Blanchard, Legault & Lindsay, 1987
Clarke Institute of Psychiatry and University of Toronto, Toronto, Ontario, Canada

This publication contains a partial aspect of a follow-up study that was already described previously. While there the psycho-social variables were presented (Blanchard et al., 1985), this publication is about the cosmetic and functional evaluation of the surgical results.

• Sample
• Study Methods
• Evaluation Fields and Criteria
• Results
• Follow-up Studies Mentioned
• Authors' Conclusion

Study Methods
The secondary author conducted a structured interview and a physical examination with each female.

Evaluation Fields and Criteria
Evaluated were the depth, width and the capacity to function of the vagina as well as the cosmetic results in the area of the vulva. Additionally, the number of corrective surgeries, incontinence, direction of the urine flow, capacity for orgasms, ejaculation during orgasm, sexual intercourse experience after surgery, pain or difficulties during sexual intercourse, difficulties after sexual intercourse and clitoris erection during intercourse were registered.

Results
Nineteen of the 22 females had at least one post-surgical sexual intercourse experience. The frequency of sexual intercourse varied greatly. Four females reported that they had never had an orgasm since surgery and seven reported that they had them seldom, or had difficulties to achieve them. Four experienced the post-surgical orgasm less intensely as before. Seven females reported about orgasms, but did not describe them. Eight females never had pain or difficulties during sexual intercourse. Five females reported that pain or difficulties only happened at the beginning or after a longer sexual inactivity. Four females only had pain when the penis of the partner was too big. Two females regularly had pain or difficulties during sexual intercourse. Three females reported about pain after sexual intercourse.
The cosmetic results were evaluated for two females as unsatisfactory, for ten as fair to good and for nine as very good. Corrective surgical procedures were necessary for seven females. The average depth of the vagina was 8.3 cm. (4.0-13.0 cm.). There was no correlation between the objective measure of the depth and the subjective evaluation of the females to the question if the vagina was deep enough for sexual intercourse. To the contrary, there was a highly significant connection between regular dilation and the depth of the vagina.

Follow-up Studies Mentioned
Ball, 1981; Benjamin, 1966; Blanchard et al., 1985; Hoenig et al., 1971; Lindemalm et al., 1976; Lothstein, 1980; McEwan et al., 1986; Randell, 1969; Sörensen, 1981a; Wålinder & Thuwe, 1975; Pomeroy, 1969; Stürup, 1976

Authors' Conclusion
It was the authors' intent to obtain reliable data about the cosmetic and functional results of vaginoplasty that they could use for pre-surgical counseling. The results were called provisional because they all stem out of the series of one treatment team. Two important results are especially highlighted: (1) the post-surgical sexual activity correlates to the quality of the cosmetic and functional surgical results; (2) even with a vagina evaluated by the researchers as too short, the females have had sexual intercourse and experienced it as satisfactory.