The inversion of penile skin is used by most gender surgeons. There is a broad agreement that GAS has a positive impact on gender dysphoria. The aim is to “create a perineogenital complex as feminine in appearance and function as possible”. GAS should be performed by a surgeon with specialized competence in genital reconstructive techniques. The aim is the formation of a perineogenital complex in appearance and function as feminine as possible with a sensitive clitoris to enable orgasms. Male-to-female (MtF) gender affirmation surgery (GAS) comprises the resection of all clearly defining features of male genitalia. In conclusion, orgasms after surgery were experienced more intensely than before in the majority of women in our cohort and neoclitoral sensitivity seems to contribute to enjoyment of sexual activity to a greater extent than neovaginal depth. There was a significant correlation between the ease with which patients were able to become sexually aroused and their ability to achieve orgasms. The self-estimated pleasure of sexual activity correlated significantly with neoclitoral sensitivity but not with neovaginal depth. Most patients were satisfied with the sensitivity of the neoclitoris (73.9%) and with the depth of the neovaginal canal (67.1%). Of those who had sexual intercourse, 55.8% rated their orgasms to be more intensive than before, with 20.8% who felt no difference. Of the study participants, 33.7% reported a heterosexual, 37.6% a lesbian, and 22.8% a bisexual orientation related to the self-perceived gender. In total, we received 119 completed questionnaires after a median of 5.05 years since surgery. We retrospectively surveyed all 254 MtF transsexual patients who had undergone GAS with penile inversion vaginoplasty at the Department of Urology, University Hospital Essen, Germany, between 20. This study aimed to evaluate the effect of GAS on sexuality. Male-to-Female (MtF) gender affirmation surgery (GAS) comprises the creation of a functional and aesthetic perineogenital complex.
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