Abstract
Introduction Phalloplasty attempts to achieve a functional and aesthetic phallus. Sensation is
a key component for sexual pleasure. Sensation is also important for protection in
the setting of penile implant insertion. Little data are available on genital sensibility
outcomes after phalloplasty, and there are no standardized approaches for assessment
of either sensibility or erogenous perception.
Methods A literature search of PubMed, Google Scholar, and MEDLINE databases was conducted
with terms related to genital sensibility after phalloplasty. Data on patient demographics,
nerves used for coaptation, and measurements of genital sensibility were collected.
Pooled event rates were determined for recovered glans sensibility and recovered erogenous
sensation using a Freeman–Tukey arcsine transformation.
Results A total of 341 articles were identified of which 26 met the inclusion criteria for
final analysis. The dorsal cutaneous branch of the pudendal nerve and ilioinguinal
were the most common donor nerves. The lateral and medial antebrachial cutaneous and
lateral femoral cutaneous were the most common recipient nerves. Pooled event rates
suggest that some recovered glans sensibility occurs in more than 70% of cismale patients
and in more than 90% of transmale patients. Recovered “erogenous” sensation occurs
in more than 75% of cismale patients and more than 95% of transmale patients. In cismale
patients, outcomes of recovered glans sensibility and erogenous sensation may be better
for upper extremity recipient nerves than lower extremity recipient nerves.
Conclusions Based on the limited data in current literature on genital sensibility after phalloplasty,
it is difficult to draw evidence-based conclusions. Yet data support improved outcomes
with innervation. A validated outcome measure of “erogenous sensation” and a standardized
approach to measuring cutaneous sensibility are required.
Keywords
phallus - phalloplasty - transgender - sensibility - peripheral nerve
