Recent questions I’ve received about life after transgender phalloplasty! For nonbinary & trans masculine people, I do have the pinned post at the top with Frequently Asked Questions. But I can also answer questions as I get them!
1) Were you able to naturally get erections? Or was a penis pump or other device needed?
I can get natural erections in my natal erectile tissue, which some people call a clitoris. I still have that tissue. Most people still have this tissue after phalloplasty; it is more of a question where the tissue went. Mine is still in its natal place.
My penis which I got through phalloplasty– I had to have an erectile implant. Pills like Viagra don’t work for us, and neither would pumps. You need a corpus spongiosum capable of engorging through the length of the penis for that to work. My implant is a three-piece hydraulic pump called the Coloplast Titan. Haha at that name. When I squeeze my left testicle, it transfers the fluid from a chamber in my belly. The fluid flows to a prosthetic corpus cylinder in my penis. Some people get two cyclinders but I fit a single one of the largest which Coloplast makes. The erection is very firm, like a stallion of an 18-year-old, haha. It goes away when I [press a button on the prosthetic vas deferens. I’ve been happy with it; it works very well. Most of my cis male friends have expressed jealousy over the control I have over my erection. I can’t have one involuntarily, and I can keep it up as long as I want, as often as I want.
2) Could the penis and balls feel touch? If so, was it more numb, or could you actually feel as if it were a part of your body, like your hands?
It took a while for sensation to come back. It was a gradual process. At three months out, I started to worry if I had a successful nerve hookup. No, really, all was well. Sensation started at the base and crept upward as the nerves re-colonized the graft. I want to say by 6 months post op I had vague sensation at most parts of my penis and scrotum, but by 9 months out it was base to tip. In the last three years, it has only gotten gradually more intense, sometimes going a few months with no change until I realize something is more… It is difficult to describe… One day I notice my flesh has become more acutely sensate?
I don’t think my penis will ever be as sensitive as a clitoris, because… Most organs we typically describe “penis” just don’t have the same nerve density; that is to be expected. But sensation is good.
3) Does the penis ejaculate? If not, what would happen?
I elected not to have urethral lengthening into my penis from phalloplasty, so when I develop pre-cum or “wet” stuff, it comes out my original urethra. When I have an orgasm, I sometimes am aware of a small gush down in my perineum area where the vagina/urethral opening is. It’s not a ton, so I think if I had gotten urethral lengthening it would not be much of an impressive issue. I mean issue in the most medieval sense, haha. Your mileage may vary! Some people do get quite a significant event through their penis, after phalloplasty. Sounds like fun!
4) As for urination, does this continue to come through the vagina? I went and read through again, searching up what urethral lengthening was, and realize that this is probably a yes, but I just want to make 100% sure.
Well… Urine doesn’t come out of vaginas. I bet you know that and are just speaking colloquially. Typically, the urethra exits just north of the vaginal opening, before surgery.
Whether you have urine routed up through the penis built by phalloplasty, this is a choice you get to make. Few surgeons are willing to perform urethral lengthening into the penis if keeping the vagina. The reason is a matter of spacing and high risk of complications. It is rare, but I know one or maybe two people who have been successful having UL with no vaginectomy. It was a long road to recovery.
When faced with the decision, standing to pee is not a huge priority to me. If this were a wedding, it would go on my ‘would be nice if convenient’ list, but since it would have extended my treatment plan beyond the years of work I already put into it, I decided I would be happy keeping “the V”. It’s been great.
5) How (approximately) expensive would this procedure be?
Oof [a ‘yikes’ sort of sound]. It can vary widely– but then again, the procedures can vary quite a bit in terms of what the surgeons are offering. I’m not sure this space can contain the answer to that one. I do not recommend trying to pay cash for it. It will always be less to buy insurance or use a National Health system. It also depends on what country you live in. I know some people who have paid nothing, or like $15 due to their health coverage. I know others who have paid $100k cash.
6) Is there a way to use other skin aside from the labia majora?
