Male‐to‐Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients

BackgroundPatients with male‐to‐female gender dysphoria (GD) require multidisciplinary assessment and management. Nowadays, more and more patients decide to undergo genital reassignment surgery (GRS) to have aesthetic and functional external female genitalia. Different techniques of this procedure have been described. Orchiectomy, penile disassembly, creation of a neovaginal cavity, repositioning of urethral meatus, and clitorolabioplasty may be identified as the five major steps in all of these techniques.MethodsWe conducted a retrospective study of 60 patients who underwent genital reassignment procedure for male‐to‐female GD at our department between November 2008 and August 2013 with a minimum follow‐up of 1 year. Data were collected on surgical technique, postoperative dilations protocol, complications, and functional and aesthetic outcomes. We describe and critically evaluate the surgical technique used in our department.ResultsFollow‐up ranged from 14 to 46 months. Two patients developed late neovaginal stricture, and two patients experienced rectovaginal fistulae (one required surgical revision with dermal porcine graft placement). Minor complications occurred in 13 patients and included urethral stenosis, partial wound dehiscence, and minor bleeding. Secondary aesthetic revision surgery was performed in 13 cases.ConclusionsGRS can provide good functional and aesthetic outcomes in patients with male‐to‐female GD. However, despite a careful planning and meticulous surgical technique, secondary procedures are frequently required to improve the function and appearance of the neovagina. Raigosa M, Avvedimento S, Yoon TS, Cruz‐ Gimeno J, Rodriguez G, and F ontdevila J. Male‐to‐female genital reassignment surgery: A retrospective review of surgical technique and complications in 60 patients. J Sex Med 2015;12:1837–1845.     

The Prevalence and the Risk Factors of Testosterone Deficiency in Newly Diagnosed and Previously Known Type 2 Diabetic Men

IntroductionWhile the epidemiology of testosterone deficiency has been well described in men with previously known type 2 diabetes mellitus (T2DM), it was less reported in those with untreated, newly diagnosed T2DM.AimThe aim of this study was to investigate the prevalence and the risk factors of testosterone deficiency of men with newly diagnosed T2DM.MethodsThe cross-sectional study included 105 men (mean age: 61.2 ± 6.8 years) with previously known T2DM and another 81 (57.8 ± 8.8 years) with newly diagnosed T2DM. All received health checkup and sex hormone measurement at our institute in 2009.Main Outcome MeasuresWe calculated the prevalence and explored the risk factors of low total (<300 ng/dL) and free (<6 ng/dL) testosterone in men with newly diagnosed and previously known T2DM.ResultsMen with previously known T2DM were older and had higher diastolic pressure and greater fasting glucose. There was no significant difference in total (358.0 [155.0] ng/dL vs. 363.0 [154.0] ng/dL, P = 0.68) and free (7.2 [2.5] ng/dL vs. 7.4 [2.4] ng/dL, P = 0.84) testosterone and sex-hormone binding globulin (SHBG) (27.3 [22.3] nmol/L vs. 28.7 [14.9] nmol/L, P = 0.46). The prevalence of low total and free testosterone was 28.4% and 21.0%, respectively, in men with newly diagnosed T2DM, and was 26.7% and 19.0% in those with previously known T2DM. In men with previously known T2DM, better glycemic control (HbA1c <7%) was associated with a higher level of total testosterone and a lower risk of low total testosterone. Men with newly diagnosed and previously known T2DM shared similar risk factors of low total testosterone, including high HbA1c (≥7%), low SHBG (<20 nmol/L), obesity, hyperuricemia, hypertriglycemia, and metabolic syndrome. Elevated prostate-specific antigen was a protective factor of low total testosterone. However, none of these factors was associated with low free testosterone.ConclusionsThe prevalence and the risk factors of testosterone deficiency are similar between newly diagnosed and previously known type 2 diabetic men. Ho C-H, Jaw F-S, Wu C-C, Chen K-C, Wang C-Y, Hsieh J-T, Yu H-J, and Liu S-P. The prevalence and the risk factors of testosterone deficiency in newly diagnosed and previously known type 2 diabetic men. J Sex Med 2015;12:389–397.     

Accuracy of 30‐Day Recall for Components of Sexual Function and the Moderating Effects of Gender and Mood

IntroductionDespite the ubiquity of 1‐month recall periods for measures of sexual function, there is limited evidence for how well recalled responses correspond to individuals' actual daily experiences.AimTo characterize the correspondence between daily sexual experiences and 1‐month recall of those experiences.MethodsFollowing a baseline assessment of sexual functioning, health, and demographic characteristics, 202 adults from the general population (101 women, 101 men) were recruited to complete daily assessments of their sexual function online for 30 days and a single recall measure of sexual function at day 30.Main Outcome MeasuresAt the baseline and 30‐day follow‐ups, participants answered items asking about sexual satisfaction, sexual activities, interest, interfering factors, orgasm, sexual functioning, and use of therapeutic aids during the previous 30 days. Participants also completed a measure of positive and negative affect at follow‐up. The main outcome measures were agreement between the daily and 1‐month recall versions of the sexual function items.ResultsAccuracy of recall varied depending on the item and on the gender and mood of the respondent. Recall was better (low bias and higher correlations) for sexual activities, vaginal discomfort, erectile function, and more frequently used therapeutic aids. Recall was poorer for interest, affectionate behaviors (e.g., kissing), and orgasm‐related items. Men more than women overestimated frequency of interest and masturbation. Concurrent mood was related to over‐ or underreporting for six items addressing the frequency of masturbation and vaginal intercourse, erectile function, and orgasm.ConclusionsA 1‐month recall period seems acceptable for many aspects of sexual function in this population, but recall for some items was poor. Researchers should be aware that concurrent mood can have a powerful biasing effect on reports of sexual function. Weinfurt KP, Lin L, Dombeck CB, Broderick JE, Snyder DC, Williams MS, Fawzy MR, and Flynn KE. Accuracy of 30‐day recall for components of sexual function and the moderating effects of gender and mood. J Sex Med 2014;11:678–696.     

