What Is the Ideal Neophallus? Response to Frey et al. (2017): An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature

Elfering, Lian; Özer, Müjde; Buncamper, Marlon E.; Smit, Jan Maerten; Pigot, Garry L.S.; Bouman, Mark Bram; Mullender, Margriet G.

doi:10.1097/gox.0000000000001450

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…16,17 Although some researchers have questioned the accuracy of this definition of the ideal neophallus, many analyses accept it as fact, and an assessment tool to address the assumption that there is an “ideal neophallus” has not yet been published. 18,19…”

Section: Resultsmentioning

confidence: 99%

“…To date, there has been remarkably little information published about patient goals and expectations from trans masculine genital affirmation surgeries. 3,13,15,18,20 Analyses have largely been limited to surgical outcome reports and retrospective studies of satisfaction, which do not take individual's presurgical expectations and desires into account. 3,7,26–30 This could potentially lead to offering a patient a surgery that is not aligned with his goals and desires but based on the surgeon's preferences.…”

Section: Discussionmentioning

confidence: 99%

“…Previous researchers have noted the need for a presurgical assessment tool that could guide decision making around genital affirmation. 18 One previous presurgical assessment has been piloted as a research tool, but not specifically with individuals seeking surgery. 15 Our goal was to be able to use this tool as part of a broader longitudinal study of how surgical expectations and goals are related to postsurgical satisfaction and/or decision regret.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, use of the formal assessment in our clinical care protocol was initiated before undertaking a formal validation protocol. Despite this, the observed diversity of responses reinforced the notion that it is important to assess individual goals and priorities for surgery when determining the best option for any given patient, 18,19 rather than to assume that all patients have the same priorities and goals for their genital surgery.…”

Section: Discussionmentioning

confidence: 99%

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Piloting a Genital Affirmation Surgical Priorities Scale for Trans Masculine Patients

et al. 2019

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Piloting a Genital Affirmation Surgical Priorities Scale for Trans Masculine Patients

et al. 2019

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“…The choice for or against UL is a shared decision-making process through weighing of personal motives and the benefits and risks of different treatment options (Elfering et al., 2017 ). Mainly, this choice is based on the consideration of complication risk and burden, against the importance of being able to void from the tip of the phallus (and being able to void while standing) (de Rooij et al., 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of surgical outcomes and urinary functioning after phalloplasty with versus without urethral lengthening in transgender men

Rooij

Sluis

Ronkes

et al. 2022

International Journal of Transgender Health

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Background: Phalloplasty in transgender men is performed with or without Urethral Lengthening (UL). To create clear expectations in the choice of UL, an overview and comparison of outcomes is useful. Aims: To provide and compare surgical outcomes and urinary functioning after phalloplasty with versus without UL in transgender men. Methods: A single-center, retrospective chart review was conducted among transgender men who underwent phalloplasty with or without UL between 01-2013 and 10-2020. Primary outcomes were differences in complication and reoperation rates. Secondary outcomes were end-stages of voiding at last follow-up and differences in voiding analyses pre- and postoperatively. Results: Of 136 men, 91 (67%) underwent phalloplasty with, and 45 (33%) without UL. Wound infection (31 vs. 16%, p = 0.06) and partial flap loss (35 vs. 13%, p = 0.008) were predominately seen after UL. In the UL group, 43% urethral fistulas and 60% urethral strictures were observed, relative to one man without UL who had a urethral fistula (both p < 0.001). Meatal or perineal orifice stenosis was seen in 29% with versus 11% without UL ( p = 0.02). Reoperation was needed in 81% with versus 27% without UL ( p < 0.001). At follow-up, 80/91 (88%) after UL reached end-stage of voiding, with 60/80 (75%) able to void while standing and 20/80 (25%) having a definitive urethrostomy. The remaining 11/91 (12%) men were awaiting further treatment for urological complications. The men able to void while standing had a median of one reoperation (range 0–6), and a significant decrease in maximum flow rate on postoperative uroflowmetry (21.4 vs. 29.8 mL/s, p < 0.001). After phalloplasty without UL, all men had a definitive perineostomy without changes in voiding analyses. Discussion: The choice for or against UL during phalloplasty has become more relevant over the years. This comparison of surgical outcomes and urinary functioning can be useful in the shared decision-making process to come to the most suitable choice of phalloplasty.

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The evolution of transgender surgery

et al. 2018

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An estimated 1.4% of the population worldwide has been diagnosed with Gender Dysphoria, as defined by the Diagnostic and Statistical Manual of Mental Disorders. Gender reassignment, which holistically encompasses psychotherapy, hormonal therapy and genital and nongenital surgeries, is considered the most effective treatment for transgender nonconforming patients afflicted with gender dysphoria. Little research is currently available identifying the psychosocial needs of the transgender population and their access to preventative and primary care during this transitioning process. This article presents an overview of the evolution and current approaches to genital surgical procedures available for both male-to-female, as well as female-to-male gender-affirmation surgeries. Clin. Anat. 31:878-886, 2018. © 2018 Wiley Periodicals, Inc.

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What Is the Ideal Neophallus? Response to Frey et al. (2017): An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature

Cited by 7 publications

References 3 publications

Piloting a Genital Affirmation Surgical Priorities Scale for Trans Masculine Patients

Piloting a Genital Affirmation Surgical Priorities Scale for Trans Masculine Patients

Comparison of surgical outcomes and urinary functioning after phalloplasty with versus without urethral lengthening in transgender men

The evolution of transgender surgery

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