Clitoral Sensitivity Research Articles

Passerini-Glazel Feminizing Genitoplasty: Modifications in 17 Years of Experience with 82 Cases

ObjectivesTo describe modifications of Passerini-Glazel feminizing genitoplasty and report on long-term functional outcome. MethodsModifications include vaginal dissection and disconnection from the urethrovaginal sinus as the initial stage of the procedure; large dissection of the neurovascular bundle on both dorsal and lateral faces of the clitoris; plication of the skin around the reduced clitoris; and suturing the lateral edge of the proximal portion of the mucocutaneous plate with the labia majora's medial edge to a plane deeper than the subcutaneous tissue. These modifications reduce bleeding and operating time, better preserve clitoral sensitivity, form the clitoral prepuce, and create labia minora. ResultsEighty-two patients underwent modified Passerini-Glazel feminizing genitoplasty. Mean operating time was 120min (range: 100–180). Forty-six patients (46 of 82, 56%) were assessed at a mean follow-up of 5 yr (range: 2–9). There were no cases of clitoral vascularization defect or urethrovaginal fistula. The urethral meatus was never hypospadic. The vaginal introitus was large and elastic in all cases. Vaginal caliber at the internal suture line was as large as the vaginal introitus and the distal native vagina in 20 (43.5%) of the 46 girls. All mothers and patients reported satisfaction with external genital appearance. ConclusionsThese long-term results suggest that our modifications of one-stage Passerini-Glazel feminizing genitoplasty facilitate the procedure and produce good cosmetic results.

The importance of parental perspectives in patients treated by feminising genitoplasty

Purpose To understand parental perspectives in patients treated by feminising genitoplasty. Material and methods Forty six parents underwent a semi-structured interview with multiple choice questions and categorical responses, aimed at assessing parents' satisfaction about information received at the time of diagnosis and their expectations about surgery. Parents were divided into 2 groups according to their daughter's age: younger or older than 18 years in group 1 and group 2 respectively. Results Forty percent of parents asked for an easier language when the sexual differentiation process and the pathology of their child are explained. Sixty percent of parents asked for more time to be spent for discussing the medical and therapeutic options Seventy percent of parents asked for outcome photographs of previously operated on cases. Discordant opinions regarding the newborn sexual identity were described in the multidisciplinary team by 60% and 8% of group 1 and 2 respectively. Explanations about possible intraoperative damage to the clitoris were reported by 10% and 85% of group 1 and 2 respectively. All parents disagreed with postponing surgery until the child was old enough to consent. Conclusions An exhaustive explanation of intersex problems is mandatory. Different results between the two parent populations can reflect the evolution of medical knowledge. Postponing surgery would be a difficult task since most parents see early genital surgery as a necessary step towards a normal life, although they are aware of the potential risk of compromising clitoral sensitivity.

Clitoral sensitivity after surgical correction in women with adrenogenital syndrome: a long term follow-up.

Surgical reduction of hypertrophy of the clitoris in early childhood, as well as vaginal reconstruction or vaginoplasty during the early teens, is required in girls with adrenogenital syndrome. In eight women (age >17 years) with adrenogenital syndrome, the sensitivity of the surgically reduced clitoris was evaluated by examination of vibration and light touch sensitivity, more than one year after vaginoplasty. When they were compared with a group of women who had not been operated on, the sensitivity to vibration and light touch were similar if the clitoris had been reduced as a one-stage procedure. In one woman who had had a second reduction, sensitivity was impaired. All women reported that the vaginal reconstruction was successful as far as sexual activity was concerned. Six of the eight had stable relationships with boyfriends or husbands. No pregnancies or children were reported.

Safety and efficacy of sildenafil in postmenopausal women with sexual dysfunction

Objectives. Sildenafil has been demonstrated to be safe and effective in the treatment of men with erectile dysfunction. The role of sildenafil in treating women with sexual dysfunction has heretofore not been reported. The purpose of this preliminary study was to ascertain the response of postmenopausal women with self-described sexual dysfunction treated with sildenafil for 3 months. Methods. Thirty-three consecutive postmenopausal women with sexual dysfunction based on history were entered in this open-label, nonrandomized study. All patients received 50 mg of sildenafil. Efficacy was assessed at weeks 4, 8, and 12 using a newly developed 9-item, self-administered Index of Female Sexual Function (IFSF) and a global efficacy question ([GEQ] Did treatment improve your sexual function?). The IFSF quantifies the domains of desire, quality of sexual intercourse, overall satisfaction with sexual function, orgasm, lubrication, and clitoral sensation. Results. Of the group, 30 women (91%) completed the study and were available for follow-up at 3 months. Mean baseline IFSF score before therapy was 24.8 ± 9.8. Mean usage of sildenafil was 3.1 ± 1.4 times per week for the duration of the study. The IFSF score improved to 29.5 ± 7.6, 30.3 ± 8.5, and 31.4 ± 10.4 at 4, 8, and 12 weeks, respectively ( P = 0.25). Mean scores for questions 2 (lubrication), 8 (orgasm), and 9 (clitoral sensation) improved by 23.2%, 7.4%, and 31.3%, respectively, at 12 weeks. Seven women (21%) noted improvement on the GEQ. Overall, only 6 (18.1%) of 33 patients had a significant (more than 60% improvement in IFSF score) therapeutic response. Clitoral discomfort and “hypersensitivity” occurred in 7 women (21%), 3 of whom withdrew from the study. Other side effects, which did not result in withdrawal from the study, included headache (n = 5), dizziness (n = 4) and dyspepsia (n = 3). Conclusions. The data suggest that sildenafil is well tolerated in postmenopausal women with sexual dysfunction. Overall sexual function did not improve significantly, although there were changes in vaginal lubrication and clitoral sensitivity. The role of sildenafil in treating sexual dysfunction in various cohorts of women remains to be determined.