Sexual health outcomes following gender-affirming phalloplasty: a systematic review.

Arousal and desire outcomes after phalloplasty varied widely across studies.

• Arousal/desire outcomes ranged from 5.4% of patients with difficulty with arousal to 77% of patients with reduced arousal to half the time or less.
• The largest post-operative increase in desire was reported after radial forearm free flap (RFFF) phalloplasty.
• 18 articles met inclusion criteria from searches across PubMed, Embase, and Web of Science from database origins through February 29, 2024.

Erogenous sensation ratings after phalloplasty were reported between 53% and 100% across the majority of studies.

• Studies varied widely in how sensation was assessed.
• The majority of studies reported ratings of erogenous sensation to be between 53% and 100%.
• The review noted that outcome measures were not standardized or validated within the transmasculine population.

The ability to achieve orgasm after phalloplasty varied substantially depending on the sexual context assessed.

• Orgasm ability ranged from 50% to 93% during masturbation.
• Orgasm ability ranged from 58% to 75% during intercourse with a partner.
• When asked generally (not context-specific), orgasm ability ranged from 29% to 100%.
• Roughly half of patients who underwent phalloplasty with either RFFF or suprapubic pedicle reported the ability to achieve orgasm.

The ability to engage in penetrative intercourse after phalloplasty ranged widely, from 19% to 100%.

• Penetrative intercourse ability ranged between 19% and 100% across studies.
• These figures often included people who had not received penile implants.
• Most patients reported penetrative ability with a penile implant, though patients also endorsed penetration without an implant.

The absence of pre-surgical baseline data limits interpretation of post-operative sexual health outcomes.

• No pre-surgical data were available, limiting the ability to assess whether reported post-operative outcomes reflect an improvement in sexual health.
• 18 articles met inclusion criteria, indicating a relatively small body of literature on this topic.
• The review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.

There is significant heterogeneity in how sexual health outcomes are measured across phalloplasty studies.

• Studies varied widely in assessment methods for arousal, desire, sensation, orgasm, and penetrative ability.
• The authors noted that future studies are needed with outcome measures validated within the transmasculine population.
• More granular information is needed regarding ancillary procedures, donor sites, and type of nerve coaptation.

Phalloplasty technique influenced sexual function outcomes, with specific differences noted between RFFF and suprapubic pedicle approaches.

• The review revealed differences in sexual function based on phalloplasty technique.
• The largest post-operative increase in desire was after radial forearm free flap (RFFF).
• Roughly half of patients who underwent phalloplasty with either RFFF or suprapubic pedicle reported the ability to achieve orgasm.