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What is Phalloplasty?

Reviewed by Dan Brennan, MD on April 12, 2021

Phalloplasty is a gender-affirming surgery for people who are transgender

Most people who get phalloplasty were initially assigned female at birth (AFAB). That means, they were born with a vagina, so doctors asssigned them the gender of a girl.

Then, throughout their lives, they experienced gender dysphoria — a discomfort felt by many transgender and gender non-conforming people throughout their lives.

Phalloplasty allows transgender persons to receive a penis in order to recognize their authentic gender and to alleviate symptoms like gender dysphoria.

How Phalloplasty Works for Gender Affirming

Phalloplasty can help people whose inner gender is different than the one they were assigned at birth and want to get rid of primary sex characteristics — like genitalia — and desire those of the opposite gender.

AFAB people who are men, also known as transgender men or transmasculine people, can also take testosterone to cause voice deepening, growth of facial hair, and changes in body composition. 

There are also several gender-affirming surgeries in addition to phalloplasty including:

  • "Top surgery:" a masculinizing chest surgery that occurs when doctors remove the breasts for a flat-chested appearance.
  • Metoidioplasty: Doctors turn the clitoris into a penis during this surgery
  • Hysterectomy: Removal of the uterus
  • Oophorectomy: Removal of the ovaries
  • Vaginectomy: Removal of the vagina
  • Facial masculinization surgery: Doctors augment your cheeks, forehead, jaw, and/or chin to give a more masculine appearance

Gender-affirming surgery used to be called " gender reassignment surgery," or "sex reassignment surgery." Now, some people prefer to call it gender-affirming surgery or gender-confirming surgery to reflect the fact that trans people were always the gender they are. Their gender is not being "reassigned."

What Happens in a Phalloplasty?

During phalloplasty, doctors create a penis from other parts of your body. It is a surgery with multiple stages including:

  • Lengthening the urethra
  • Creating the tip of the penis
  • Removing the vagina
  • Creating the scrotum
  • Putting in penile and scrotal implants
  • Creating the penis

To create the penis, doctors usually choose from three different areas of the body: the arm, the leg, or the abdomen. Your doctor will work with you to find the best choice for your body. All phalloplasties do not include each of the steps above. You have a choice over which of these options you would like, based on your goals for your penis.

Phalloplasty sometimes takes multiple surgeries over the course of a year to complete. If you would like to have a hysterectomy, doctors recommend doing that before starting the phalloplasty process.

Other phalloplasties happen during one longer surgery.

What is a Penis Like After a Phalloplasty?

The functioning of the penis after phalloplasty is different for each person. Your doctor will tailor your surgery to your personal goals, which may include:

  • Retaining the ability to orgasm
  • Getting and maintaining an erection
  • Being able to stand to urinate

Continued

Most penises are about 5 to 6 inches after phalloplasty. The size depends on the availability of skin and tissue from the grafting site.

Your doctor can insert an erectile implant to allow you to get an erection. They can transport your clitoris to the base of your penis to enhance sensations. Another option is "nerve hook up." During this part of the procedure, doctors connect nerves from the donor tissue to your pelvis to enhance sensation.

Who is Eligible for a Phalloplasty?

In general, to get a phalloplasty you must:

  • Take hormones for at least a year
  • Live as your gender for at least a year
  • Be age 18 or over
  • Receive treatment for gender dysphoria from a mental health professional
  • Have a BMI of less than 35
  • Quit smoking
  • Have a hysterectomy and/or oophorectomy at least 8 weeks before your phalloplasty

Phalloplasty Risks

Every surgery comes with some level of risk, including phalloplasty. In general, risks include infection, pain, excessive bleeding, and tissue damage. However, there are potential complications specific to phalloplasty including:

  • Catheter complications: The catheter you may have to use for a few weeks can become blocked or twisted. You can also experience bladder spasms while using a catheter. There is also an increased risk of urinary tract infection.
  • Flap loss: This is when the grafted tissue does not receive proper blood flow, usually due to an error. If recognized quickly, the graft can still be saved.
  • Urethral strictures: The tightening of the urethra makes it harder to pass urine and can occur six to 12 months after surgery.

Recovery From Phalloplasty

While you can often go back to your usual activities about six weeks after a phalloplasty, it can take anywhere from 12 to 18 months to fully recover. You may need to use a catheter to urinate for a few weeks after phalloplasty surgery. 

If you plan to travel to a different city for your phalloplasty, you will likely need to stay in town for several weeks following each surgery.

WebMD Medical Reference

Sources

SOURCES:

Boston Children's Hospital: "Phalloplasty."

JOHNS HOPKINS MEDICINE: "FAQ: Phalloplasty."

HEALTH UNIVERSITY OF UTAH: "PHALLOPLASTY GUIDE: HOW TO PREPARE & WHAT TO EXPECT DURING YOUR RECOVERY."

MAYO CLINIC: "Gender dysphoria."

UCSF Transgender Care: "Phalloplasty and metoidioplasty - overview and postoperative considerations."

University Hospitals: "UH Experts Offer a Wide Variety of Surgical Options for Female to Male (FTM) Transition."

University of Nebraska Omaha: "Queer and Trans Spectrum Definitions."

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