(074) With Gender Affirming Vaginoplasty, Are We Placing The Neoclitoris In The Correct Anatomic Location? Results of Anatomic And MRI-Based Studies, And A Novel Surgical Technique For True Orthotopic Placement

Abstract Introduction Transwomen undergoing vaginoplasty prioritize having a “normal appearing” vulva, comparable to ciswomen. A review of the literature and online surgical videos shows that the standard surgical technique is, (after penectomy) to anchor the neoclitoris to the stump of the oversewn penile crura. However, we noticed that in this location the clitoris appeared to be too far posterior, as compared to cisgender vulvas. Objective To show that that the true orthotopic position of the neoclitoris is more cephalad. Methods 10 cisgender women and 10 transgender men (intact birth-genitalia) were examined to palpate the position of the glans clitoris relative to the pubic symphysis. Pelvic MRI studies of 25 cisgender women (age 40 40) were reviewed to determine the position of the glans clitoris relative to the pubic symphysis. The location of the mid-point of the glans clitoris was measured relative to the inferior edge of the pubic symphysis. We describe our DNVB-splitting technique for anchoring the neoclitoris in the correct (orthotopic) location. Results In all 20/20 subjects the glans clitoris was palpated over pubic symphysis and was always (100%) medial to the insertion of the Adductor longus tendon. The average distance from the inferior-edge of the pubic symphysis to the center of the glans was 2.6cm±0.3cm (Range: 2.0–3.3cm). At midline, 2.6cm. anterior to the inferior edge of the pubic symphysis, we create a 1.5 cm2 window through the DNVB, splitting it with the blunt tip of a Kelly clamp. We anchor the neoclitoris to periosteum using two 3-0 Vicryl sutures. The redundant DNVB is anchored to Scarpa’s fascia at midline with 5-0 PDS. There were no DNVB injuries or complications. Conclusions To create a more normal appearing vulva, the clitoris should reside medial to the adductor longus muscle, which is 2.6cm anterior to the inferior edge of the pubic symphysis. Our simple DNVB-splitting technique is simple and safe. Anchoring can be accomplished using our novel, simple, anatomy-based technique. Disclosure No