XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Sensate Pedicled Neoclitoris in the Neovaginoplasty for 250 Male Transexuals

TIEWTRANON, PREECHA Thailand
Co-authors: Prayuth Chokerungvaranon, Sirachai Jindarak & S. Wannachamras (Thailand)
E-mail: ansdr@samart.co.th

Objective: Aesthetic and sensational neoclitoris is highly considered by male to female patients for Genital Reassignment Surgery. This study is to determine the result of our refined technique of using the glans penis (homologous with the female clitoris) with the neurovascular pedicle to provide the circulation and sensation in the 250 male transexuals.

Methods: 250 sensate pedicled neurovascular glans neoclitorides were reconstructed in the neovaginoplasties during January 1999 – December 2000. The age ranged between 18-72 years, the most common age groups were 20-30 years old and 30-40 years old respectively. 26 patients were HIV+ , 4 patients had diabetes mellitus under control by insulin. Our surgical technique was by excising 8-10 mm of the glans penis and 5 mm of the preputial skin, with the dorsal vessels and nerves, the Buck’s fascia, the tunica albuginea as the pedicle. It was curled over the mons pubis and descended through the tunnel of the skin to form the clitoral column and the glans neoclitoris with the prepuce at the designated location about the vulva vestibule and the neourethra opening.

Results: For the immediate result (7-14 days) 94-4% was very pinkish, but it was only 84%, 70% and 50% in the patients age group of 50-60 years, 60-70 years and more than 70 years respectively. Hypersensitive clitorides were found in 93.2%, it was 100% in the patients who were less than 40 years; 2 out of 4 diabetes mellitus patients’ clitorides were sensitive. The delayed results (3-27 months) will be evaluated in 187 patients. 100% of the neoclitorides decreased in size; 2.6% completely disappeared. Only one patient had no sensation and a flat clitoris. 82% had orgasm; 16% had sexual pleasure and 2% had no sexual intercourse. All were satisfied except for one patient.

Conclusions: Our new refined technique of clitoroplasty was very reliable and offered the most satisfaction rate both immediate and delayed.