Phalloplasty
Phalloplasty is a complex surgery to construct a penis, repair a penis after an injury or fix a congenital condition. Benefits include relieving physical and emotional difficulties. Working with a surgeon who has lots of experience in phalloplasty reduces surgery risks. Recovery time may take a month or longer.
In most cases, phalloplasty (FAL-oh-plas-tee) is a type of genital reconstructive surgery to create a neophallus to treat a congenital (present at birth) anomaly, severe penile injury (trauma) or disease.
Phalloplasty surgery goals may include creating a natural-looking penis that allows you to:
- Pee while standing up.
- Feel sensation and sexual pleasure.
- Get an erection with the use of a penile implant.
- Have penetrative sexual intercourse.
Phalloplasty for people who have congenital conditions or experienced trauma to their penises.
Congenital conditions include:
- Genitals that don’t look typically male or female (atypical genitalia).
- The penis doesn’t develop during embryo development (aphallia).
- The opening at the end of the urethra (meatus) forms at the top of the penis instead of the tip (epispadias).
- The meatus forms below the tip of the penis (hypospadias).
- An atypically small penis (micropenis).
Penile trauma may include:
- Car accidents.
- Complications after removing the foreskin (circumcision).
- Penile cancer.
Before a phalloplasty, your provider will make sure you're in the best shape possible for surgery for the best possible outcome. This may include:
- A physical exam to assess your overall health and learn more about your medical history.
- Patient education, including conversations with a provider and literature so you fully understand the risks, benefits and postsurgical care requirements.
- A mental status exam from a qualified mental health provider (therapist, psychiatrist or social worker) to ensure your understanding of the procedure. They’ll ask why you want a phalloplasty, explain how the procedure will affect your life and ask about your expectations. You’ll need surgery referral letters from two mental health providers.
- Hair removal (electrolysis or laser hair removal) in an area your provider will take tissue from to create your neophallus.
- Health recommendations to help reduce your risk of complications, such as quitting smoking or having a body mass index (BMI) of less than 32.
Where will the tissue for the neopenis come from?
A healthcare provider may take tissue flaps from your:
- Forearm (radial forearm free flap).
- Thigh (anterolateral thigh free flap).
The donor tissue area will also require a skin graft. You may have the donor area skin graft at the same time as the phalloplasty or a few weeks later.
In general, before phalloplasty, you’ll need to:
- List all of your allergies.
- List all of your prescription or over-the-counter (OTC) medications, including herbal supplements.
- Temporarily stop all blood-thinning medications, if you take them.
- Not eat or drink eight to 12 hours before your surgery.
If you must take some medications before surgery, you may take them with a small sip of water.
The following healthcare providers may make up your phalloplasty team:
- Reconstructive urologist.
- Plastic surgeon.
- Anesthesiologist.
An anesthesiologist first gives you general anesthesia before surgery. General anesthesia puts you to sleep. You won’t feel pain or experience any other sensations during surgery.
Then, surgeons take a large flap of skin from your forearm or thigh. The flap contains all the parts that make up biological penile tissue, except for erectile tissue. This includes:
- Nerves.
- Arteries.
- Veins.
They’ll roll the flap to form a shaft and attach it to your groin. You’ll just have a shaft — you won’t have a head (glans).
You may also get additional surgeris at the same time as your phalloplasty, or your surgeons may break them up into different stages so you have time to heal between procedures. These extra procedures may include:
- Making your urethra longer (urethroplasty or urethral lengthening) so you can pee while standing.
- Constructing a head for your penis (glansplasty).
- Inserting a penile implant to enable erections.
- Creating a scrotum (scrotoplasty) to add testicular prostheses.
It depends on many factors, including whether your phalloplasty care team performs other procedures. But in general, phalloplasty may take eight to 10 hours or longer to complete. If you choose to have other procedures in different stages, it may take between 12 and 18 months to complete.
After phalloplasty, you’ll stop receiving anesthesia. You’ll wake up after a few minutes but likely feel groggy. Healthcare providers will monitor your overall health and manage your pain once you fully wake up.
Phalloplasty is an inpatient procedure. You’ll be in the hospital for at least a week after phalloplasty to monitor the blood supply to your neophallus.
You need time to heal after the procedure. If your phalloplasty team performs the surgery in several stages, you need to schedule the other procedures several months after your first procedure.
One of the main benefits of phalloplasty is relief from physical or emotional challenges. Results include a natural-looking penis that’s capable of functioning sexually.
Other benefits depend on which options you choose:
- Flaps from your forearm provide excellent cosmetic results and better sensation.
- Flaps from your thigh give you more penis length options. Scars on your thigh from removing the flap are also easier to hide with pants or shorts.
- Making your urethra longer enables you to pee while standing.
You may get a penile implant to get an erection whenever you choose. A healthcare provider will talk to you about and review penile implant options with you.
Yes, you can feel sensation after phalloplasty. But you may have less feeling in your neophallus than the donor area of your skin before the procedure. The sensation may increase on its own over time. A healthcare provider may also recommend a special rehabilitation training to improve feeling over time.
