What effects does it have?

  • Lower body

    Creates a penis and ability to stand to urinate

What is it?

Surgical creation of a penis.

How long does it last?

The effects are permanent and cannot be reversed. Phalloplasty usually takes several separate surgeries to complete, with healing time in between them, and may take more than a year to complete.

More information

Warning

Phalloplasty is a complex surgical procedure with significant risks that you must understand before it is carried out. Phalloplasty usually causes significant scarring due to skin grafting (usually on the lower arm). Complications are also common in this operation, particularly problems with urinating which may require surgical correction, including urethral strictures and fistulae (urethra closing up so you cannot urinate) 1.

Phalloplasty is surgery to create a penis, usually with the ability to urinate out of the end of it, and to make it erect. Often scrotoplasty is performed at the same time.

Before phalloplasty surgery, you will need to choose to decide whether you wish to be able to use the penis to pass urine standing, and whether you wish to be able to make the penis hard for penetrative sex using prosthetic implants. Both of these will increase the length and complexity of surgery.

For some people, phalloplasty can provide a significant improvement in mental health. There is overall agreement in medical studies that after gender confirming medical interventions, rates of psychiatric disorders and psychiatric symptoms reduce considerably 2. However, as with other major life changes, you may find that counselling before and after surgery may be helpful.

An alternative option to phalloplasty is metoidioplasty. Phalloplasty usually creates an average sized penis, compared to the much smaller (5-7cm length) results of metoidioplasty. However, as metoidioplasty uses only clitoral tissue, it will usually provide an organ with good erogenous sensation which can become erect without the use of prostheses. Metoidioplasty also often requires less surgeries, less time in hospital, and less scarring.

Phalloplasty involves a degree of risk. UK surgeons have reported a 3% rate of phallus loss, thought this risk can be reduced by avoiding smoking and not being overweight. In the event of phallus loss, further attempts can be made 6-12 months later 3. It is important to note that if a prosthetic erectile implant is used, it will likely need replacement later in life, so you will need to be prepared for further surgeries in the future 3.

You can find more information about phalloplasty and metoidioplasty on the St. Peter’s Andrology Centre website.

Types of phalloplasty

Phalloplasty requires reuse of skin from some other part of the body. Three types of phalloplasty are performed in the UK, which differ in which site skin is taken from 3:

  • radial artery phalloplasty using a free flap from the forearm; this is the most commonly used technique in the UK
  • pubic phalloplasty using a local flap from the lower belly and crotch area; this may not be possible if you have had surgeries on your abdomen such as Caesarian section or hysterectomy
  • antero-lateral thigh phalloplasty using either a free or pedicled flap from the outer thigh

The amount of sensation in the penis will depend on the technique used, with radial artery phalloplasty giving the best results. There is no guarantee of sensation: UK surgeons report 10% of patients have no sensation after two years with radial artery phalloplasty 3.

The donor area receives skin grafts to replace the removed skin (normally from the buttocks 3), but there will be significant scarring on donor area 1, and it should not be exposed to strong sunlight as it will get sunburned easily 3.

Other types of phalloplasty are possible but not normally performed in the UK, including MLD (muscular latissimus dorsi meaning the side of the chest or back), Gracilis, Fibular (lower leg), Deltoid (upper arm/shoulder), and Gillies (from the abdomen but using a pedicled tube) 3.

Erections

Several options are available for people who wish to have erections:

  • inflatable prostheses: this is an implant inside the penis. This is usually inflated by a pump, usually hidden inside one of the testicular prostheses, which you squeeze to inflate the penis implant. This is the usual approach to providing the ability to get erections used in the UK 4. It is important to note that if an inflatable erectile implant is used, it will likely need replacement later in life, so you will need to be prepared for further surgeries in the future 3.
  • malleable rods: these are implanted into the penis. These are not usually used in the UK as the implant exerts constant pressure on the skin, causing damage over time 4.
  • external aids: these are devices worn around the penis. They can either provide support to hold it straight and stiff, constrict around the base of the penis to hold blood in to stiffen the penis, or provide additional length and girth by providing a sleeve around the penis.

Cost and funding

If you have a formal diagnosis, the NHS will usually provide funding for phalloplasty or metoidioplasty. The NHS will normally also fund hair removal from the donor skin sites for phalloplasty, either by laser hair reduction or electrolysis. You will normally need to meet the following conditions:

  • persistent and well-documented gender dysphoria
  • capacity to make fully informed decisions and to consent to treatment
  • if significant medical or mental health concerns are present, they must be reasonably well controlled
  • two medical opinions, usually at least one from a gender clinic, that surgery is appropriate
  • 12 months’ continuous endocrine treatment as appropriate to the patient’s goals (unless the patient has medical contraindications or is otherwise unable to take hormones)
  • at least 12 months’ living continuously in a gender role that is congruent with the gender identity 5.

References

  1. 1 Frey, Jordan D, Poudrier, Grace, Chiodo, Michael V and Hazen, Alexes (2017) “An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature.” Plastic and Reconstructive Surgery, 139(3), pp. 728–737.
  2. 2 Arcelus, Jon and De Cuypere, Griet (2017) “Mental Health Problems in the Transgender Population: What Is The Evidence?,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 173–188.
  3. 3 Christopher, Nim, Ralph, David and Garaffa, Giulio (2017) “Genital Reconstructive Surgery for Transgender Men,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 277–300.
  4. 4 Pryor, A J and Christopher, A N (2016) “Patients’ guide to Phalloplasty techniques.” [online] Available from: https://www.andrology.co.uk/download/documents/1/0/Patients-Guide-To-Phalloplasty.pdf
  5. 5 Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” [online] Available from: www.rcpsych.ac.uk/usefulresources/publications/collegereports/cr/cr181.aspx

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Page last updated: July 2018