Clitoral Sensation Diagnosis and Report of Orgasm Following Vulvoplasty and Vaginoplasty Surgery in Transgender Women

INTRODUCTION: Few studies have reported on the ability for patients to orgasm following feminizing genital gender affirmation surgery (vulvoplasty/vaginoplasty); however, this remains an important outcome that patients inquire about when they seek out surgery for gender affirmation. OBJECTIVE: To describe the incidence of orgasm following vulvoplasty/vaginoplasty surgery and to compare patient and perioperative factors between patients who report the ability to orgasm and those who do not. METHODS: This was a retrospective cohort study of transgender women undergoing vulvoplasty with and without vaginoplasty surgery for gender affirmation between January 2016 and June 2023. All surgeries were performed by a single urogynecologist at a tertiary care referral center. Patients were included if they had in-office follow-up of at least 12 months following surgery and if there was documentation of ability to orgasm in the electronic medical record. Patient characteristics and perioperative factors were compared between those patients who reported the ability to orgasm and those who reported inability to orgasm. RESULTS: A total of 223 patients underwent vulvoplasty alone (n=41 ) or vulvoplasty with vaginoplasty (n=182) and met inclusion criteria during the study period. The mean (SD) age and BMI of the cohort was 38 (16) years and 26 (4.8) kg/m2, respectively. The incidence of patients reporting ability to experience orgasm by 6 months following surgery was 90.1% (95% CI 78.3%,94.6%), n=201. Patients who reported inability to orgasm were older (53 vs 36 years, p=0.002), had a higher BMI (27.6 vs 25.8 kg/m2, p=0.04), had a higher incidence of medical comorbidities (45.5% vs 18.5%, p=0.003) as well as a history of prostate cancer (13.6% vs 0%, p=0.003). Inability to orgasm was also associated with patients undergoing a vulvoplasty-only procedure rather than a vulvoplasty with vaginoplasty (72.7% vs 12.4%, p=0.003); however, this finding was no longer statistically significant once we controlled for age and medical commodities. There were no differences in intraoperative complications between the groups, and while there was no difference in the overall incidence of postoperative complications, patients reporting inability to orgasm did have a higher incidence of postoperative bleeding and reoperation, although the incidence of both complications was low. CONCLUSIONS: In this cohort of transgender women undergoing genital gender affirmation surgery, 90% reported the ability to orgasm within 6 months of surgery. There are several patient factors that seem to be associated with inability to orgasm postoperatively, including a patient’s age and their medical comorbidities.