(114) WITH “STANDARD” VAGINOPLASTY TECHNIQUE, ARE SURGEONS POSITIONING THE NEOCLITORIS IN THE SAME LOCATION IN THE VULVA AS IN A CIS-GENDER WOMAN? RESULTS OF ANATOMIC AND MRI-BASED STUDIES AND, A NOVEL SURGICAL TECHNIQUE FOR ORTHOTOPIC PLACEMENT

Abstract Introduction The clitoris is a “defining” element of the vulva. It is a primary source of female sexual pleasure. Its location close to the vaginal opening allows for stimulation during vaginal-receptive intercourse. To date, the only described vaginoplasty techniques anchor the newly constructed neoclitoris to the anterior aspect of the penile-corporal stump. We questioned whether this location is orthotopic relative to cis-gender women. Objective 1. To measure the location of the glans clitoris, relative to boney landmarks. 2. Describe our technique for orthotopic positioning of the neoclitoris during vaginoplasty. Methods I. Magnetic Resonance Imaging (MRI) scans of 25 cis-gender women’s pelvises (all with otherwise normal genital anatomy; women positioned flat) were reviewed in A/P and sagittal planes. 12/25 were in cis-women age < 40; 13/25 in women age > 40. The clitoris-shaft and glans, urethra all elements of the pubic symphysis, were identified by a specialized MRI-radiologist. II. We describe our technique for anchoring the neoclitoris in transgender women undergoing vaginoplasty in the correct anatomic position. Results In the flat/supine position during the MRI scans, the glans clitoris was identified superficial to (overlying) the pubic symphysis, at midline. The average distance between the center of glans-clitoris to the inferior edge of the pubic symphysis was 19.6 ± 3.1 mm (range: 13.5-25 mm). (Figure 1) This distance did not differ statistically across age groups (p = 0.91) Our technique (Fig. 2): We now anchor the constructed neoclitoris glans at midline, 20 mm anterior to the inferior-edge of the pubic symphysis. To do this, we bluntly-dissect a 1.5 cm 2 midline-window in the dorsal neurovascular bundle (DNVB), to anchor the neoclitoris-glans to periosteum. Conclusions To date, no publication has described positioning the neoclitoris glans anywhere but to the corporal stump. This location is not orthotopic relative to cis-women, because, anatomically, the penile corporal stump is located posterior to the inferior edge of pubic symphysis. The approach we describe is orthotopic, and, we believe, improves vaginoplasty cosmesis and female sexual pleasure. Disclosure No.