Impact of Prostate Cancer Treatment on the Sexual Quality of Life for Men‐Who‐Have‐Sex‐with‐Men

IntroductionWith earlier prostate cancer (PCa) diagnosis and an increased focus on survivorship, post‐treatment sexual quality of life (QoL) has become increasingly important. Research and validated instruments for sexual QoL assessment based on heterosexual samples have limited applicability for men‐who‐have‐sex‐with‐men (MSM).AimWe aimed to create a validated instrument for assessing sexual needs and concerns of MSM post‐PCa treatment. Here we explore post‐PCa treatment sexual concerns for a sample of MSM, as the first part of this multi‐phase project.MethodsIndividual semi‐structured interviews were conducted with 16 MSM face‐to‐face or via Internet‐based video conferencing. Participants were asked open‐ended questions about their experiences of sexual QoL following PCa. Interviews were recorded, transcribed verbatim, uploaded to NVivo 8^TM, and analyzed using qualitative methodology.Main Outcome MeasureWe have conducted semi‐structure qualitative interviews on 16 MSM who were treated for PCa. Focus was on post‐treatment sexual concerns.ResultsThe following themes were inductively derived: (i) erectile, urinary, ejaculation, and orgasmic dysfunctions; (ii) challenges to intimate relationships; and (iii) lack of MSM‐specific oncological and psychosocial support for PCa survivorship. Sexual practices pre‐treatment ranked in order of frequency were masturbation, oral sex, and anal sex, an ordering that prevailed post‐treatment. Sexual QoL decreased with erectile, urinary, and ejaculation dysfunctions. Post‐treatment orgasms were compromised. Some single men and men in non‐monogamous relationships reported a loss of confidence or difficulty meeting other men post‐treatment. Limited access to targeted oncological and psychosocial supports posed difficulties in coping with PCa for MSM.ConclusionsThe negative impact on sexual QoL can be severe for MSM and requires targeted attention. Penile–vaginal intercourse and erectile function have been the primary focus of sexual research and rehabilitation for men with PCa, and do not adequately reflect the sexual practices of MSM. Our findings suggest that future research dedicated to MSM with PCa is needed to incorporate their sexual practices and preferences specifically into treatment decisions, and that targeted oncological and psychosocial support services are also warranted. Lee TK, Handy AB, Kwan W, Oliffe JL, Brotto LA, Wassersug RJ, and Dowsett GW. The impact of prostate cancer treatment on the sexual quality of life for men‐who‐have‐sex‐with‐men. J Sex Med 2015;12:2378–2386.     

Development and Initial Validation of the PROMIS® Sexual Function and Satisfaction Measures Version 2.0

IntroductionThe Patient‐Reported Outcomes Measurement Information System (PROMIS)® Sexual Function and Satisfaction measure (SexFS) version 1.0 was developed with cancer populations. There is a need to expand the SexFS and provide evidence of its validity in diverse populations.AimThe aim of this study was to describe the development of the SexFS v2.0 and present preliminary evidence for its validity.MethodsDevelopment built on version 1.0, plus additional review of extant items, discussions with 15 clinical experts, 11 patient focus groups (including individuals with diabetes, heart disease, anxiety, depression, and/or are lesbian, gay, bisexual, or aged 65 or older), 48 cognitive interviews, and psychometric evaluation in a random sample of U.S. adults plus an oversample for specific sexual problems (2281 men, 1686 women). We examined differential item functioning (DIF) by gender and sexual activity. We examined convergent and known‐groups validity.ResultsThe final set of domains includes 11 scored scales (interest in sexual activity, lubrication, vaginal discomfort, clitoral discomfort, labial discomfort, erectile function, orgasm ability, orgasm pleasure, oral dryness, oral discomfort, satisfaction), and six nonscored item pools (screeners, sexual activities, anal discomfort, therapeutic aids, factors interfering with sexual satisfaction, bother). Domains from version 1.0 were reevaluated and improved. Domains considered applicable across gender and sexual activity status, namely interest, orgasm, and satisfaction, were found to have significant DIF. We identified subsets of items in each domain that provided consistent measurement across these important respondent groups. Convergent and known‐groups validity was supported.ConclusionsThe SexFS version 2.0 has several improvements and enhancements over version 1.0 and other extant measures, including expanded evidence for validity, scores centered around norms for sexually active U.S. adults, new domains, and a final set of items applicable for both men and women and those sexually active with a partner and without. The SexFS is customizable, allowing users to select relevant domains and items for their study. Weinfurt KP, Lin L, Bruner DW, Cyranowski JM, Dombeck CB, Hahn EA, Jeffery DD, Luecht RM, Magasi S, Porter LS, Reese JB, Reeve BB, Shelby RA, Smith AW, Willse JT, and Flynn KE. Development and Initial Validation of the PROMIS® Sexual Function and Satisfaction Measures Version 2.0. J Sex Med 2015;12:1961–1974.