The surgical procedure to construct penis is called phalloplasty. The aims of phalloplasty are:

  • Male genitals cosmetically looking as natural as possible.
  • Ability to perform sexual intercourse.
  • Ability to attain orgasm.

The erectile and functional penis requires two stages for reconstruction:

Phalloplasty Stage I

There are two techniques for penile reconstruction depending on the donor tissue site.

  • The penis is constructed using local skin tissues like groin, lower abdomen or from thighs. The skin is tabularized to give penile shape.
  • The more common and popular procedure to construct penis is a free flap, in which the tissues including the blood vessels and arteries are removed from any other part of body. The most common donor site is forearm ( Radial artery forearm flap, Ulnar artery flap). The other flaps which can be used are Lateral Arm flap, Para scapular flap, Latissimus dorsi flap etc. The skin and underlying tissues are reshaped into a penis and the whole structure is transferred to the pubic area along with the nerves , arteries and veins. The nerves, arteries and veins are anastomosed at the recipient area. The urethra is anastomosed to the native urethra, though it is optional and can be done at a later stage. With meticulous planning and execution, the free flap phalloplasty gives excellent results in the form of a long thick penis which gains erotic sensations over next few months. The nerves lead to sensate penis over a period of 6 to 9 months, though the buried clitoral tissue at the base of penis contributes to erotic sensation starting from early post operative period.

Duration of Procedure: 7-8 hrs. You need to stay for about two to three weeks.

Anesthesia:GA.

Recovery Time:Back to work in 4-5 weeks. Strenuous activities in 8- 9 weeks.

Longevity of Results:Permanent.

Phalloplasty Stage II

To make the penis erectile and stiff, a penile implant is inserted. The usual requirement is that the penis should be fully sensate. It means it can be performed 6 to 9 months after stage I of phalloplasty as the penis gains sensations till tip during this period.

Duration of Procedure:1 -2 hrs. You may go home on the same day, though if you wish you may stay overnight.

Anesthesia:GA or local with sedation.

Recovery Time:Back to work in 2- 5 days. Strenuous activities in 4- 6 weeks. Sexual activities after 8 week.

Longevity of Results:Permanent .

Frequently Asked Questions

  • Do the urinary complications resolve within a few months or may be permanent?
Most of the urinary problems (mostly the fistula) resolves within one or two months. Nowadays a controlled fistula is recommended at the junction of neourethra and native urethra. After few weeks (3 to 5 weeks) both are joined thus leading to normal urethra. Urinary problem can always be rectified and it is should never be permanent.
  • After inserting implants, are the erection and penetrative sex painful or uncomfortable?
After penile implants, erection is not painful. Nowadays the prostheses are hinged and erect penis is easily accommodated in the underwear. Sexual intercourse has not been experienced as uncomfortable by our clients.
  • After the nerve connecting erogenous, is sexual sensation both on the clitoris and on neophallus?
Native clitoris remains erogenous and is buried at the base of neophallus. Owing to usage of maximum nerves in free flaps (like in radial artery forearm flap phalloplasty), the sensations are normal in neophallus.
  • After surgery is it possible to achieve complete orgasm or is there only some pleasure feeling?
In addition to sexual pleasure almost all achieve orgasm. This is because the native nerves used are erogenous pudendal nerves leading to fully sensate and erogenous penis/ phallus.
  • Will I get the gender change certificate after stage 1 of phalloplasty? Would that certificate be legally valid and easily acceptable for changing my documents?
Yes, you will get certificate after phalloplasty stage 1 and that is legally valid.
  • Is is better to have vaginectomy pre or post phalloplasty? Can it be performed with Stage 1 or Stage 2?

There is no thumb rule for the timings of vaginectomy and it is personal preference of the client. In most of the cases vaginectomy is done before phalloplasty. During vaginectomy I use a vaginal tissues to elongate the urethra (also called as urethral extension and urethral masculinization). This elongated urethra is very useful during phalloplasty. Stage one phalloplasty is long and dedicated procedure and should not be combined with vaginectomy. Vaginectomy can be done along with stage 2 phalloplasty.

  • When is scrotoplasty done? Is it After stage 2 or along with Stage 2?

Scrotoplasty can be done with phalloplasty stage 2 or as a separate procedure depending on the budget.

  • Do you perform glansoplasty as well and if yes can u please share the cost and confirm after how much gap this should have from stage 2?

Glansplasty can be done about 3 months after stage one once the tissues are soft. This can also be done about 3 months after stage 2 once the implants are settled. Please note that glans reshaping is also done during phalloplasty stage 1 (subjected to blood supply) to give more or less normal looks.

  • Will I be able to stand and urinate after stage 1 or urinary tube connection will be done later, may be around stage 2?

You will be able to urinate while standing if native urethra is joined to phallo neo urethra. Occasionally the urethra is joined at a later date to allow better healing for neo phallus.

  • After all the surgery and treatment can I have a complete male look and can I do an sexual intercourse?

You will look like male and you can perform sexual activities like normal males. Most of the FTM candidates start look like a male even after few months of testosterone therapy.


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