOL-100 5 were in a stable relationship, 42 were not. Cocci et al 2019, Male-to-female 138 Outcome measures 4 94 AMAB M 29.5 y Intercourse, erogenous sensitivity Not specified 81 (86.1%) had intercourse. Erogenous sensitivity during dilatation, intercourse or masturbation was present in 78 (82.9%).…”