Editing Gender-affirming surgery (section)

=== Sexuality ===
Looking specifically at transsexual people's genital sensitivities, both trans men and trans women are capable of maintaining their genital sensitivities after gender-affirming surgery. However, these are counted upon the procedures and surgical tricks which are used to preserve the sensitivity. Considering the importance of genital sensitivity in helping transsexuals to avoid unnecessary harm or injury to the genitals, allowing trans men to obtain erection by inserting a [[penile implant]] after [[phalloplasty]],<ref name="Selvaggi_2007">{{cite journal | vauthors = Selvaggi G, Monstrey S, Ceulemans P, T'Sjoen G, De Cuypere G, Hoebeke P | title = Genital sensitivity after sex reassignment surgery in transsexual patients | journal = Annals of Plastic Surgery | volume = 58 | issue = 4 | pages = 427–433 | date = April 2007 | pmid = 17413887 | doi = 10.1097/01.sap.0000238428.91834.be | s2cid = 46169398 }}</ref> the ability of trans people to experience erogenous and [[tactile sensitivity]] in their reconstructed genitals is one of the essential objectives surgeons want to achieve in gender-affirming surgery.<ref name="Selvaggi_2007" /><ref name="Hage_1993">{{cite journal | vauthors = Hage JJ, Bouman FG, de Graaf FH, Bloem JJ | title = Construction of the neophallus in female-to-male transsexuals: the Amsterdam experience | journal = The Journal of Urology | volume = 149 | issue = 6 | pages = 1463–1468 | date = June 1993 | pmid = 8501789 | doi = 10.1016/S0022-5347(17)36416-9 }}</ref> Moreover, studies have also found that the critical procedure for genital sensitivity maintenance and achieving orgasm after phalloplasty is to preserve both the clitoral hood and the clitoris underneath the reconstructed [[phallus]].<ref name="Selvaggi_2007" /><ref name="Hage_1993" />

Erogenous sensitivity is measured by the abilities to reach [[orgasm]] in genital sexual activities, like masturbation and intercourse.<ref name="Selvaggi_2007" /> Many studies reviewed that both trans men and trans women have reported an increase of orgasms in both sexual activities,<ref name="Wierckx_2011" /><ref name="De_Cuypere_2005">{{cite journal | vauthors = De Cuypere G, T'Sjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, Monstrey S, Vansteenwegen A, Rubens R | title = Sexual and physical health after sex reassignment surgery | journal = Archives of Sexual Behavior | volume = 34 | issue = 6 | pages = 679–690 | date = December 2005 | pmid = 16362252 | doi = 10.1007/s10508-005-7926-5 | s2cid = 42916543 }}</ref> implying the possibilities to maintain or even enhance genital sensitivity after gender-affirming surgery.

Most trans persons report enjoying better sex lives and improved sexual satisfaction after gender-affirming surgery.<ref name="De_Cuypere_2005" /> The enhancement of sexual satisfaction was positively related to the satisfaction of new primary sex characteristics.<ref name="De_Cuypere_2005" /> Before gender-affirming surgery, trans patients had unwanted sex organs which they were eager to remove. Hence, they were not enthusiastic about engaging in sexual activity. Transsexual individuals who have undergone gender-affirming surgery are more satisfied with their bodies and experienced less stress when participating in sexual activity.<ref name="De_Cuypere_2005" />

Most of the individuals report that they have experienced sexual excitement during sexual activity, including masturbation.<ref name="De_Cuypere_2005" /> The ability to obtain orgasm is positively associated with sexual satisfaction.<ref name="Wierckx_2011" /> Frequency and intensity of orgasm are substantially different for trans men and trans women. Almost all female-to-male individuals revealed an increase in sexual excitement and can achieve orgasm through sexual activity with a partner or via masturbation,<ref name="De_Cuypere_2005" /><ref name="Wierckx_2011" /> whereas only 85% of the male-to-female individuals are able to achieve orgasm after gender-affirming surgery.<ref>{{cite journal | vauthors = Lawrence AA | title = Sexuality before and after male-to-female sex reassignment surgery | journal = Archives of Sexual Behavior | volume = 34 | issue = 2 | pages = 147–166 | date = April 2005 | pmid = 15803249 | doi = 10.1007/s10508-005-1793-y | s2cid = 25671520 | citeseerx = 10.1.1.538.6381 }}</ref> A study found that both trans men and trans women reported qualitative change in their experience of orgasm. The female-to-male trans individuals reported that they had been experiencing intensified and stronger excitements and orgasm while male-to-female persons have been encountering longer and more gentle feelings.<ref name="De_Cuypere_2005" />

Rates of masturbation have also changed after gender-affirming surgery for both trans women and trans men. A study reported an overall increase of masturbation frequencies in most transsexuals and 78% of them were able to reach orgasm by masturbation after gender-affirming surgery.<ref name="Wierckx_2011" /><ref name="De_Cuypere_2005" /><ref name="Gómez-Gil_2014">{{cite journal | vauthors = Gómez-Gil E, Zubiaurre-Elorza L, de Antonio IE, Guillamon A, Salamero M | title = Determinants of quality of life in Spanish transsexuals attending a gender unit before genital sex reassignment surgery | journal = Quality of Life Research | volume = 23 | issue = 2 | pages = 669–676 | date = March 2014 | pmid = 23943260 | doi = 10.1007/s11136-013-0497-3 | s2cid = 23051224 }}</ref> A study showed that there were differences in masturbation frequency between trans men and trans women; female-to-male individuals masturbated more often than male-to-female.<ref name="De_Cuypere_2005" /> The possible reasons for the difference in masturbation frequency could be associated with the surge of libido, which was caused by the testosterone therapies, or the withdrawal of gender dysphoria.<ref name="Wierckx_2011" />

Concerning trans people's expectations for different aspects of their life, the sexual aspects have the lowest level of satisfaction among all other elements (physical, emotional and social levels).<ref name="Gómez-Gil_2014" /> When comparing trans with [[cisgender]] persons of the same gender, [[trans women]] had a similar sexual satisfaction to cis women, but [[trans men]] had a lower level of sexual satisfaction to cis men. Moreover, trans men also had a lower sexual satisfaction with their sexual life than trans women.<ref name="Wierckx_2011" />