Can penile reconstruction affect sexual function and sensation?

Penile reconstruction surgeries, such as phalloplasty and metoidioplasty, can have implications for sexual function and sensation. The specific effects can vary depending on the surgical technique chosen, the individual’s anatomy, and the goals of the surgery. Here are some considerations regarding sexual function and sensation in relation to penile reconstruction:

1. Metoidioplasty: In metoidioplasty, the surgeon releases the clitoral hood to allow the clitoris to extend further, creating a neophallus. This procedure generally preserves the sensory nerves of the clitoris, which can result in the retention or improvement of clitoral sensation. Some individuals experience increased sensitivity in the neophallus, allowing for sexual pleasure and arousal.
2. Phalloplasty: Phalloplasty involves the creation of a neophallus using tissue grafts from donor sites (e.g., forearm, thigh). While the neophallus may resemble a natural penis in terms of appearance, achieving full sexual function and sensation can be more complex:
   • Erectile Function: Phalloplasty does not typically result in natural erectile function. Many individuals choose to undergo additional procedures to implant penile prosthetic devices that allow for erections. These devices can enable penetrative sexual intercourse but may not provide the same level of rigidity as a natural erection.
   • Sensation: Sensation in the neophallus can vary. Some individuals experience decreased sensation due to nerve damage during surgery, while others may retain some degree of sensation. Sensation may not be the same as in the donor site or may be concentrated in specific areas of the neophallus.
   • Orgasm and Sexual Pleasure: Achieving orgasm and sexual pleasure can be possible for many individuals who have undergone phalloplasty. Sensory feedback from the neophallus and other erogenous zones can contribute to sexual satisfaction.
3. Urethral Lengthening: Both metoidioplasty and phalloplasty procedures often include urethral lengthening to allow for voiding while standing. This can improve urinary function and may have a positive impact on a person’s self-esteem and overall well-being.
4. Lubrication and Moisture: The neophallus may not produce natural lubrication or moisture as a natural penis does. Individuals may need to use personal lubricants during sexual activities to ensure comfort and reduce friction.