Phalloplasty: Surgery and After Care

Phalloplasty is a gender-affirming surgery that creates a penis and scrotum. Read on to learn more about this procedure and the recovery.

Getting ready for your surgery

There are certain things you may need to do before having a phalloplasty. Some need to happen many months in advance.

• Your surgeon will likely require you to have surgery to remove the uterus (hysterectomy) and the ovaries (oophorectomy). This will be done several months before phalloplasty. Talk with your surgeon about whether you need to have surgery to remove your vagina (vaginectomy).

• Talk with your surgeon about any fertility-preserving procedures you want to do before having the above surgeries. These may include freezing (cryopreservation) of ovarian tissue, eggs, or embryos.

• You will need to take testosterone for 12 months before phalloplasty. Talk with the healthcare provider who prescribes your hormones.

• You will need to have hair permanently removed from the donor skin site a few months before your surgery. Your surgeon will advise you on this.

In addition, before your surgery:

• Stop smoking or using any tobacco products, including vaping products.

• You may need to have certain tests done, such as blood tests. Your surgeon will advise you on this.

• Tell your healthcare provider about any medicines you are taking. This includes prescription and over-the-counter medicines, vitamins, herbs, and other supplements. You may need to stop taking some or all of these before the surgery.

• Follow any directions you are given for not eating or drinking before the procedure.

• Follow any directions you are given for bowel prep to clean out your bowels before the procedure.

• Your surgical team may advise you to wash your body using chlorhexidine gluconate (CHG) skin cleanser. This is a cleanser that helps reduce your risk for a surgical site infection.

• Read any consent form carefully. This is a form that gives your permission to do the procedure. Ask questions before you sign it if something is not clear.

• Follow all other directions from your healthcare provider before surgery.

How is phalloplasty done?

Phalloplasty is done in 3 stages over a period of time. You may choose to do 1, 2, or all 3 stages. This is a personal choice.

The procedure is often done using tissue taken from the forearm of your nondominant arm (called the radial forearm flap method or RFF). But tissue from your leg or belly may be used instead. Your surgeon will work with you to find the best option for you.

The exact procedures done in stage 1 and stage 2 will vary depending on your surgeon. In general, here is what you can expect during a phalloplasty using skin from your forearm.

Stage 1. Creating the penis and new urethra

Recovery time: About 3 to 4 months

• A skin flap (including skin, vein, artery, and nerves) is taken from the forearm to create the penis. The skin flap will start at the wrist and go midway up your forearm.

• You will need a skin graft to cover the donor skin site on your arm. This may be done during the stage 1 surgery. Or it may be done a few weeks later. A thinner layer of skin will be taken from the side of your thigh. This is grafted onto your forearm.

• A new section of the urethra is made. This is done using tissue from the labia minora and the vaginal cavity. The new urethra is placed inside the penis.

• The penis is connected to the groin area.

Stage 2. Connecting the urethra, creating the glans, scrotoplasty

This is done about 6 months after stage 1.

Recovery time: About 3 to 4 weeks

• The new urethra that was created inside the penis is connected to the biological urethra. To do this, a tube is made between the 2 urethral openings.

• The head of the penis (glans) is created.

• The vaginal cavity is closed.

• The scrotum is made using the skin of the labia majora (called scrotoplasty).

• The clitoris is tucked away under the bottom of the new penis.

Stage 3: Inserting implants into the penis and testicles

This is done about 1 year after stage 2.

Recovery time: About 3 weeks

• An implant is inserted into the penis. This may be an inflatable implant or a semi-rigid one. This will allow you to have an erection and to have penetrative sex.

• Implants will also be placed inside the testicles to give them shape.

Risks of phalloplasty

As with any surgery, phalloplasty has some risks. These include:

• Bleeding

• Infection

• Risks from anesthesia

• Nerve damage

Particular risks of this surgery include:

• Skin graft failure

• Narrowing of the urethra (urethral stricture)

• The urethra may open to the skin, leaking urine (called a urethral fistula)

• Need for additional surgeries if there are complications

When to call your healthcare provider

Call your healthcare provider right away if you have any of these:

• Fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

• Chills

• More swelling in the penis

• Fluid leaking from your incision

• New or increased redness, swelling, or pain at the incision site

• Your incision opens

• Nausea or vomiting

• Bad-smelling discharge that is yellow or green

• Urine smells and is cloudy

• Pain that's not controlled or is getting worse

• Lasting diarrhea

• Long-lasting fatigue