MALE AND FEMALE SURGICAL INTERVENTIONS (C CARSON & P SELPH, SECTION EDITORS) Sexual Function After Gender-Affirming Genital Reconstruction Federico I. Tirapegui 1 & Ömer Acar 2 & Ervin Kocjancic 2 Accepted: 29 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020 Abstract Purpose of Review This nonsystematic review aims to discuss the contemporary literature about sexual (dys)function in trans- gender population from the biopsychosocial model point of view, focusing on those patients who underwent gender-affirming genital reconstruction (GAGR). Recent Findings We analyzed the questionnaires and diagnostic tools that have been used to evaluate sexual health-related issues, including the non-specific ones and the ones specifically designed for transgender individuals. All aspects of sexual function including desire, arousal, orgasm, and pain have been shown to be influenced by GAGR. Summary Literature regarding sexual activity in trans women are diverse, showing increase, decrease, and no changes after genital surgery, while sexual satisfaction was shown to be highly related to self-image and self-esteem. Metoidioplasty and flap- based phalloplasty in trans men are successful in treating gender dysphoria, and improving quality of life which commonly lead to high satisfaction rates. Keywords Transgender . Sexual dysfunction . Gender-affirming genital reconstruction . Gender dysphoria Introduction Gender identity refers to an innate and deeply feeling of being a male, a female, or some other non-binary gender [1, 2]. It includes male, female, non-binary, gender fluid, transgender, gender queer, transgender men (TM), and transgender women (TW) [3, 4]. Gender dysphoria (GD) refers to a distress or discomfort that some people have due to a discordance be- tween their gender identity and the gender assigned at birth [5] (Table 1). The global prevalence of GD has been estimated to be 4.6– 6.8 per 100,000 [6, 7], and the incidence and prevalence of GD are on the rise [6, 8, 9]. This nonsystematic review aims to discuss the current lit- erature about sexual (dys)function in trans population from the biopsychosocial model point of view, focusing on those pa- tients who underwent gender-affirming genital reconstruction (GAGR). Materials and Methods A comprehensive and nonsystematic literature review was conducted. Original articles, case series, case reports, and re- view articles that were published in English and indexed in the PubMed, Google Scholar, and Embase databases were taken into consideration. Key search terms used were transgender, genital, reconstruction, sexual, function, dysfunction, and management. All 3 authors used the same search methodology and came to a consensus regarding which articles were rele- vant to the review. Data regarding sexual function in transgen- der individuals and changes in sexual health-related domains following gender-affirming treatment (GAT), particularly GAGR, were extracted, reviewed, and discussed. Hormone and Surgical Treatment Aside from a social transition like change of name, gender expressions, and gender role, people with GD might look for a medical transition which refers to GAT [5, 6, 10, 11]. This article is part of Topical Collection on Male and Female Surgical Interventions * Federico I. Tirapegui federico.tirapegui@hospitalitaliano.org.ar 1 Department of Urology, Hospital Italiano de Buenos Aires, Perón Tte Gral Juan Domingo 4190, C1199ABB Buenos Aires, Argentina 2 Department of Urology, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA Current Sexual Health Reports https://doi.org/10.1007/s11930-020-00294-0