Frequently asked questions about phalloplasty

Phalloplasty surgery

Phalloplasty is a gender-affirming surgery designed for transgender men and non-binary individuals assigned female at birth who wish to construct a neopenis. The surgery is also an option for cisgender men who have lost their penis due to illness or injury.

Phalloplasty is intended to provide both a functional and aesthetically realistic penis, allowing the patient to urinate standing up and, after additional procedures, engage in penetrative sexual activities. Each phalloplasty is tailored to the specific goals and anatomy of the patient.

Preparation involves consultations with your surgical team, psychological assessments and often a period of hormone therapy. Smoking cessation, maintaining a healthy weight and improving overall health are also important.

There are different techniques used in phalloplasty, each depending on the area of the body where the donor tissue is taken from. Common donor sites include the forearm (radial forearm flap), thigh (anterolateral thigh flap) and back (dorsal flap). The choice of donor site will influence factors like the appearance of the neopenis, the length of recovery and the degree of scarring at the donor site.

Your surgeon will help you decide which technique is most appropriate based on your individual anatomy, goals, and medical history.

An important component of phalloplasty is the construction of a functional urethra that allows the individual to urinate while standing. This is achieved by extending the existing urethra using tissue from the donor site.

To extend the urethra in the first few centimetres, the surgeon uses tissue from the anterior wall of the vagina and a flap made from the skin of the labia minora. It is then sutured to the urethra previously created in the phallus.

Phalloplasty is usually performed in multiple stages. The initial surgery focuses on constructing the neopenis and, when necessary, creating a functional urethra. Later stages may involve the placement of testicular implants and a penile prosthesis for achieving penetrative sexual function.

Discussing the expected timeline and the need for multiple procedures with your surgeon is an important part of preparing for the process.

Once genital surgery has been performed, you should make an appointment with your endocrinologist, who will recommend guidelines for your hormone treatment, if you wish.

AESTHETIC AND PROSTHETIC OPTIONS

Testicular implants are available in different sizes and are placed in a secondary surgery. The size of the implants will depend on your personal preferences as well as the elasticity and capacity of the surrounding tissue. Your surgeon will guide you in selecting the most appropriate size.

Insertion of the first testicle is performed three to four months after the phalloplasty surgery. The second is inserted four to five months later. 

A penile implant, which enables penetrative sex, is typically placed about a year after the initial surgery, once healing is complete and sensation is restored. The decision to have a prosthesis is made in consultation with your surgeon, based on your personal goals and progress.

Phalloplasty for gender affirmation aims to create a neopenis with a realistic appearance. The success in achieving this depends on the surgical technique, the skill of the surgeon, and the patient’s healing process.

To improve the appearance of the phallus a series of aesthetic treatments is available after phalloplasty aimed at achieving a phallus with a more appropriate colouring and vein structures. One of the most popular treatments is often phallus micropigmentation, which imitates the aesthetic structures of a natural penis.

SEXUAL FUNCTION AND SENSITIVITY

The sensitivity of the penis can be divided into two components: on the one hand, we have sensitivity to touch, heat and pain – that is, the sensitivity we have in any body part. On the other hand, we have erogenous sensitivity, specific to certain parts of the body, such as the penis or clitoris. Both sensitivities are present after phalloplasty. The first, thanks to the union of a nerve from the phallus to one of the nerves in the leg. The second, thanks to the union of a nerve from the trans man’s penis to a nerve from the clitoris.

However, this sensitivity is not present at first. You must wait for a period of approximately 6–8 months for full sensory recovery. A “learning” period is also necessary for the brain to identify the nerve stimulus as coming from the penis.

After phalloplasty, the rigidity of the trans man’s phallus does not allow penetrative sex. It is too flaccid and, while some patients report having had penetrative sex, it is not possible to maintain sexual relations. This requires a second operation to implant a penile prosthesis so as to provide the necessary rigidity.

Before proceeding with this second procedure, the patient must have regained sensation in the penis. Once this second procedure is carried out, the patient will be able to have normal intercourse.

The penis after phalloplasty has full erogenous sensitivity so that it can indeed receive sexual pleasure and reach orgasm quite normally.

POST-OPERATIVE CARE AND RESULTS

Post-operative care includes managing pain, caring for surgical sites, avoiding strenuous activities and attending follow-up appointments. Your surgeon will provide detailed instructions tailored to your phalloplasty surgery.

After phalloplasty, you will need to stay in the hospital for at least one week. This allows the medical team to closely monitor your recovery and ensure that everything is progressing as expected. It also provides a comfortable and supportive environment for both you and any accompanying person during the initial stages of recovery.

As with any surgery, complications can occur. These may include infections, urethral complications (such as fistulas), and extrusion of implants. It’s important to follow all post-operative instructions and attend regular follow-ups with your medical team. If any issues arise, contact your surgeon immediately to address potential complications.

Phalloplasty aims to construct a neopenis that closely resembles a cisgender male penis in appearance. The outcome depends on the surgical technique and donor site used, with common areas being the forearm, thigh or back. Post-surgery, patients can expect scarring at the donor and surgical sites, which may fade over time.

On our website, you can find videos, testimonials and actual results of phalloplasty performed at IM GENDER.