This is a review of the available data on post-operative orgasm in MtF transsexuals.
Unfortunately, none of the studies reviewed below are entirely satisfactory in their methodology. Note that the few anonymous surveys have generally yielded lower percentages of patients reporting orgasm -- this suggests that some post-op transsexual women are unwilling to admit their inability to achieve orgasm.
Lindemalm et al (1986) interviewed thirteen of their postoperative patients, three of whom had undergone only castration and penectomy. Six of the thirteen (46%) reported "some kind of orgastic experience." Two of the women had ejaculatory orgasms.
Blanchard et al (1987) surveyed 22 patients, most operated by the same surgeon. Eleven of their patients (50%) reported being usually or regularly orgasmic. Seven women (32%) had orgasms only rarely or with difficulty, and four were never orgasmic. Based on the descriptions the transsexual women provided, Blanchard and colleagues thought that many of the women were probably describing something other than orgasm. Nine of the 22 patients (41%) produced a watery ejaculate with orgasm; the researchers thought this might be a useful indicator that a genuine orgasm had occurred.
Martin, in an unpublished 1988 PhD thesis, studied 64 post-op women operated by various surgeons, using an anonymous survey. 40 of her respondents (63%) said they were orgasmic at least some of the time via masturbation, less so with other activities. Martin noted that the descriptions of what the women were reporting as orgasms varied widely.
Stein et al (1990) interviewed ten of their postoperative patients. Two of these women (20%) usually had the "capacity for orgasm," six (60%) seldom did, and two were never orgasmic.
Lief and Hubschman (1993) reported on 14 post-ops, mostly from one surgeon. 4 were orgasmic via coitus (29%); the number orgasmic via other outlets was not reported.
Freundt et al (1993) reviewed data from 10 post-op patients, all of whom had undergone sigmoid vaginoplasty. All but one patient had also previously undergone penile inversion vaginoplasty, by unspecified surgeons. 7 of the 10 (70%) were currently experiencing "at least some capacity for orgasm." Evaluations were performed via structured interviews.
Ogborn and Chase reported data from the 1993 New Woman Conference in 1994. Their informants had been to several surgeons, and they used an anonymous survey method. 4 of 16 women (25%) were orgasmic, 3 regularly so. 2 others were uncertain.
Schroder, in an unpublished 1995 PhD thesis, found in face-to- face interviews that 11 of her 17 patients (65%) reported being orgasmic, most reliably through masturbation. Various surgeons were represented.
Lawrence reported anonymous data from the 1996 New Woman Conference (various surgeons) in 1997. 7 of 13 women (54%) had had at least one orgasm postoperatively; but only 1 of 13 (8%) was regularly orgasmic. At least 9 of the 13 (69%) have now been orgasmic at least once, with at least 2 regularly orgasmic (15%) (personal communication).
There are also three reports from Europe concerning series of patients operated by a single surgeon or team, all using some variation on the sensate pedicled clitoroplasty technique (which Dr. Toby Meltzer and Dr. Neal Wilson also use). These are among the best results reported anywhere:
Rubin (1987) reported 12 of 13 patients orgasmic (92%).
Eldh (1993) reported 20 of 20 patients orgasmic (100%).
Hage and Karim (1996) reported 47 of 59 patients orgasmic (80%).
Overall this is an 86% orgasm rate for the sensate pedicled clitoroplasty technique. I believe this is currently the procedure of choice for clitoral construction during vaginoplasty, if the goal is to provide the best chance of postoperative orgasmic capability.
Blanchard R, Legault S, Lindsay W (1987) Vaginoplasty outcomes in male-to-female transsexuals. J Sex Marital Ther 13: 265-275.
Eldh J (1993) Construction of a neovagina with preservation of the glans penis as a clitoris in male transsexuals. Plast Reconst Surg 91: 895-900.
Freundt I, Toolenaar T, Huikeshoven F, Jeekel H, Drogendijk A (1993) Long-term psychosexual and psychosocial performance of patients with a sigmoid neovagina. Am J Obstet Gynecol 169: 1210-1214.
Hage J, Karim R (1996) Sensate pedicled neoclitoroplasty for male transsexuals: Amsterdam experience in the first 60 cases. Ann Plast Surg 36: 621-624
Lawrence A (1997) Life after surgery: questions and answers from the 1996 new woman conference. Paper presented at the Second International Congress on Sex and Gender Issues, Philadelphia, PA., June 20, 1997.
Lief H, Hubschman L (1993) Orgasm in the postoperative transsexual. Arch Sex Behav 22: 145-155.
Lindemalm G, Korlin D, Uddenberg N (1986) Long-term follow-up of "sex change" in 13 male-to-female transsexuals. Arch Sex Behav 15: 187-210.
Martin J (1988) The incidence, frequency and rate of genital satisfaction of sixty-four post-operative male-to-female transsexuals reported to be experienced during various sexual behaviors: a descriptive study. Unpublished Ph.D. thesis, Institute for Advanced Study of Human Sexuality, San Francisco, CA.
Ogborn A, Chase C (1994) Orgasmic function in postoperative transsexual women. TransSisters, Winter 1994, 24-25.
Rubin S (1993) Sex reassignment surgery male to female. Scand J Urol Nephrol, Supplement 154: 1-28.
Schroder M (1995) New women: sexological outcomes of gender reassignment surgery. Unpublished Ph.D. thesis, Institute for Advanced Study of Human Sexuality, San Francisco, CA.
Stein M, Tieffer L, Melman A (1990) Followup observations of operated male-to-female transsexuals. J Urol 143: 1188-1192.
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© 1999 Anne A. Lawrence, MD