In the hands of a qualified surgeon with a lot of experience, you’ll have a typical-looking penis after phalloplasty.
The skin that healthcare providers use to make your neophallus is different than typical penis skin, so there may be differences in color and thickness — you may not be able to see veins. You may have scarring on the bottom of your shaft and around the tip. Your penis will also be about the same size when it’s erect as it is flaccid (not erect).
Your penis length may vary according to the donor site. But on average, you should expect your penis to be 5 to 6 inches (12.7 to 15.2 centimeters).
Yes, it’s possible to orgasm. Regardless of your flap type, the nerves for orgasm connect to the flap. For most people, this preserves their ability to orgasm.
Studies show that phalloplasty has a very high satisfaction rate. Most people are happy with how their neophallus looks and its sexual function.
Phalloplasty is a complex penis surgery. Many people experience complications. It’s very important to go to an experienced surgeon to lower your risk. Complications are less likely to affect your long-term results if a healthcare provider catches them early.
Potential complications of phalloplasty may include:
- Anesthesia complications. These may include sore throat, nausea and vomiting, constipation, severe allergic reaction (anaphylaxis) and stroke.
- Bacterial infection. Harmful bacteria can enter your body through your open wounds and cause sepsis.
- Partial phallic loss. Your neophallus must have adequate blood flow. If it doesn’t, the neophallus tissue can die (necrosis).
- Urethral stricture. Inadequate blood flow can cause scar tissue to form. Scar tissue can slow or completely block pee from leaving your body.
- Urinary fistula. An abnormal connection or opening may form between your urinary system and a nearby organ, like your intestines (bowel). A urinary fistula may also open to the outside of your body.
- Dribbling pee. You may dribble pee, especially after using the bathroom (postvoid dribbling).
After phalloplasty, you must rest. Many people don’t resume their usual activities until at least six weeks after surgery. Recovery includes:
- Limiting physical activity. This includes exercising and household chores.
- Using a Foley catheter or suprapubic catheter to pee.
- Keeping your incisions clean and dry.
- Reapplying dressings over your surgical wounds during the early stages of your recovery.
- Taking medications as prescribed by your healthcare provider to ease pain, prevent infection and relieve constipation.
Most people can return to work or school about two to three months after a phalloplasty. But if you have a more physically demanding job, it’s a good idea to take more time off — you may need to take up to three to four months off work to recover.
Achieving the full function of your penis takes time — in most cases, a year or longer. It will require multiple surgeries. The time it takes depends on whether your treatment involves:
- Repairing or constructing a penis.
- Closing the vagina and removing the uterus or ovaries.
- Taking a flap from your arm or leg.
- Constructing a scrotum or glans.
- Implanting a device to allow erections.
When should I call a healthcare provider?
Schedule regular follow-up appointments with your healthcare team after a phalloplasty to see how your body is healing. Call a healthcare provider or seek emergency care if you have:
- Signs of infection, including fever, chills, headache, discoloration, swelling or pus.
- Vomiting and not being able to keep fluids down.
- Excessive bleeding or blood-soaked dressings.
- Difficulty or pain while peeing.
- Pain that lasts longer than expected or doesn’t respond to medications.
- Signs of blood clots, like abnormal swelling in your groin or lower leg.
- Discoloration or other skin changes in your neophallus.
References
- Elfering L, van de Grift TC, Al-Tamimi M, et al. How Sensitive Is the Neophallus? Postphalloplasty Experienced and Objective Sensitivity in Transmasculine Persons (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8498953/). Sex Med. 2021 Oct;9(5):100413. Accessed 6/6/2024.
- Heston AL, Esmonde NO, Dugi DD III, et al. Phalloplasty: Techniques and Outcomes (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6626313/). Transl Androl Urol. 2019 Jun;8(3):254-265. Accessed 6/6/2024.
- Liu JL, Eisenbeis L, Preston S, et al. Postphalloplasty Urinary Function Test: An Observational Study of Novel Outcome Instrument to Capture Urinary Dysfunction and Quality of Life after Phalloplasty (https://ncbi.nlm.nih.gov/pmc/articles/PMC9809483/). Asian J Androl. 2022 Nov-Dec;24(6):570-574. Accessed 6/6/2024.
- Phallo.net. Is Phalloplasty Worth It? Examining Reported Satisfaction after Phalloplasty (https://www.phallo.net/phalloplasty-satisfaction.htm). Last updated 1/3/2019. Accessed 5/24/2024.
- Sarıkaya S, Ralph DJ. Mystery and Realities of Phalloplasty: A Systematic Review (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562237/). Turk J Urol. 2017 Sep;43(3):229-236. Accessed 6/6/2024.
- Terrier JÉ, Courtois F, Ruffion A, et al. Surgical Outcomes and Patients’ Satisfaction with Suprapubic Phalloplasty (https://pubmed.ncbi.nlm.nih.gov/24024755/). J Sex Med. 2014 Jan;11(1):288-98. Accessed 6/6/2024.
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