Introduction

Gender dysphoria is the distress that a person may experience when their gender identity does not align with the sex they were assigned at birth. Gender-affirming hormone therapy (GAHT) and gender-affirming surgery (GAS) are two treatment options that aim to align the characteristics of an individual with their gender identity. Studies suggest that these two medical interventions can reduce distress and improve the quality of life of people who are experiencing gender dysphoria.

However, to maintain or improve the sexual health of transgender people after GAS, it is important for the surgeon to preserve the sensitivity of the genital area as much as possible. For transgender individuals who opt to undergo a vaginoplasty procedure, (i.e., the surgical creation of a vagina and vulva), this means that the surgeons must keep the neurovascular bundle on the top surface of the penis intact when creating the neovagina and neoclitoris.

To explore the genital sensitivity and perceived intensity of orgasm in transgender women after GAS, researchers took measures of genital sensory thresholds at the clitoris, vagina, and anus using evoked responses to stimulation, and collected subjective reports of orgasm intensity using the Orgasmometer tool.

Methods

Six patients who had undergone a penile inversion vaginoplasty GAS through the Center for the Diagnosis and Treatment of Gender Dysphoria at the University Hospital of Pisa participated in this study.

The authors used somatosensory evoked potential (SEP) tests to measure the electrical activity of the brain that occurred when three regions were electrically stimulated: the neoclitoris, the neovagina, and the anus. SEP results provided an objective measure of the individuals’ genital sensitivity.

Participants also completed the Orgasmometer, a validated questionnaire that assesses orgasmic sensations at different stimulation sites. This provided a subjective measure of orgasmic intensity.

Results

The SEP results confirmed that current surgical techniques with neurovascular bundle preservation during gender-affirming vaginoplasty seem to maintain fairly good genital sensitivity in transgender women who have undergone this procedure. Interestingly, the perceptual threshold (or the electrical intensity at which participants were first able to perceive the stimulus) was much lower at the neoclitoris than it was at the neovagina and anus. Additionally, there was a trend between the SEP results and Orgasmometer scores at the neoclitoris site. The participants reported higher orgasmic intensity while SEP showed more electrical activity in the brain.

Discussion & Conclusion

Unfortunately, few studies explore the genital sensitivity and subjective sensations of transgender people after GAS. In this respect, this study provides very useful information for gaining a better understanding of the sexual health of transgender women post-surgery and may point to how such surgeries can be further improved. However, the small number of participants is a limitation of this study, and future studies should strive to include more patients for more robust results.

The authors concluded, “Our study clearly has different weak points…However, [it] provides the first assessment of the sensory pelvic floor innervation of a population of transgender women with gender dysphoria after GAS, by means of an objective method, i.e., electrophysiological tests. Furthermore, even if in an exploratory way, we tried to correlate the electrophysiological findings to the subjective experience of the sexual orgasm.”

References:

• Canale, D., Molinaro, A., Marcocci, C., Morelli, G., Matteucci, V., Mollaioli, D., Jannini, E.A., & Sartucci, F. (2022). Genital Sensitivity and Perceived Orgasmic Intensity in Transgender Women With Gender Dysphoria After Gender-Affirming Surgery: A Pilot Study Comparing Pelvic Floor Evoked Somatosensory Potentials and Patient Subjective Experience. The Journal of Sexual Medicine, 19(9), 1479-1487. DOI: https://doi.org/10.1016/j.jsxm.2022.06.002