Peters Blair R, Annen Alvin A, Berli Jens U, Gallagher Sandra, Smigelski Caitlin, Kahn Lorna H, Skelton Hales E
Division of Plastic Surgery, Oregon Health & Science University, Portland, Oreg.
Department of Urology, Oregon Health & Science University, Portland, Oreg.
Plast Reconstr Surg Glob Open. 2022 Oct 24;10(10):e4616. doi: 10.1097/GOX.0000000000004616. eCollection 2022 Oct.
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.
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.
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.
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.
感觉神经移植是阴茎成形术的一部分。尽管如此，尚未采用感觉再教育来恢复这些神经移植。此外，阴茎成形术后中枢神经系统在感觉体验中的作用很少受到关注。本文的目的是报告一种有针对性的康复方案的制定，以整合和优化阴茎成形术后外周和中枢对感觉的贡献。
这个神经感觉再教育方案由一个多学科团队（阴茎成形术/周围神经外科医生、重建泌尿科医生、盆底物理治疗师、神经治疗师、性治疗师、性医学医生）和有阴茎成形术亲身经历的个体分四个阶段构建。最终方案得到了所有团队成员的认可，并且有阴茎成形术亲身经历者的定性叙述在此提供支持。
该方案是按照阴茎成形术的每个阶段制定的。在每个阶段，练习分为三个核心主题：可视化、触觉刺激和性/性感刺激。可视化练习从静态发展到动态。触觉练习从简单触摸开始，逐步发展为有针对性的感觉刺激。性刺激专注于在阴茎中培养与原生阴蒂组织中的性感不同的性感。根据阴茎成形术患者的建议，该方案现已纳入我们中心所有接受阴茎成形术患者的阴茎成形术护理路径。
我们引入了一种针对外周和中枢对感觉贡献的新颖方案，以提供一种工具，帮助优化接受阴茎成形术的跨男性个体的感觉体验。
