Phalloplasty

For some trans men, phalloplasty is a natural and important step, while for others it is an unnecessary procedure. Therefore, each trans person must make personal decisions that best suit their individual needs.

Before undergoing phalloplasty, the medical team will assess the suitability of this surgery in each case, taking into account your state of health, your medical history and evaluating all possible options.

Preparation before phalloplasty

Before undergoing phalloplasty, preparation before the procedure is as important as postoperative care.

It is important to have a blood test at least 3 months before the phalloplasty surgery. It is also essential to control your diet and clean your intestines.

It is also necessary to undergo hormonal treatment that aims to increase the size of the clitoris. The surgeon, along with the medical team at IM GENDER, will advise you on how and when to undergo this treatment.

Finally, if there is a lot of hair on the inner side of the forearm, it is recommended to undergo laser hair removal on the non-dominant forearm 3 months to 1 year before the surgery. This is done to remove as much hair as possible from the forearm, because this area will become part of the urethra of the neophallus.

When you visit your doctor, everything will be explained and any doubts that may arise will be clarified.

What is phalloplasty?

Phalloplasty is a surgical technique that allows the reconstruction of a phallus (penis). To achieve this, tissue from other parts of the body is used, most commonly skin and fat from the forearm, although tissue from the thigh or abdomen, among others, can also be used.

This neopenis has a very anatomical appearance, allows bipedal urination (urinating while standing up) and has tactile and erogenous sensitivity. It is important to clarify that in order to allow sexual penetration, it will require a prosthesis that will have to be implanted in a second surgical procedure.

What is phalloplasty surgery like?

The phalloplasty technique uses tissue from other parts of the body, usually skin and fat from the forearm. With this tissue, the surgeon can recreate a penis of anatomical dimensions that, once shaped, is transported to its final position. Once there, thanks to the advancement of microsurgery, the suturing of the arteries and veins, which supply blood and nerves, is performed in order to achieve tactile and erogenous sensitivity. To extend the urethra in the first few centimeters, the surgeon uses tissue from the anterior wall of the vagina (with a length of about 5 centimeters and a width of 2 to 3 centimeters) and a flap made with the skin of the labia minora. Then it is sutured with the urethra previously created in the phallus.

During the same procedure, the labia majora are mobilized dorsally and joined in the midline to form a new scrotum. Once the scrotal sac is created, silicone testicular implants are placed. The implantation of the testicular prostheses can be performed during the same surgical procedure or postponed to a second intervention depending on the surgical criteria.

Is hospital admission necessary for phalloplasty?

For phalloplasty, you will be admitted to IM GENDER on the same day as the surgery. During the hours before the operation, our team will carry out the necessary monitoring. Phalloplasty is always performed under general anesthesia and usually takes 10 to 12 hours.

Is there sensitivity with phalloplasty?

To achieve erogenous sensitivity in phalloplasty, the surgeon anastomoses a nerve from the clitoris to one of the nerves of the neopenis and also to the clitoris itself, which will remain buried under the phallus.

Will I have to be hospitalised after phalloplasty?

After phalloplasty, you will need to remain hospitalised for at least one week to ensure better monitoring of your progress by the medical team at the IM GENDER Gender Unit. This is also to provide both the patient and their companion with the necessary environment and comfort for a speedy recovery.

After the first 48 hours following the surgery, patient mobility will be permitted.

When will I be able to go home after phalloplasty?

Although you will be discharged from hospital one week after the phalloplasty, you will need to wear a bladder catheter for at least 21 days. Occasionally, at the surgeon’s discretion, a suprapubic catheter may be inserted. This allows the bladder to empty by preventing urine from flowing through the urethra, keeping it dry in the early stages of recovery.

Can there be complications in the postoperative period of phalloplasty?

A member of the medical team will instruct you on how to prevent possible complications and what to do in case they happen. If you have any doubts or abnormalities after the procedure, you should consult your doctor so that they can diagnose the issue and provide a solution.

These are the most common complications that may arise:

• • • Urinary infection (burning sensation in the urethra, discomfort, and/or hematuria).
    • Urine leakage through adjacent areas to the neophallus.
    • Fever.
    • Urinary retention.
    • Wound dehiscence.
    • Redness and swelling of the phallus.
    • Increased pain.

If you have any doubts or discomfort, you should consult your referring surgeon or the patient care team. A 24 hour phone line will be available for you to make your inquiries.

What is phalloplasty recovery like?

It is important to follow the advice of the medical team at IM GENDER throughout the postoperative period, as well as attend all follow-up visits after phalloplasty and contact the medical team if there are any doubts about the recovery process. Only they can properly evaluate your recovery from phalloplasty. Usually, once you have been discharged from the hospital, you will be given an appointment for the next postoperative check-ups and wound care. These will typically take place about one month, three months, six months, and one year after the phalloplasty. At all times, you will have access to a support phone number during the postoperative period.

What is the result of phalloplasty?

After phalloplasty and your recovery, you will have a penis that is functional, anatomically and aesthetically similar to that of any man. While you will have to wait a few months after surgery for a penile prosthesis to allow penetrative sex, you will have erogenous sensation.