Sexual health outcomes following gender affirming metoidioplasty: a systematic review
Bibliographic record
Abstract
INTRODUCTION: Numerous studies have evaluated urologic and aesthetic outcomes of genital gender affirming surgery. However, minimal data exist on sexual function of transmasculine individuals after genital gender affirming surgery, and studies often aggregate outcomes from different techniques. This paper aims to systematically review the literature on sexual health outcomes following metoidioplasty surgery. OBJECTIVES: To synthesize and analyze the literature on sexual health following metoidioplasty, to identify areas of further investigation, and to improve shared decision making and sexual outcomes following metoidioplasty. METHODS: Studies were systematically identified using PubMed, Embase, and Web of Science from database origins through July 30, 2025, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Included sexual health outcomes were desire/arousal, sensation, orgasm, masturbation, erection, penetrative capacity, sexual activity, and sexual satisfaction. Studies were screened independently by two authors and reviewed by four authors for eligibility. Disagreements were decided between three authors, including a sexual health expert and a gender affirming surgeon. Quality assessment was done using the Newcastle-Ottawa Scale. RESULTS: Twenty-three papers met inclusion criteria. All studies used ad-hoc questionnaires, and the majority did not primarily assess sexual health. Arousal/desire, preservation of erogenous sensation, and masturbation received high ratings (85+%). Erectile function scores were high (94+%), despite one outlier study (20%). Orgasm outcomes were mixed (66%-100%). Ability for penetrative intercourse was generally low (0%-24%), with one outlier study (70%). Overall sexual satisfaction was moderate-high (53%-88%). CONCLUSIONS: Metoidioplasty appears to have largely satisfactory sexual health outcomes if penetrative sex is not a priority. Potential areas of further research include phallus lengthening protocols, PDE5 inhibitors (eg, Viagra), intracavernosal injections, and insertion of penile prostheses. Future studies are needed that include larger populations, are transparent regarding selection criteria and baseline anatomy, use standardized outcome measures, and investigate these complex outcomes from a person-centered, holistic approach.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.040 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.008 |
| Bibliometrics | 0.008 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".