(326) Reduction of Dysphoria-Causing Erections in Transgender Women – A Novel Surgical Technique to Gender Dysphoria Caused by Penile Erection: Bilateral Crural Artery Ligation & Transection

Introduction Transgender women (TW) awaiting vaginoplasty can experience erections despite hormone therapy and bilateral orchiectomy (BO), aggravating gender dysphoria, and pain. Given delays pre-vaginoplasty, strategies must be developed to aid TW who experience erections. To date, no surgical technique to abrogate erections has been described. Objective Crural vein ligation has been shown to improve venous-leak ED. This study describes the procedure and its outcomes. Methods TW scheduled for BO who reported erection-related dysphoria were offered simultaneous crural artery ligation. We assessed changes in erection quality, frequency (spontaneous, arousal-induced, and self-stimulated), postoperative dysphoria, and overall satisfaction. A detailed surgical description is provided. Results 12 TW underwent BO with crural ligation. Of these, 7/12 (58%) underwent ligation and excision of the cavernosal artery bilaterally. Mean follow-up was 150 days (Range 33-397 days). 7/7 (100%) reported cessation of spontaneous erections and erections with sexual arousal. 5/7 (71%) reported no rigid erection with self-stimulation, and 2/7 (29%) did not engage in any physical stimulation either alone or with a partner. 2/7 (29%) tried partnered stimulation and 2/2 (100%) did not achieve a rigid erection. Dysphoria improved in all patients undergoing crural artery ligation. Surgical technique: A median perineal incision is used to expose the crura. The cavernosal artery is located using Doppler ultrasound. For ligation, the crus is tied at the artery location using four 0-Ethibond sutures. For ligation/excision, the crus is incised, and the artery is dissected, ligated, and removed. Doppler is used to confirm absence of distal arterial flow. Conclusions Crural artery ligation with excision is more effective than ligation alone in eliminating spontaneous and arousal-induced erections. Though mild tumescence may occur with physical stimulation, rigid erections were prevented. This simple procedure effectively reduces erection-related dysphoria in TW, warranting further investigation. Disclosure No