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

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.

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References

  1. Reiner WG (2004) Psychosexual development in genetic males assigned female: the cloacal exstrophy experience. Child Adolesc Psychiatr Clin N Am 13:657–674

    PubMed  Article  Google Scholar 

  2. Money J, Ehrhardt A (1972) Man & woman, boy & girl: differentiation and dimorphism of gender identity from conception to maturity. Johns Hopkins University Press, Baltimore

    Google Scholar 

  3. Meyer-Bahlburg HF (2005) Gender identity outcome in female-raised 46, XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation. Arch Sex Behav 34:423–438

    PubMed  Article  Google Scholar 

  4. Baskin L (2004) Anatomical studies of the female genitalia: surgical reconstructive implications. J Pediatr Endocrinol Metab 17:581–587

    PubMed  Article  Google Scholar 

  5. De Castro R, Merlini E, Rigamonti W, Macedo A Jr (2007) Phalloplasty and urethroplasty in children with penile agenesis: preliminary report. J Urol 177:1112–1117

    PubMed  Article  Google Scholar 

  6. Chang T, Hwang W (1984) Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg 74:251–258

    CAS  PubMed  Article  Google Scholar 

  7. Hurwitz RS (2010) Long-term outcomes in male patients with sex development disorders-how are we doing and how can we improve? J Urol 184:831–832

    PubMed  Article  Google Scholar 

  8. Woodhouse CR, Lipshultz L, Hwang K, Mouriquand P, Creighton S (2012) Adult care of children from pediatric urology: part 2. J Urol 188:717–723

    PubMed  Article  Google Scholar 

  9. Hughes IA, Houk C, Ahmed SF, Lee PA (2006) Consensus statement on management of intersex disorders. J Pediatr Urol 2:148–162

    CAS  PubMed  Article  Google Scholar 

  10. Selvaggi G, Monstrey S, Hoebeke P, Ceulemans P, Van Landuyt K, Hamdi M, Cameron B, Blondeel P (2006) Donor-site morbidity of the radial forearm free flap after 125 phalloplasties in gender identity disorder. Plast Reconstr Surg 118:1171–1177

    CAS  PubMed  Article  Google Scholar 

  11. Garaffa G, Christopher NA, Ralph DJ (2010) Total phallic reconstruction in female-to-male transsexuals. Eur Urol 57:715–722

    PubMed  Article  Google Scholar 

  12. Gilbert D, Jordan G, Devine C, Winslow B, Schlossberg S (1993) Phallic construction in prepubertal and adolescent boys. J Urol 149:1521–1526

    CAS  PubMed  Google Scholar 

  13. Lumen N, Monstrey S, Selvaggi G, Ceulemans P, Decuypere G, Van Laecke E, Hoebeke P (2008) Phalloplasty: a valuable treatment for males with penile insufficiency. Urology 71:272–276

    PubMed  Article  Google Scholar 

  14. Sengezer M, Ozturk S, Deveci M, Odabasi Z (2004) Long-term follow-up of total penile reconstruction with sensate osteocutaneous free fibula flap in 18 biological male patients. Plast Reconstr Surg 114:439–450

    PubMed  Article  Google Scholar 

  15. Perovic SV, Djinovic RP, Bumbasirevic MZ, Santucci RA, Djordjevic ML, Kourbatov D (2009) Severe penile injuries: a problem of severity and reconstruction. BJU Int 104:676–687

    PubMed  Article  Google Scholar 

  16. Djordjevic ML, Bumbasirevic MZ, Vukovic PM, Sansalone S, Perovic SV (2006) Musculocutaneous latissimus dorsi free transfer flap for total phalloplasty in children. J Pediatr Urol 2:333–339

    PubMed  Article  Google Scholar 

  17. Timsit MO, Mouriquand PE, Ruffion A, Bouillot A, Dembele D, Mejean A, Lalloue F, Leriche A, Morel-Journel N (2009) Use of forearm free-flap phalloplasty in bladder exstrophy adults. BJU Int 103:1418–1421

    PubMed  Article  Google Scholar 

  18. De Fontaine S, Lorea P, Wespes E, Schulman C, Goldschmidt D (2001) Complete phalloplasty using the free radial forearm flap for correcting micropenis associated with vesical extrophy. J Urol 166:597–599

