Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol
Background:. Sensory nerve transfers are performed as part of phalloplasty surgery. Despite this, sensory re-education to rehabilitate these nerve transfers has not been employed. Additionally, little attention has been paid to the role of the central nervous system in experienced sensation followin...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-10-01
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| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004616 |
| _version_ | 1811197904755359744 |
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| author | Blair R. Peters, MD Alvin A. Annen, MD Jens U. Berli, MD Sandra Gallagher, PT Caitlin Smigelski, PT Lorna H. Kahn, PT Hales E. Skelton, BA |
| author_facet | Blair R. Peters, MD Alvin A. Annen, MD Jens U. Berli, MD Sandra Gallagher, PT Caitlin Smigelski, PT Lorna H. Kahn, PT Hales E. Skelton, BA |
| author_sort | Blair R. Peters, MD |
| collection | DOAJ |
| description | Background:. Sensory nerve transfers are performed as part of phalloplasty surgery. Despite this, sensory re-education to rehabilitate these nerve transfers has not been employed. Additionally, little attention has been paid to the role of the central nervous system in experienced sensation following phalloplasty. The purpose of this article is to report on the development of a targeted rehabilitation protocol to integrate and optimize peripheral and central contributions to sensation following phalloplasty.
Methods:. This neurosensory re-education protocol was constructed over four phases by a multi-disciplinary team (phalloplasty/peripheral nerve surgeon, reconstructive urologist, pelvic floor physiotherapists, nerve therapist, sex therapist, sexual medicine physician) and individuals with lived phalloplasty experience. The final protocol was approved by all team members and is supported here by qualitative narratives from people with lived phalloplasty experience.
Results:. The protocol is built to follow each stage of phalloplasty surgery. In each stage, exercises are grouped into three core themes: visualization, tactile stimulation, and sexual/erogenous stimulation. Visualization exercises progress from static to dynamic. Tactile exercises start at simple touch and progress toward targeted sensory stimulation. Sexual stimulation focuses on developing erogenous sensation in the phallus that is separate from erogenous sensation in the natal clitoral tissue. By recommendation of individuals with phalloplasty, the protocol is now integrated into our center’s phalloplasty care pathway for all individuals undergoing phalloplasty surgery.
Conclusion:. We introduce a novel protocol targeting peripheral and central contributions to sensation to provide a tool to help optimize experienced sensation for transmasculine individuals undergoing phalloplasty. |
| first_indexed | 2024-04-12T01:22:01Z |
| format | Article |
| id | doaj.art-b035638adf9c40ebbc9b3f110db29874 |
| institution | Directory Open Access Journal |
| issn | 2169-7574 |
| language | English |
| last_indexed | 2024-04-12T01:22:01Z |
| publishDate | 2022-10-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj.art-b035638adf9c40ebbc9b3f110db298742022-12-22T03:53:45ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742022-10-011010e461610.1097/GOX.0000000000004616202210000-00046Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment ProtocolBlair R. Peters, MD0Alvin A. Annen, MD1Jens U. Berli, MD2Sandra Gallagher, PT3Caitlin Smigelski, PT4Lorna H. Kahn, PT5Hales E. Skelton, BA6From the * Division of Plastic Surgery, Oregon Health & Science University, Portland, Oreg.From the * Division of Plastic Surgery, Oregon Health & Science University, Portland, Oreg.From the * Division of Plastic Surgery, Oregon Health & Science University, Portland, Oreg.‡ School of Medicine, Oregon Health & Science University, Portland, Oreg.‡ School of Medicine, Oregon Health & Science University, Portland, Oreg.§ Division of Plastic Surgery, Washington University in St. Louis, St. Louis, Mo.From the * Division of Plastic Surgery, Oregon Health & Science University, Portland, Oreg.Background:. Sensory nerve transfers are performed as part of phalloplasty surgery. Despite this, sensory re-education to rehabilitate these nerve transfers has not been employed. Additionally, little attention has been paid to the role of the central nervous system in experienced sensation following phalloplasty. The purpose of this article is to report on the development of a targeted rehabilitation protocol to integrate and optimize peripheral and central contributions to sensation following phalloplasty. Methods:. This neurosensory re-education protocol was constructed over four phases by a multi-disciplinary team (phalloplasty/peripheral nerve surgeon, reconstructive urologist, pelvic floor physiotherapists, nerve therapist, sex therapist, sexual medicine physician) and individuals with lived phalloplasty experience. The final protocol was approved by all team members and is supported here by qualitative narratives from people with lived phalloplasty experience. Results:. The protocol is built to follow each stage of phalloplasty surgery. In each stage, exercises are grouped into three core themes: visualization, tactile stimulation, and sexual/erogenous stimulation. Visualization exercises progress from static to dynamic. Tactile exercises start at simple touch and progress toward targeted sensory stimulation. Sexual stimulation focuses on developing erogenous sensation in the phallus that is separate from erogenous sensation in the natal clitoral tissue. By recommendation of individuals with phalloplasty, the protocol is now integrated into our center’s phalloplasty care pathway for all individuals undergoing phalloplasty surgery. Conclusion:. We introduce a novel protocol targeting peripheral and central contributions to sensation to provide a tool to help optimize experienced sensation for transmasculine individuals undergoing phalloplasty.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004616 |
| spellingShingle | Blair R. Peters, MD Alvin A. Annen, MD Jens U. Berli, MD Sandra Gallagher, PT Caitlin Smigelski, PT Lorna H. Kahn, PT Hales E. Skelton, BA Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol Plastic and Reconstructive Surgery, Global Open |
| title | Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol |
| title_full | Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol |
| title_fullStr | Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol |
| title_full_unstemmed | Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol |
| title_short | Neurosensory Re-education following Gender-affirming Phalloplasty: A Novel Treatment Protocol |
| title_sort | neurosensory re education following gender affirming phalloplasty a novel treatment protocol |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000004616 |
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