Clitoral sensation and report of orgasm following vulvoplasty and vaginoplasty surgery in transgender women.

[BACKGROUND] Limited research exists on postoperative orgasmic function following feminizing genital gender affirmation surgery (vulvoplasty/vaginoplasty).

[AIM] To describe the incidence of orgasm following vulvoplasty/vaginoplasty surgery and compare factors between patients who report the ability to orgasm and patients who do not.

[METHODS] A retrospective cohort study was conducted of transgender women undergoing gender-affirming vulvoplasty with and without vaginoplasty between January 2016 and June 2023. Patients were included if they had in-office follow-up for at least 12 months following surgery and documentation of an ability to orgasm.

[OUTCOMES] Of 223 patients, 41 underwent vulvoplasty alone and 182 underwent vulvoplasty with vaginoplasty. The mean (SD) age and body mass index of the cohort were 38 (16) years and 26 (4.8) kg/m2. At 6 months after surgery, 90.1% (n = 201; 95% CI, 78.3%-94.6%) reported an ability to orgasm. Patients who reported an inability to orgasm were older (53 vs 36 years, P = .002) and had higher body mass indexes (27.6 vs 25.8 kg/m2, P = .04), a higher incidence of medical comorbidities (45.5% vs 18.5%, P = .003), and a history of prostate cancer (13.6% vs 0%, P = .003). Inability to orgasm was also associated with patients undergoing a vulvoplasty-only procedure (72.7% vs 27.3%, P = .003), but this was not significant when controlling for age and comorbidities. There were no significant differences in intraoperative complications between the groups, but patients who were unable to orgasm had a higher incidence of postoperative bleeding and reoperation.

[RESULTS] Among transgender women undergoing genital gender affirmation surgery, 90% reported the ability to orgasm within 6 months of surgery. Age and medical comorbidities were associated with an ability to orgasm.

[CLINICAL IMPLICATIONS] These findings suggest that most patients undergoing feminizing gender affirmation surgery can orgasm within 6 months postsurgery. This information is critical for preoperative counseling, enabling patients to make more informed decisions and set realistic expectations regarding surgical outcomes.

[STRENGTHS AND LIMITATIONS] Strengths include inclusion of patients with vulvoplasty only and patients with vulvoplasty and vaginoplasty. Limitations include the experience of a single surgeon and the retrospective nature of our study.

[CONCLUSION] Our study's findings are encouraging for individuals considering feminizing genital surgery, as 90% of the transgender women in our cohort reported an ability to orgasm within 6 months of surgery. This study adds to the growing body of literature that can help patients make informed decisions and set realistic expectations for their gender-affirming surgical outcomes.