ERECTILE FUNCTION AFTER FEMALE-TO-MALE TRANSSEXUAL SURGERY

Abstract

Neophalloplasty is one of the most difficult surgical procedures in genital reconstructive surgery. Many different tissues have been applied such as local vascularized flaps or microvascular free transfer grafts. The main goal of the neophalloplasty is to construct the functional and cosmetically acceptable penis. Although voiding while standing is a priority for most female-to-male transgenders, most patients want to use the neophallus for sexual experience. Erectile function in male transgenders is based on erogenous sensitivity and possibility to achieve erection. In transgenders who underwent metoidioplasty, erogenous sensation is fully preserved while the erectile size of the reconstructed clitoris is not enough for penetration. In patients with total phalloplasty, erectile dysfunction is occurred due to the lack of erectile tissue and penile prosthesis implantation presents a suitable option. Two types of penile prostheses, semi-rigid and inflatable, are usually used after total phalloplasty. Different techniques have been described to enable insertion of both types of prosthesis, but they often resulted in complications and failure. The main limiting factor is presented by the fact that there is no adequate substitute for the penile erectile tissue after phalloplasty. In contrary to serious complications reported in the past, new techniques and modifications for penile prosthesis implantation into the neophallus seem to be safe in experienced hands. © 2020 by Nova Science Publishers, Inc. All rights reserved.