Gender-affirming vaginoplasty is a surgery to create a vaginal canal and vulva (including the clitoris) for transgender, non-binary, or gender diverse individuals who wish to align their physical characteristics with their gender identity. People who undergo gender-affirming vaginoplasty may have different goals or priorities related to their gender expression, the appearance of their genitals, and/or their sexuality when it comes to surgery. For some, the ability to orgasm after vaginoplasty is an important goal.

There is limited information available on the number of vaginoplasty patients who are able to orgasm before and after surgery, and previous studies have reported that anywhere between 17.4%-100% of individuals can achieve orgasm after surgery, which is a notably wide range.

A recent study looked at the pre- and postoperative orgasmic ability of 199 patients who underwent vaginoplasty between September 2017 and August 2020. The authors of the study collected relevant health, relationship, and demographic information about the participants to determine whether any of these variables could be associated with orgasmic ability before or after surgery.

Participants shared information about their preoperative orgasmic ability and orgasm quality, sexual preferences, age, smoking history, HIV status, circumcision status, body mass index (BMI), diabetes status, and whether or not they received physical therapy after surgery.

Importantly, all participants were asked to share the number of days after surgery at which they were able to orgasm, if they were able to do so. Since the times of the patients’ follow-up visits varied, the researchers defined the periods as follows: 1 month (25–50 days), three months (50–120 days), 6 months (120–300), 1 year (300–550 days), and greater than 1 year (>550 days).

By these definitions, (and accounting for the 21 people who were lost to follow up during the process,) 153 of 178 participants (86%) were orgasmic after 1-year post-surgery. The remaining 25 individuals in this sample were not documented as being able to orgasm at 1 year or later, or had pending follow-up visits and were considered anorgasmic at that point.

The average time it took the participants of this study to regain their orgasmic function after surgery was 217 days, and the median time to orgasm was 180 days. Surprisingly, the ability to orgasm before surgery was not significantly associated with the ability to orgasm after surgery. In fact, 13 of the 19 individuals who were unable to orgasm before surgery gained the ability to do so after vaginoplasty.

With regard to pre-surgery orgasmic ability, older age was the only significant predictor of orgasmic difficulties. After surgery, the only factor that was shown to be associated with difficulties achieving orgasm was smoking history, and 12 of 55 patients (22%) who had a history of smoking were anorgasmic after vaginoplasty (at least during the follow-up period of this study).

Fortunately, there are options to improve orgasmic function after vaginoplasty including pelvic floor physical therapy, psychotherapy, and testosterone replacement (for patients who are open to it).

Resources:

• Blasdel, G., Kloer, C., Parker, A., Castle, E., Bluebond-Langner, R., & Zhao, L.C. (2022). Coming Soon: Ability to Orgasm After Gender Affirming Vaginoplasty. The Journal of Sexual Medicine, 19(5), 781-788. DOI: https://doi.org/10.1016/j.jsxm.2022.02.015