Nerve Transfer to Restore Genital Sensation in Women with Low Spinal Lesion: The Female TOMAX Procedure.

Background: Women with spinal cord lesions have loss of sensation in the lower body, negatively affecting sexuality in many ways: decreased, lost, or changed genital sensation and difficulties with orgasm. Restoring genital sensation in men with low spinal lesions using a nerve transfer (to maximize sensation, sexuality, and quality of life [TOMAX] procedure) has shown the potential to enhance sexual functioning and satisfaction. This procedure was adapted to a female version, in which the dorsal clitoral nerve was transferred to the ilioinguinal nerve to restore genital sensation. We report the results of the first female TOMAX patients. Methods: Four patients with spinal lesions below L1 with unilaterally or bilaterally absent genital sensations and normal sensation in the groin were included. All patients underwent both neurological and psychological assessments preoperatively and at 6, 12, and 18 months postoperatively. Results: The mean patient age was 53.3 years. Three patients experienced sensations in the clitoris and labia minora at 18 months postoperatively, which led to orgasms in 1 patient. One patient gained no sensation in her genitals but had a surprising side effect: she did not have to catheterize herself anymore. Conclusion: The female TOMAX procedure is a new promising technique for restoring sensation of the genitals in women with low spinal cord lesions.