Treatment of Dyspareunia by Creation of a Pseudojoint in Rigid Bone Following Total Penile Reconstruction with Fibular Osteocutaneous Flap

Abstract

Gender reassignment requires total penile reconstruction, which is commonly performed with autologous tissue. One option for reconstruction is the free fibula osteocutaneous flap, which provides a long segment of vascularized bone that is less susceptible to infection and allows for deep penetration into the vagina during sexual intercourse. One problem, however, is that their sexual partner may suffer from pain (dyspareunia) because of the long and rigid bone. Our intent is to elucidate the treatment of female dyspareunia by surgically modifying the reconstructed penis with segmental osteotomies and fascia interposition within the rigid bone stock resulting from gender reassignment with a free fibula osteocutaneous flap. In order to improve their sexual relations and alleviate dyspareunia, a semirigid penis was created by forming a pseudojoint at the junction of the proximal and distal third of the fibula bone stock with osteotomies and fascia interposition. Alleviation of dyspareunia by surgical modification of a previously reconstructed penis for the couple to continue to have sexual relations. The created pseudojoints in the reconstructed penis allowed for pain-free vaginal intercourse between the patient and his wife because of its now semirigid structure. The surgical modification presented in this case report addresses the treatment of dyspareunia by creating a more malleable penile reconstruction, which will now allow for a pain-free vaginal intercourse.