How I decided to skip urethral lengthening for trans phalloplasty

Dr. Devin O’Brien-Coon: the phallo ty card of my dreams

It’s hard to explain. Dysphoria is such a moving target for many of us. For whatever reason, STP (standing to pee) was never something I felt I really needed. Understanding why it was right for me to skip urethral lengthening (UL) might be as complex a question as asking how I know my gender. I just knew it wasn’t a big need.

I think back to my earliest memories, and maybe it influenced me that from time to time I would glimpse my dad on the commode as a young child, and he would be sitting down to pee. I can picture it as clear as day. He would have his hand in front of his groin, pushing it into the toilet space to sit and pee. It was how he did it, so for many years my mental concept of how graceful gentlemen like my father would urinate. I have later learned 40% or more of Japanese men sit to pee, also considering it more civilized.

Well, whatever early memories played into this, I arrived at adulthood seeing male partners stand at the toilet from time to time. I was utterly repulsed by the splash of urine it made inevitably on the floor and around the commode. I thought, in passing, this is not how I would do it.

Around age 24, I started packing at work. I had an STP packer, but it was impossible for me to figure out how to use it without getting pee all over myself, and after two accidents like that at work, I threw in that towel. No, sir. I just used it as a packer at work, happy to be home to take it off. In this hot climate, packers make you sweat and stimulate all sorts of funky smells. The moment of taking it on and off was a dysphoria hell for me, and I’d rather not have worn it, but I felt obligated to do so at work.

By the time I finally made it to my phalloplasty consult at the age of 30, I was so fresh at hearing the year or more of traumatic complications one of my best friends endured trying to get his phalloplasty urethra to act right. Most of the complications I read about in groups were about urinary strictures or fistulas. I know most resolved within a year, but especially being from a place far away from my surgeon or anyone capable of managing care, a place notably hostile to trans people… I had another close friend who had major issues with UL with his meta here, and he was travelling thousands of miles to fix it. We felt powerless to find good support to battle complications. Their pain and suffering had a tremendous impact on me.

Now, I also know a few folks who haven’t had any serious urinary complications at all. But for myself, I thought… If it would make my recovery so much easier, and I want to sit to pee anyway, why not just pee out of the original urethra between my legs? I completely understand that it is some people’s top reason for seeking phalloplasty, to stand to pee. For me, it just isn’t or wasn’t ever a big draw for all the work and possible complications.

Now, if it had been easy? If it had been the wave of a magic wand? Sure. But then there was the issue of my vagina. They wanted vaginal mucosa for the hookup, and I love penetration there. I didn’t want to risk having the v no longer usable for this purpose, permanently uncomfortable, or no longer able to accommodate without arduous dilation. Very few doctors will even do UL with no vaginectomy, and even then, it isn’t guaranteed you’ll be able to use it again.

For a while, Dr. Coon and I discussed ways to do UL to the bottom of my penis, like hypospadias, an intersex pattern of development. I liked this; we also discussed a way of routing a modified UL through the natal glans (aka tdick or cli*****) using buccal mucosa. All of this was super cool to me, but then I just got so fatigued with more surgery that I asked if we could just keep it simple.

In my mind, with the divet Dr. Coon punched in it and the tattooing there on the tip of the glans, it doesn’t feel different than having a urethra that’s just not hooked up, or having two pee holes? Oddly enough the psychological effect is that I feel like my penis is “cleaner” since urine doesn’t touch it and semen doesn’t come out of it. It is only for looking congruent and pretty and giving me and others pleasure. Sort of like what dicks would be like if they had no association with semen or urine, ha.

There isn’t a way to give me UL after the fact without extraordinary effort, now, unless I revisited one of those hypospadias or meta hookup options. I accept this.

Maybe… If I were to be very vulnerable and honest, I’d say I’m a tinge sad not to have the experience of peeing out of my penis or having an orgasm and feeling the gush from the skene’s glands come out there (as it does for some guys with phallo I know)– or sharing that with a partner.

But you know, I have so much already. It’s like playing Blackjack. I had a 20. I didn’t want to risk anything else for a 21. If this is my hand, I’m 31, and I’m very pleased. When I say I’m a tinge sad, this is how sad I am: I’m a tinge sad my hair isn’t the same share it was when I was a kid. I’m a tinge sad my left arm isn’t hairy. I’m a tinge sad about how hard it seems to be for me to lose weight. Like… It’s not amazing, but really, it’s all okay, and I’m really good.

I think in the future more folks will consider if UL is a need for them, rather than a given. More people may want to know what that is like. Oh hey, did you know urethrostomy is very common in older men with prostate issues? They urinate from a similar perineal location. It doesn’t change their gender. I find myself in good company.

It’s just another opportunity to embrace my body as a unique experience. It doesn’t have to be like the average cis guy to be sexy or complete. My partner agrees. And I agree, too.

1 thought on “How I decided to skip urethral lengthening for trans phalloplasty”

  1. Thank you so much for this blog. I’m seeking exactly the same thing, I think, and it’s been tough to find others who also want the same functions (or lack thereof) out of a phalloplasty.

Leave a Reply