{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T22:40:07Z","timestamp":1771368007374,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2020,9,2]],"date-time":"2020-09-02T00:00:00Z","timestamp":1599004800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"}],"content-domain":{"domain":["jsm.jsexmed.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Among the various steps of a penile inversion feminizing genitoplasty, reconstruction of the clitoris and labia minora remains the most challenging procedure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Aim<\/jats:title>\n                  <jats:p>This study aims to evaluate surgical outcomes of neoclitoroplasty performed before and after the introduction of the labia minora\u2019s creation in our surgical technique.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective analysis was carried out comparing 2 groups of patients that underwent penile inversion feminizing surgery: group A (64 patients) who had labia minora and clitoral hood creation and group B (103 patients) who did not.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcomes<\/jats:title>\n                  <jats:p>To describe the surgical technique and outcomes of clitorolabiaplasty in male-to-female gender-affirmation surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Concerning overall complication rates, there were significant differences in the incidence of hemorrhage and urethral stenosis (P\u00a0&amp;lt;\u00a0.01). Hemorrhage surrounding the urethra and labia was identified in 40 patients (group A: n\u00a0=\u00a08 [12.5%]; group B: n\u00a0=\u00a032 [31%]) (P\u00a0=\u00a0.006). Neomeatal stenosis occurred in 17 patients (group A: n\u00a0=\u00a01 [1.5%]; group B: n\u00a0=\u00a016 [15.5%]) (P\u00a0=\u00a0.003). Partial necrosis of the clitoris occurred in 2 cases (group A: n\u00a0=\u00a00; group B: n\u00a0=\u00a02 [1.9%]) (P\u00a0=\u00a0.52). Necrosis of the labia majora occurred in 3 cases (group A: n\u00a0=\u00a00; group B: n\u00a0=\u00a03 [2.9%]) (P\u00a0=\u00a0.28). 5 patients (group A: n\u00a0=\u00a02 (3.1%); group B: n\u00a0=\u00a03 [2.9%]) (P\u00a0=\u00a0.93) developed rectovaginal fistula. 6 patients experienced neovaginal canal stricture (group A: n\u00a0=\u00a03 [4.6%]; group B: n\u00a0=\u00a03 [2.9%]) (P\u00a0=\u00a0.54). 2 patients (group A: n\u00a0=\u00a00; group B: n\u00a0=\u00a02 [1.9%]) (P\u00a0=\u00a0.52) reported introital stenosis; Persistent granulation tissue inside the neovagina that required in-office treatments occurred in 4 cases (group A: n\u00a0=\u00a02 [3.1%]; group B: n\u00a0=\u00a02 [1.9%]) (P\u00a0=\u00a0.62). Wound dehiscence occurred in 23 patients (group A: n\u00a0=\u00a013 [20.3%]; group B: n\u00a0=\u00a010 [9.7%]) (P\u00a0=\u00a0.05). 24 patients (group A: n\u00a0=\u00a03 [4.6%]; group B: n\u00a0=\u00a021 [20.3%]) (P\u00a0=\u00a0.004) underwent 28 different types of aesthetic refinements.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Implications<\/jats:title>\n                  <jats:p>Incorporating the creation of labia minora and clitoral hood in one step is a safe and viable option in patients undergoing male-to-female gender-affirmation surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Strengths &amp; Limitations<\/jats:title>\n                  <jats:p>Strength of the study is the large cohort of patients included and the consistent surgical technique. To our knowledge, this is the first study that compares with a control group, the introduction of labia minora creation in male-to-female gender-affirmation surgery. Limitations include the retrospective nature of the study and the absence of patient-reported outcomes measures.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Technical refinements of our technique led to a significative reduction in urethral stenosis and postoperative hemorrhage without an increased risk of major complications.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1016\/j.jsxm.2020.08.006","type":"journal-article","created":{"date-parts":[[2020,9,3]],"date-time":"2020-09-03T01:25:36Z","timestamp":1599096336000},"page":"2508-2517","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["Refinement Procedures for Clitorolabiaplasty in Male-to-Female Gender-Affirmation Surgery: More than an Aesthetic Procedure"],"prefix":"10.1093","volume":"17","author":[{"given":"Mauricio","family":"Raigosa","sequence":"first","affiliation":[{"name":"Plastic and Maxillofacial Dept , Barcelona, , Spain"},{"name":"Hospital Clinic , Barcelona, , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Avvedimento","sequence":"additional","affiliation":[{"name":"Plastic Surgery Department , Napoli, , Italy"},{"name":"Villa de Fiori , Napoli, , Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordi","family":"Descarrega","sequence":"additional","affiliation":[{"name":"Plastic and Maxillofacial Dept , Barcelona, , Spain"},{"name":"Hospital Clinic , Barcelona, , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Yuste","sequence":"additional","affiliation":[{"name":"Plastic and Maxillofacial Dept , Barcelona, , Spain"},{"name":"Hospital Clinic , Barcelona, , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Cruz-Gimeno","sequence":"additional","affiliation":[{"name":"Plastic and Maxillofacial Dept , Barcelona, , Spain"},{"name":"Hospital Clinic , Barcelona, , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joan","family":"Fontdevila","sequence":"additional","affiliation":[{"name":"Plastic and Maxillofacial Dept , Barcelona, , Spain"},{"name":"Hospital Clinic , Barcelona, , Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,9,2]]},"reference":[{"key":"2023011111071597800_bib1","article-title":"Plastic Surgery Statistics Report","author":"American Society of Plastic Surgeons","year":"2017"},{"key":"2023011111071597800_bib2","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1055\/s-0031-1281486","article-title":"Aesthetic and functional male to female genital and perineal surgery: Feminizing vaginoplasty","volume":"25","author":"Reed","year":"2011","journal-title":"Semin Plast Surg"},{"key":"2023011111071597800_bib3","article-title":"An overview of neovaginal reconstruction options in male to female rranssexuals","volume":"638919","author":"Bizic","year":"2014","journal-title":"Sci World J"},{"key":"2023011111071597800_bib4","first-page":"1837","article-title":"Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients","volume":"12","author":"Raigosa","year":"2015","journal-title":"J\u00a0Sex Med"},{"key":"2023011111071597800_bib5","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1007\/s00266-013-0172-7","article-title":"Self-made compressive dressing for vaginoplasty","volume":"37","author":"Raigosa","year":"2013","journal-title":"Aesthet Plast Surg"},{"key":"2023011111071597800_bib6","doi-asserted-by":"crossref","first-page":"729e","DOI":"10.1097\/PRS.0000000000004926","article-title":"Creation of clitoral hood and labia minora in penile inversion vaginoplasty in circumcised and uncircumcised transwomen","volume":"142","author":"Opsomer","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"2023011111071597800_bib7","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1097\/PRS.0000000000006282","article-title":"Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery","volume":"144","author":"Boas","year":"2019","journal-title":"Plast Reconstr Surg"},{"key":"2023011111071597800_bib8","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1097\/LGT.0000000000000308","article-title":"The Size of Labia Minora and Perception of Genital Appearance: A Cross-Sectional Study","volume":"21","author":"Lykkebo","year":"2017","journal-title":"J\u00a0Low Genit Tract Dis"},{"key":"2023011111071597800_bib9","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1055\/s-0031-1281482","article-title":"Aesthetic surgery of the female genitalia","volume":"25","author":"Dobbeleir","year":"2011","journal-title":"Semin Plast Surg"},{"key":"2023011111071597800_bib10","article-title":"Male-to-Female (MtoF) gender affirming surgery: Modified surgical approach for the glans reconfiguration in the neoclitoris (M-shape neoclitorolabioplasty)","volume":"91","author":"Cocci","year":"2019","journal-title":"Arch Ital di Urol e Androl"},{"key":"2023011111071597800_bib11","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1097\/01.PRS.0000138240.85825.2E","article-title":"Corona glans clitoroplasty and urethropreputial vestibuloplasty in male-to-female transsexuals: The vulval aesthetic refinement by the andalusia gender team","volume":"114","author":"Giraldo","year":"2004","journal-title":"Plast Reconstr Surg"},{"key":"2023011111071597800_bib12","doi-asserted-by":"crossref","first-page":"153","DOI":"10.3109\/2000656X.2014.967253","article-title":"Male-to-female vaginoplasty: Preecha\u2019s surgical technique","volume":"49","author":"Wangjiraniran","year":"2015","journal-title":"J\u00a0Plast Surg Hand Surg"},{"key":"2023011111071597800_bib13","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1097\/SAP.0000000000001532","article-title":"Aesthetic Refinement in the Creation of the Clitoris, Its Preputial Hood, and Labia Minora in Male-to-Female Transsexual Patients","volume":"81","author":"Ma\u00f1ero Vazquez","year":"2018","journal-title":"Ann Plast Surg"},{"key":"2023011111071597800_bib14","first-page":"843","article-title":"Vaginoplasty in male to female transsexuals using penile skin and urethral flap","volume":"86","author":"Perovic","year":"2005","journal-title":"Int J Transgenderism"},{"key":"2023011111071597800_bib15","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jpra.2015.09.003","article-title":"Male to female gender reassignment surgery: Surgical outcomes of consecutive patients during 14 years","volume":"6","author":"Sigurjonsson","year":"2015","journal-title":"JPRAS Open"},{"key":"2023011111071597800_bib16","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1590\/S1677-55382012000100014","article-title":"Gender reassignment surgery - A 13 year review of surgical outcomes","volume":"38","author":"Neto","year":"2012","journal-title":"Int Braz J Urol"},{"key":"2023011111071597800_bib17","doi-asserted-by":"crossref","first-page":"241","DOI":"10.21037\/tau.2019.06.03","article-title":"Transgender vaginoplasty: Techniques and outcomes","volume":"8","author":"Pariser","year":"2019","journal-title":"Transl