Neoclitoral location may affect sexual function in transgender women: a preliminary pelvic MRI study.
Journal
International journal of impotence research
ISSN: 1476-5489
Titre abrégé: Int J Impot Res
Pays: England
ID NLM: 9007383
Informations de publication
Date de publication:
13 May 2023
13 May 2023
Historique:
received:
18
06
2022
accepted:
27
04
2023
revised:
25
04
2023
medline:
14
5
2023
pubmed:
14
5
2023
entrez:
13
5
2023
Statut:
aheadofprint
Résumé
Assigned female at birth 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 MRI measurements of neoclitoris volume and distance between the neoclitoris and the neovagina were correlated with differences in sexual function. We recruited for a prospective survey study 40 operated male to female patients (oMtF) who had undergone genital gender affirming surgery 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 MtFs operated with pubic neoclitoris technique (PNT) and 11 with neo-urethroclitoroplasty according to Petrović (NCP). The NCP group presented a neoclitoris mean volume of 1.04 (SD 0.39) cc vs 1.31 (SD 0.78) cc of the other group (p = 0.55). The mean distance between neoclitoris and neovagina was 4.20 (SD 0.57) cm in the PNT group and 2.55 (SD 0.45) 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 technique (FSFI 25.81 SD 3.02 vs 18.62 SD 9.92 p = 0.08; oMtFSFI 37.63 SD 8.28 vs 43.36 SD 13.02 p = 0.23). According to pelvic MRI measurements, this study suggests a correlation between neoclitoral location and oMtF sexual satisfaction.
Identifiants
pubmed: 37179422
doi: 10.1038/s41443-023-00716-2
pii: 10.1038/s41443-023-00716-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer Nature Limited.
Références
Oakley SH, Vaccaro CM, Crisp CC, Estanol MV, Fellner AN, Kleeman SD, et al. Clitoral size and location in relation to sexual function using pelvic MRI. J Sex Med. 2014;11:1013–22.
doi: 10.1111/jsm.12450
pubmed: 24521081
Wallen K, Lloyd EA. Female sexual arousal: genital anatomy and orgasm in intercourse. Horm Behav. 2011;59:780–92.
doi: 10.1016/j.yhbeh.2010.12.004
pubmed: 21195073
Vaccaro CM. The use of magnetic resonance imaging for studying female sexual function: a review. Clin Anat. 2015;28:324–30.
doi: 10.1002/ca.22531
pubmed: 25759259
Trombetta C, Liguori G, Benvenuto S, Petrovic M, Napoli R, Umari P, et al. [Neo-urethroclitoroplasty according to Petrovic]. Urologia. 2011;78:267–73.
doi: 10.5301/RU.2011.8855
pubmed: 22139804
Filocamo MT, Serati M, Li Marzi V, Costantini E, Milanesi M, Pietropaolo A, et al. The female sexual function index (FSFI): linguistic validation of the Italian version. J Sex Med. 2014;11:447–53.
doi: 10.1111/jsm.12389
pubmed: 24224761
Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31:1–20.
doi: 10.1080/00926230590475206
pubmed: 15841702
Vedovo F, Di Blas L, Perin C, Pavan N, Zatta M, Bucci S, et al. Operated male to female sexual function index (oMtFSFI): a study on the validity of the first questionnaire developed to assess the sexual function after male to female gender affirming surgery. J Urol. 2020;204:115–20.
doi: 10.1097/JU.0000000000000791
pubmed: 32003598
Brunocilla E, Soli M, Franceschelli A, Schiavina R, Borghesi M, Gentile G, et al. Radiological evaluation by magnetic resonance of the new anatomy of transsexual patients undergoing male to female sex reassignment surgery. Int J Impot Res. 2012;24:206–9.
doi: 10.1038/ijir.2012.18
pubmed: 22673584
Cova M, Mosconi E, Liguori G, Bucci S, Trombetta C, Belgrano E, et al. Value of magnetic resonance imaging in the evaluation of sex-reassignment surgery in male-to-female transsexuals. Abdom Imaging. 2003;28:728–32.
doi: 10.1007/s00261-002-0100-9
pubmed: 14628886
Bertolotto M, Liguori G, Bucci S, Iannelli M, Vedovo F, Pavan N, et al. MR imaging in patients with male-to-female sex reassignment surgery: postoperative anatomy and complications. Br J Radiol. 2017;90:20170062. http://www.birpublications.org/doi/10.1259/bjr.20170062 .