    PubMed  Article  Google Scholar 

  19. Mureau M (1995) Psychosexual and psychosocial adjustment of hypospadias patients. Erasmus Universiteit Rotterdam, Rotterdam

    Google Scholar 

  20. Mureau M, Slijper F, van der Meulen J, Verhulst F, Slob A (1995) Psychosexual adjustment of men who underwent hypospadias repair: a norm-related study. J Urol 154:1351–1355

    CAS  PubMed  Article  Google Scholar 

  21. Lumen N, Monstrey S, Ceulemans P, van Laecke E, Hoebeke P (2008) Reconstructive surgery for severe penile inadequacy: phalloplasty with a free radial forearm flap or a pedicled anterolateral thigh flap. Adv Urol 2008:704343. doi:10.1155/2008/704343

  22. Monstrey S, Hoebeke P, Dhont M et al (2005) Radial forearm phalloplasty: a review of 81 cases. Eur J Plast Surg 28:206–212

    Article  Google Scholar 

  23. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale, NJ

    Google Scholar 

  24. Hasselblad V, Hedges LV (1995) Meta-analysis of screening and diagnostic tests. Psychol Bull 17:167–178

    Article  Google Scholar 

  25. Callens N, De Cuypere G, Van Hoecke E, T’Sjoen G, Monstrey S, Cools M, Hoebeke P (2013) Sexual quality of life after hormonal and surgical treatment, including phalloplasty, in men with micropenis: a review. J Sex Med 10:2890–2903

    PubMed  Article  Google Scholar 

  26. Hoebeke PB, Decaestecker K, Beysens M, Opdenakker Y, Lumen N, Monstrey SM (2010) Erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol 57:334–340

    PubMed  Article  Google Scholar 

  27. Lumen N, Monstrey S, Goessaert A-S, Oosterlinck W, Hoebeke P (2011) Urethroplasty for strictures after phallic reconstruction: a single-institution experience. Eur Urol 60:150–158

    PubMed  Article  Google Scholar 

  28. Chadwick P, Liao L, Boyle M (2005) Size matters: experiences of atypical genital and sexual development in males. J Health Psychol 10:529–543

    PubMed  Article  Google Scholar 

  29. Schonbucher VB, Weber DM, Landolt MA (2008) Psychosocial adjustment, health-related quality of life, and psychosexual development of boys with hypospadias: a systematic review. J Pediatr Psychol 33:520–535

    PubMed  Article  Google Scholar 

  30. van der Zwan YG, Callens N, van Kuppenveld J, Kwak K, Drop SLS, Kortmann B, Dessens AB, Wolffenbuttel KP (2013) Long term outcomes in males with disorders of sex development. J Urol 190:1038–1042

    PubMed  Article  Google Scholar 

  31. Lee P, Houk C (2004) Outcome studies among men with micropenis. J Pediatr Endocrinol Metab 17:1043–1053

    PubMed  Google Scholar 

  32. Money J, Lehne G, Pierre-Jerome F (1985) Micropenis: gender, erotosexual coping strategy, and behavioral health in nine pediatric cases followed to adulthood. Compr Psychiatry 26:29–42

    CAS  PubMed  Article  Google Scholar 

  33. Husmann D (2004) The androgen insensitive micropenis: long-term follow-up into adulthood. J Pediatr Endocrinol Metab 17:1037–1041

    CAS  PubMed  Article  Google Scholar 

  34. Miller M, Grant D (1997) Severe hypospadias with genital ambiguity: adult outcome after staged hypospadias repair. Br J Urol 80:485–488

    CAS  PubMed  Article  Google Scholar 

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Acknowledgments

This study was made possible through a research grant from the Flanders Research Foundation (FWO Vlaanderen).

Conflict of interest

None.

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Correspondence to Martine Cools.

Additional information

Piet Hoebeke and Martine Cools have a shared senior authorship.

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Callens, N., De Cuypere, G., T’Sjoen, G. et al. Sexual quality of life after total phalloplasty in men with penile deficiency: an exploratory study. World J Urol 33, 137–143 (2015). https://doi.org/10.1007/s00345-014-1283-8

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  • DOI: https://doi.org/10.1007/s00345-014-1283-8

Keywords

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