Neoclitoris location may affect sexual function in transgender women: a pelvic MRI study.

Abstract

Natal women with anorgasmia possess a smaller clitoral glans and clitoral components farther from the vagina lumen than women with normal orgasmic function. There are no studies evaluating this correlation in operated transgender women. We evaluated whether differences in magnetic resonance imaging (MRI) measurements of neoclitoris volume and distance between the neoclitoris and the neo-vagina were correlated with differences in sexual function. We recruited for a prospective survey study 40 operated male to female patients (oMtF) who had undergone gender affirming surgery (GAS), using two different techniques, the pubic neoclitoris technique (PNT) and the neourethroclitoroplasty according to Petrović (NCP), and postoperative pelvic MRI. Individual pelvic MRIs were reviewed by two blinded investigators, the three axes of the neoclitoris were measured and the volume was calculated using the ellipsoid formula. The distance between the neoclitoris and the neovagina was also measured. Sexual functioning was assessed using the Female Sexual Function Index (FSFI) and the operated Male to Female Sexual Function Index (oMtFSFI). Mean scores differences in FSFI, oMtFSFI were examined; associations with clitoral size, location, sexual functioning and demographical variables were investigated as well. The response rate was 55%, 11 oMtFs were operated with PNT and 11 with NCP. The PNT group presented a neo-clitoris mean volume of 1.04 cc vs 1.31 cc of the other group (p = 0.55). The mean distance between neo-clitoris and neovagina was 4.20 cm in the PNT group and 2.55 in the NCP group (p < 0.001). Patients who had undergone NCP achieved a higher FSFI and oMtFSFI mean Total Score than those operated with the previous used PNT (FSFI 25.8 vs 18.6 p = 0.08; oMtFSFI 23.36 vs 27.18 p > 0.20). According to pelvic MRI measurements, this study suggests a correlation between neoclitoris location and operated male to female sexual satisfaction.