(278) Neurosensory Re-Education Following Gender-Affirming Phalloplasty: A Novel Treatment Protocol
Authors: Peters B , Aboubacar K , Annen A , Gallagher S , Smigelski C , Skelton H 
Published: May 2023

Abstract

Introduction
Sensory nerve transfers are performed as a routine part of phalloplasty surgery. It is well documented that nerve transfers are dependent on therapy and rehabilitation in order to optimize outcomes. Despite this, targeted sensory re-education to rehabilitate the nerve transfers in phalloplasty has yet to be employed in this clinical setting. Additionally, little attention has been paid to the role of the central nervous system in experienced sensation following surgery. Addressing these contributions to sensation may represent a step forward in optimizing sensory outcomes in phalloplasty.

Objective
The purpose of this paper is to report on the development and implementation 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 and peripheral nerve surgeon, reconstructive urologist, pelvic floor physiotherapists, peripheral nerve therapist, sex therapist, specialist in sexual medicine) and individuals with lived phalloplasty experience. The final protocol was approved by all members of the team and is supported here by qualitative narratives from people with lived phalloplasty experience now using the protocol.

Results
In each stage of the protocol, exercises were grouped into three core themes: visualization, tactile stimulation and sexual/erogenous stimulation. Visualization exercises progress from static to dynamic. Tactile exercises progress from simple touch towards targeted sensory stimulation. Sexual exercises focus on developing erogenous sensation in the phallus that is separate from erogenous sensation in the natal clitoral tissue. Overall individuals who underwent phalloplasty felt the protocol was a valuable and helpful resource. It was felt that the protocol provided a meaningful way to connect with the phallus and process ongoing dysphoria while working towards the next stages of surgery. The protocol helped individuals stay excited about new sensation entering the phallus and encouraged additional interaction with their penis. For individuals highly focused on sensation, the protocol provided peace of mind that everything was being done to optimize sensation and strengthen the mind-body connection By recommendation of phalloplasty patients, the protocol is now integrated into our centers phalloplasty care pathway for all individuals undergoing phalloplasty surgery.

Conclusions
This protocol is the first instrument available to support and engage phalloplasty patients in their sensory rehabilitation and sexual recovery following surgery. It was constructed by a robust multi-disciplinary team and individuals undergoing phalloplasty. We introduce this novel protocol targeting peripheral and central contributions to sensation to provide a tool for patients and care teams to best optimize experienced sensation for transmasculine individuals following phalloplasty surgery.

Disclosure
No