Androl Urol"},{"key":"2023011111071597800_bib18","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1038\/nrurol.2011.46","article-title":"Gender reassignment surgery: An overview","volume":"8","author":"Selvaggi","year":"2011","journal-title":"Nat Rev Urol"},{"key":"2023011111071597800_bib19","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.eururo.2012.12.030","article-title":"Surgical reconstruction for male-to-female sex reassignment","volume":"64","author":"Amend","year":"2013","journal-title":"Eur Urol"},{"key":"2023011111071597800_bib20","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1046\/j.1464-410X.2001.02323.x","article-title":"Male-to-female transsexualism: A technique, results and long-term follow-up in 66 patients","volume":"88","author":"Krege","year":"2001","journal-title":"BJU Int"},{"key":"2023011111071597800_bib21","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s10508-006-9104-9","article-title":"Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery","volume":"35","author":"Lawrence","year":"2006","journal-title":"Arch Sex Behav"},{"key":"2023011111071597800_bib22","doi-asserted-by":"crossref","first-page":"101089","DOI":"10.1016\/j.eucr.2019.101089","article-title":"A very rare case of delayed catastrophic arterial bleed post-vaginoplasty","volume":"29","author":"Walters","year":"2020","journal-title":"Urol Case Rep"},{"key":"2023011111071597800_bib23","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.cps.2018.03.007","article-title":"Vaginoplasty complications","volume":"45","author":"Ferrando","year":"2018","journal-title":"Clin Plast Surg"},{"key":"2023011111071597800_bib24","first-page":"5","article-title":"Sleep-related painful erections: a meta-analysis on the pathophysiology and risks and benefits of medical treatments","volume":"15","author":"Vreugdenhil","year":"2018","journal-title":"J\u00a0Sex Med"},{"key":"2023011111071597800_bib25","author":"Dunford C, Bell K, Rashid T. Genital reconstructive surgery in male to female transexuals: A systematic review of primary surgical techniques, complications and functional outcomes from 1950 to present day. Eur Urol Focus."},{"key":"2023011111071597800_bib26","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.anplas.2018.08.002","article-title":"Postoperative complications of male to female sex reassignment surgery: A 10-year French retrospective study","volume":"64","author":"Cristofari","year":"2019","journal-title":"Ann Chir Plast Esthet"},{"key":"2023011111071597800_bib27","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1136\/pgmj.2007.057190","article-title":"Learning curves in surgical practice","volume":"83","author":"Hopper","year":"2007","journal-title":"Postgrad Med J"},{"key":"2023011111071597800_bib28","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1200\/JCO.2003.05.169","article-title":"Role of surgeon volume in\u00a0radical prostatectomy outcomes","volume":"21","author":"Hu","year":"2003","journal-title":"J\u00a0Clin Oncol"},{"key":"2023011111071597800_bib29","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1097\/SAP.0000000000001393","article-title":"Complications and Patient-Reported Outcomes in Male-to-Female Vaginoplasty-Where We Are Today: A Systematic Review and Meta-Analysis","volume":"80","author":"Manrique","year":"2018","journal-title":"Ann Plast Surg"},{"key":"2023011111071597800_bib30","first-page":"479","article-title":"Systematic review of studies reporting perioperative and functional outcomes following male-to-female gender assignment surgery (MtoF GAS): A call for standardization in data reporting","volume":"71","author":"Cocci","year":"2019","journal-title":"Minerva Urol e Nefrol"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609520308444?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1743609520308444?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/17\/12\/2508\/48526657\/jsm_17_12_2508.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/17\/12\/2508\/48526657\/jsm_17_12_2508.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T14:47:52Z","timestamp":1675954072000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/17\/12\/2508\/6973710"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,2]]},"references-count":30,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,9,2]]},"published-print":{"date-parts":[[2020,12,1]]}},"URL":"https:\/\/doi.org\/10.1016\/j.jsxm.2020.08.006","relation":{},"ISSN":["1743-6109","1743-6095"],"issn-type":[{"value":"1743-6109","type":"electronic"},{"value":"1743-6095","type":"print"}],"subject":[],"published-other":{"date-parts":[[2020,12]]},"published":{"date-parts":[[2020,9,2]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Refinement Procedures for Clitorolabiaplasty in Male-to-Female Gender-Affirmation Surgery: More than an Aesthetic Procedure","name":"articletitle","label":"Article Title"},{"value":"The Journal of Sexual Medicine","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.jsxm.2020.08.006","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2020 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.","name":"copyright","label":"Copyright"}]}}