Sexual health and fertility issues

  • Sexual function and fertility are variable in the exstrophy population, and these patients can face unique anatomic issues related to their sexual health.
  • In the adult patient dissatisfied with penile length, it is important to determine if correctable residual defects, such as dorsal curvature, are present.
  • Some patients may benefit from phalloplasty, but this is generally a select population. To date, no safe, reliable penile lengthening procedures have been demonstrated.
  • Females with exstrophy tend to have a shortened vagina with the vaginal long axis lying parallel to the ground when standing, and the introitus is narrowed; many patients require vaginal dilation, episiotomy, or vaginoplasty to allow for penetrative intercourse.
  • Pelvic organ prolapse remains highly prevalent in females with exstrophy and is attributable to the anatomic pelvic anomalies present since prenatal development.
  • Fertility includes several unique issues related to the intrinsic development of the pelvis and to prior surgical repairs. Retrograde ejaculation or anejaculation are prevalent in male patients.
Transitional urology
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