Original Article

World Journal of Urology

, Volume 33, Issue 1, pp 137-143

Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study

  • Nina CallensAffiliated withDepartment of Pediatric Endocrinology, Ghent University and University Hospital Ghent
  • , Griet De CuypereAffiliated withCentre of Sexology and Gender Problems, Ghent University and University Hospital Ghent
  • , Guy T’SjoenAffiliated withCentre of Sexology and Gender Problems, Ghent University and University Hospital GhentDepartment of Endocrinology, Ghent University and University Hospital Ghent
  • , Stan MonstreyAffiliated withDepartment of Plastic Surgery, Ghent University and University Hospital Ghent
  • , Nicolaas LumenAffiliated withDepartment of Urology, Ghent University and University Hospital Ghent
  • , Erik Van LaeckeAffiliated withDepartment of Urology, Ghent University and University Hospital Ghent
  • , Piet HoebekeAffiliated withDepartment of Urology, Ghent University and University Hospital Ghent
  • , Martine CoolsAffiliated withDepartment of Pediatric Endocrinology, Ghent University and University Hospital Ghent Email author 

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Abstract

Purpose

Total phalloplasty is rarely performed today in males with severe penile deficiency, despite its successful use in the transgender population. Can phalloplasty replicate the complexity of penile anatomy and function on the long term?

Methods

Sexual quality of life (QoL) was assessed in 10 men (aged 20–43 years) at least 1 year after phalloplasty in a single institution (80 % radial forearm flap and 20 % anterolateral thigh flap). In all but one, an erectile prosthesis was implanted on average 1 year after phallic reconstruction. Sexual QoL outcomes were compared to those of men with hypospadias repair (n = 73) and control men (n = 50).

Results

After phalloplasty (mean 36.9 months, 14–92 months), all men were sexually active (80 % intercourse and 100 % masturbation with orgasm and ejaculation). However, 75 % indicated to be inhibited in seeking sexual contacts, compared to 40 % of hypospadias patients (p < 0.05) and 11 % of controls (p < 0.01). Although 90 % were satisfied with the final surgical result, dissatisfaction with some aspects of genital appearance was present in 50 %. Erogenous neophallus sensitivity was said to be less than previously hoped for. Six men developed urinary complications (urethral stricture and/or fistula), and one man underwent revision of the erectile implant because of dysfunction. Nevertheless, all indicated they would choose again for phalloplasty if necessary.

Conclusions

Total phalloplasty opens new horizons for the treatment of men with penile deficiency, but limitations of the technique should be emphasized prior to surgery. An exploration of patient expectations and continued follow-up including psychological support is important for optimizing psychosexual comfort.

Keywords

Disorder of sex development (DSD) Micropenis Phalloplasty Psychosexual functioning Reconstructive penile surgery