The labia majora is used to construct the scrotum, because it is the same kind of skin. My penis was built from a donation of forearm tissue, arteries, veins, and nerves, linked to pelvic nerves and circulation. I have varieties of implanted prosthetic and functional parts inside, wrapped in cadaverous donor tissue from someone else [AlloDerm]. Other common donor sites are the thigh, abdomen, and the back/flank. Each donor site has advantages and potential drawbacks.
7) This is probably a dumb question but, do all surgeons do this type of surgery (as pictured in the photo)? and how should I go about finding a good surgeon?
No, surgeons offering trans phalloplasty are seldom offering the same range of procedures. You will find some surgeons will only use certain donor sites. That goes along with the pros and cons of that donor site. Some surgeons do not offer nerve hook-up; this was important to me. This requires advanced microsurgery. Some surgeons will not allow any customizations whatsoever: they may have only one way of performing this procedure and are very uncomfortable with any modifications to the surgical plan. Some surgeons have a rigid timeline, and others will allow you to adjust for the risk acceptable to you.
The site healthytrans.com has a great list of questions to ask the surgeon to find out how they might be able to meet your needs.
8) Do you have any other sources of information regarding this type surgery (keeping vagina but adding a penis)?
Actually, I don’t! So much of this has been learned in direct conversations with surgeons and years of conversations with people who have shared our experiences and options. If we didn’t have trans stresses on our lives, we would probably each write a book. Maybe one day– but for now, the best places to get information seem to be at our conferences where people share their experiences, groups/forums supporting trans surgery, and blogs. Some people seem to be open on social media, but this is a rare one to be on public since it attracts creeps like flies to honey!
9) Where is this type of surgery offered?
Trans phalloplasty generally? What country are we talking… Callen-Lorde compiled a wonderful list of surgeons in the US and what they offer, if that is what you mean. There is a great list on Healthytrans as well. However, these things are always changing, and the listings are usually incomplete. For example, my surgeon Devin O’Brien-Coon does lots of craniofacial reconstruction (FFS, “facial feminization surgery” / facial gender confirming surgery / facial gender affirming surgery / facial masculinization), but I have not yet seen him on lists for facial surgery. Academic research hospitals like Johns Hopkins or NYU are least likely to take out ads in paid lists like phallo.net, but these are the kinds of surgeons I was looking for.
10) Do some of the above questions vary per person alike to bottom surgery (where the vagina is turned into a penis) such as, some people may not feel their penis, and need a penis pump, or cannot ejaculate, etc. etc.
Ok, let’s backtrack a friendly second. They don’t turn a vagina into a penis 🙂 Maybe the urethral hookup to the penis is made with a strip of vaginal lining, borrowed, but… Largely this ol’ friend is a bystander (or eviction) alongside the new neighbor. Ha.
Regarding sensation, the surgical technique used sets the initial parameters for what you would expect. If there is burial of the natal tissues (clitoral) within the new penis, you could expect that sensation to remain there. It is extremely rare to lose sensation in the parts you already have, even when transposed to a new location. If they are left in their natal position, you could expect them to feel the same way they ever did. Different donor sites offer different possibilities for the number of nerves they can graft into the pelvic nerve and genital nerve. Some donor sites offer 2-3 nerve hookups; some offer none. (My donor site was forearm, which offers 2-3 nerve hookups, depending on the person.)
Now, related to the erection, there are many different kinds of implants a person could receive to be able to achieve erection: semi-rigid rod implants like the AMS Spectra or Coloplast Genesis, 2-piece hydraulic, and 3-piece hydraulic like I have. There are probably new technologies on the way. Or, one might not be interested in erection like that, especially if someone is asexual [not planning to engage in sex in a typical way]. I’ve heard some aces and bottoms [penetration receivers]– some, not all– who felt less compelled to pursue erectile ability. Some people prefer an external device to support rigidity rather than another surgery. But… We do know it will not become firm spontaneously prior to those options. As for myself, I didn’t think I would be topping with it much [penetrating someone else], but I’ve been pleased to have the option available.
This was fun to answer! Hope it helps.