Formation of neoclitoris from glans penis by reduction glansplasty with preservation of neurovascular bundle in male-to-female gender surgery: Functional and cosmetic outcome

Purpose: During male-to-female gender reassignment surgery we used an abdom inal pedicled inverted penile skin technique to create a vagina and extra f olds of skin to create a clitoral hood. Although patients had orgasms with that technique, there was a general request for the placement of a sensate, erectile clitoris. Therefore, in 10 such patients undergoing transsexual s urgery a neoclitoris was fashioned from the glans penis. Surgical technique and results are described. Material and Methods: From 1980 to 1995, 57 male-to-female gender surgeries were performed at our university center. In the last 10 such patients unde rgoing transsexual surgery a neoclitoris was created. Glans volume is reduc ed to match that of a normal size clitoris and the entire length of the dor sal neurovascular bundle is preserved. The neoclitoris is placed through a buttonhole in the newly constructed introitus. There was minimal bleeding f rom the bundle intraoperatively. Results: In 8 of 10 patients the neoclitoris remained intact postoperativel y with good sensation to touch, vibration and Light pressure (sexual sensat ion). The cosmetic and functional appearance was that of a normal clitoris, and patients were satisified. In 2 patients the results were not satisfact ory because of necrosis of the neoclitoris. Conclusions: This technique has excellent functional and cosmetic results i n the majority of patients. Preservation of the somatic, tactile and vibrat ory sensation of the neoclitoris is surgically practical, and can afford th e patient the possibility of a more functional outcome of gender reassignme nt surgery.