Phalloplasty and Metoidioplasty: a Systematic Review of Sensation, Orgasm, and Penetrative Intercourse

Purpose of ReviewCurrently, there are a lack of systematic and standardized methods to evaluate sensation in individuals who have undergone masculinizing gender affirmation surgery (GAS). An individual's choice to pursue phalloplasty or metoidioplasty is driven by consideration of cosmetic satisfaction, urethral function, phallic rigidity, and penetrative ability. Regardless of the chosen procedure, phallic sensation is desired for satisfactory sexual function, pleasure, and overall well-being. The purpose of this review is to evaluate the current literature on sensory outcomes after masculinizing GAS and to identify gaps in knowledge that may benefit from further research.Recent FindingsThere is great variability in the collection and reporting of sensation, orgasm, and sexual function data. Due to design limitations and potential bias, all included studies received "low" or "very low" GRADE of evidence. Tactile and erogenous sensation were the most common types of sensation reported. Although most studies report that their participants are eventually able to achieve erogenous and tactile sensation, it is difficult to draw firm conclusions due to significant variability in methodology and results. Additionally, there is limited available literature poised to compare sexual function outcomes between phalloplasty techniques and donor tissue sites. Percentages of participants able to orgasm via masturbation ranged from 71.8 to 100%, while orgasming with sexual intercourse ranged from 69.5 to 100%. Fewer than half of studies discussed the ability for penetrative sex. Between these studies, the ability to engage in penetrative sex ranged from 39.5 to 75%. Only two studies reported the length of time post-operatively to orgasmic ability; both reported that participants were able to orgasm by 1 year post-op.Overall, there are a wide variety of surgical techniques for GAS described in the literature. The data on sensation, orgasm, and sexual function remains limited, but the authors of this manuscript feel that this study highlights gaps that future researchers may seek to fill.