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(1) masturbating their neophallus; and (2) achieving orgasm with stimulation of the phallus alone. This
was independent of the treatment of the clitoris and supports the concept that additional factors contribute
to the ability to achieve orgasm. One potential contributing factor is the improvement that occurs in one’s
[12]
[12]
identity following phalloplasty . van de Grift et al. report the development of positive self-esteem
and affirmation of a masculine identity following phalloplasty. This may facilitate engagement in and,
enjoyment of, sexual activity including increased sexual initiative and pleasure.

CONCLUSION
While there is no consensus as to the optimal flap or the optimal pattern of innervation, tactile, and
erogenous sensation following phalloplasty is an important goal. Understanding the relevant flap and donor
site anatomy is important in optimizing outcomes, but there are likely multiple factors that contribute to
both sexual satisfaction and orgasmic potential. Additional studies comparing various nerve coaptation
strategies will help elucidate these issues.

DECLARATIONS
Authors’ contributions
Literature review, writing: Hontscharuk R, Siotos C
Generation of an idea, editing, writing, photo contributor: Schechter LS

Availability of data and materials
All referenced publications can be searched and found on PubMed. These papers are available to all readers
through published journal websites.

Financial support and sponsorship
None.

Conflicts of interest
Hontscharuk R and Siotos C have no potential conflicts; Schechter LS receives royalties from textbooks
from Elsevier and Springer publishers.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Consent for publication has been obtained from the publisher of the anatomy textbook.

Copyright
© The Author(s) 2020.

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