doi: 10.1259/bjr.20170062
pubmed: 28256903
pmcid: 5605084
Cocci A, Frediani D, Cacciamani GE, Cito G, Rizzo M, Trombetta C, et al. Systematic review of studies reporting perioperative and functional outcomes following male-to-female gender assignment surgery (MtoF GAS): a call for standardization in data reporting. Minerva Urol Nefrol. 2019;71:479–86.
doi: 10.23736/S0393-2249.19.03407-6
pubmed: 31144492
De Cuypere G, T’Sjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, et al. Sexual and physical health after sex reassignment surgery. Arch Sex Behav. 2005;34:679–90.
doi: 10.1007/s10508-005-7926-5
pubmed: 16362252
Bouman MB, van der Sluis WB, van Woudenberg Hamstra LE, Buncamper ME, Kreukels BPC, Meijerink WJHJ, et al. Patient-reported esthetic and functional outcomes of primary total laparoscopic intestinal vaginoplasty in transgender women with penoscrotal hypoplasia. J Sex Med. 2016;13:1438–44.
doi: 10.1016/j.jsxm.2016.06.009
pubmed: 27475240
Zavlin D, Schaff J, Lellé JD, Jubbal KT, Herschbach P, Henrich G, et al. Male-to-female sex reassignment surgery using the combined vaginoplasty technique: satisfaction of transgender patients with aesthetic, functional, and sexual outcomes. Aesthetic Plast Surg. 2018;42:178–87.
doi: 10.1007/s00266-017-1003-z
pubmed: 29101439
Weyers S, Elaut E, De Sutter P, Gerris J, T’sjoen G, Heylens G, et al. Long-term assessment of the physical, mental, and sexual health among transsexual women. J Sex Med. 2009;6:752–60.
doi: 10.1111/j.1743-6109.2008.01082.x
pubmed: 19040622
Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BPC, Mullender MG. Aesthetic and functional outcomes of neovaginoplasty using penile skin in male-to-female transsexuals. J Sex Med. 2015;12:1626–34.
doi: 10.1111/jsm.12914
pubmed: 26096123
Bucci S, Mazzon G, Liguori G, Napoli R, Pavan N, Bormioli S, et al. Neovaginal prolapse in male-to-female transsexuals: an 18-year-long experience. Biomed Res Int. 2014;2014:240761.
doi: 10.1155/2014/240761
pubmed: 24895556
pmcid: 4033431
Dreher PC, Edwards D, Hager S, Dennis M, Belkoff A, Mora J, et al. Complications of the neovagina in male-to-female transgender surgery: a systematic review and meta-analysis with discussion of management. Clin Anat. 2018;31:191–9.
doi: 10.1002/ca.23001
pubmed: 29057562
Vaccaro CM, Fellner AN, Pauls RN. Female sexual function and the clitoral complex using pelvic MRI assessment. Eur J Obstet Gynecol Reprod Biol. 2014;180:180–5.
doi: 10.1016/j.ejogrb.2014.02.024
pubmed: 24630291
Abdulcadir J, Botsikas D, Bolmont M, Bilancioni A, Djema DA, Bianchi Demicheli F, et al. Sexual anatomy and function in women with and without genital mutilation: a cross-sectional study. J Sex Med. 2016;13:226–37.
doi: 10.1016/j.jsxm.2015.12.023
pubmed: 26827253
Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM. Female genital appearance: “normality” unfolds. BJOG. 2005;112:643–6.
doi: 10.1111/j.1471-0528.2004.00517.x
pubmed: 15842291
Buisson O, Foldes P, Jannini E, Mimoun S. Coitus as revealed by ultrasound in one volunteer couple. J Sex Med. 2010;7:2750–4.
doi: 10.1111/j.1743-6109.2010.01892.x
pubmed: 20626602
Sigurjónsson H, Möllermark C, Rinder J, Farnebo F, Lundgren TK. Long-term sensitivity and patient-reported functionality of the neoclitoris after gender reassignment surgery. J Sex Med. 2017;14:269–73.
doi: 10.1016/j.jsxm.2016.12.003
pubmed: 28087356
Selvaggi G, Monstrey S, Ceulemans P, T’Sjoen G, De Cuypere G, Hoebeke P. Genital sensitivity after sex reassignment surgery in transsexual patients. Ann Plast Surg. 2007;58:427–33.
doi: 10.1097/01.sap.0000238428.91834.be
pubmed: 17413887