Piloting a Genital Affirmation Surgical Priorities Scale for Trans Masculine Patients

Abstract

Purpose: Many transgender men seek surgical interventions to create male genitalia. Currently, there is no standardized tool to assess individual goals and expectations for such reconstructive genital surgery. The purpose of this study was to develop and pilot a genital affirmation surgical priorities scale (GASPS) in transgender men seeking metoidioplasty and/or phalloplasty. Methods: The research team developed the GASPS and piloted it with 63 patients seeking reconstructive genital surgery. The scale was constructed after a comprehensive literature review identified key areas of importance, including size, erogenous and tactile sensation, interest in penetrative sex, ability to urinate standing up, and maintenance of orgasmic function. Results were then tabulated and analyzed to look for trends. Results: Sixty three consecutive patients, mean age 24.98 years (standard deviation [SD] = 5.87), were administered the assessment. On the 5 point Likert scale, patients were most concerned about being able to stand to urinate (mean = 4.38, SD = 1.06) and erotic sensation (mean = 4.21, SD = 0.8). The ability to engage in penetrative intercourse (mean = 3.98, SD = 1.34), tactile sensation (mean = 3.93, SD = 1.01), and penis length (mean = 3.37, SD = 1.18), and girth (mean = 3.09, SD = 1.20) were not universally considered to be important and responses varied widely. Most patients (86%) stated they had a history of being able to orgasm, and 8% did not know. Feedback suggested that scale use helped patients clarify goals for surgery. Conclusion: GASPS use confirmed the diversity of patient priorities and the importance of individualized goal assessment. It also confirmed previous reports that standing to urinate is a major genital affirmation motivation for many transgender men.

The role of androgens in clitorophallus development and possible applications to transgender patients

“…These goals can then be translated into informed decision-making. 71 Patients whose desires fall outside the typical requests should be further vetted and assessed to understand how those desires reflect and interact with their gender identity and psychosocial readiness. Some patients feel best with anatomy that has both penetrative and receptive potential and may request specific subprocedures.…”

“…Although sexual penetration is not of interest to all individuals who seek modification of the small clitorophallus, it is important for some. 71,83 Individuals considering metoidioplasty should be advised that they should not anticipate sufficient length after surgery to engage in unassisted penetration, although some metoidioplasty patients do achieve this goal. 70 There are two primary types of internal prostheses, malleable and inflatable.…”

“…The patient should be asked to rate components of their goals and desires such as outward appearance, standing while voiding, sexual penetration, orgasm, and donor site considerations (for phalloplasty). These goals can then be translated into informed decision‐making 71 . Patients whose desires fall outside the typical requests should be further vetted and assessed to understand how those desires reflect and interact with their gender identity and psychosocial readiness.…”

Gender-Affirming Surgeries in Transgender and Gender Diverse Adolescent and Young Adults: A Pediatric and Adolescent Gynecology Primer

“…In particular, patients interested in metoidioplasty should be counseled that they are unlikely to be able to engage in insertive intercourse with their new anatomy. 7 For patients who have sexual penetration as a priority, phalloplasty is likely to be a better option for masculinizing genital surgery, although patients should be counseled that this will require the use of either an external or internal erectile device. 8 Those who currently use their vagina for insertive sex and/or wish to do so in the future should be counseled that there are limited data suggesting an increased risk of urethral complications when genital affirmation surgeries are performed without vaginectomy, but that it may be reasonable to accept that increased risk after discussion with their surgeon.…”

Penile Reconstruction: Current Thoughts, Techniques, and Outcomes

“…6 Generally speaking, goals of phalloplasty include the facilitation of sexual penetration, protective sensation, orgasm, standing micturition, and natural aesthetics. 7 Additionally, the ideal choice of reconstructive method would have few stages and minimal morbidity. 8 Our Editor's Pick for EMJ Urology 8.1 is this review paper by Brazio et al Availability and incidence of penile reconstructive surgeries has increased, with techniques refined over recent years to reduce complication rates.…”