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Hontscharuk et al. Plast Aesthet Res 2020;7:65 I http://dx.doi.org/10.20517/2347-9264.2020.124 Page 11 of 15

Figure 9. The clitoral-urethral construct transferred subcutaneously into position at the pubic symphysis

transposition may lead to a loss of pre-existing erogenous sensation. Clitoral transposition has not been
found to result in a loss of ability to achieve orgasm with direct stimulation, and in these individuals,
[8]
erogenous sensation remains consolidated outside of the neophallus . Some surgeons postulate that placing
the clitoris more superficially, just below the skin surface, rather than deeper, on the pubic symphysis,
[8]
leaves it more accessible for direct stimulation and may enhance postoperative sexual function . Despite
this, no studies have compared the various techniques of clitoral placement.

Some patients report experiencing erogenous sensibility on the shaft of the neophallus during self-
stimulation or penetrative intercourse [8,10,30,34,42] . Some transgender men report masturbating their
neophallus regardless of whether or not they have undergone clitoral transposition and also report the
[8]
ability to achieve orgasm with stimulation of the neophallus itself . These findings are based on subjective
patient reports rather than validated instruments. As such, it is difficult to discern the mechanism by which
orgasmic function is attained. Future research is required to evaluate outcomes and elucidate the role by
[15]
which various nerve coaptations result in orgasmic capability .

DISCUSSION
Current innervation strategies are based on the premise that nerve coaptations to the dorsal pudendal or
[29]
dorsal clitoral nerves and the ilioinguinal nerves will elicit erogenous and tactile sensation, respectively .
[15]
However, the ability to compare techniques is limited by a lack of standardized measures . In a recent
[15]
literature review , recovered sensibility, whether tactile or erogenous, was found to be similar regardless
of the choice of donor nerve. This finding is consistent with patient reports [8,10,22-24,26,29,31,34,42,66] . These findings
suggest that the choice of donor nerve may also have little impact on post-surgical tactile or erogenous
[15]
sensory outcomes . This has led some surgeons to leave the dorsal clitoral nerves untouched, and simply
bury the denuded clitoris within the base of the flap. While this technique may not lead to erogenous
[28]
sensation along the shaft of the neophallus, it may reduce the possibility of a loss of erogenous sensation .
Conversely, other surgeons may advocate the importance of coaptation to the dorsal clitoral nerve so as to
[30]
provide erogenous sensation to the neophallic shaft [8,10,30,34,42] . Doria-Medina et al. reported functional