Construction of a Neovagina with Preservation of the Glans Penis as a Clitoris in Male Transsexuals

In 20 male-to-female transsexual patients, a neovagina has been constructed using a combination of penile and scrotal flaps. By dissecting the dorsal vessels and nerves of the penis from the base to the tip, the blood supply and sensation to the glans have been preserved. After resection of the corpora cavernosa, the glans has been left as an innervated island flap and repositioned as a clitoris. There were few complications. Circulatory problems in the flaps resulted in short vaginas in three patients. Stricture of the urethral meatus and excessive length of the urethra were easily corrected with another operation in three patients. Nineteen of the patients expressed an excellent sexual sensation of the clitoris, and all 20 were very satisfied with both the cosmetic and functional results.