Does a Phalloplasty Get Erect? Insights and Experiences for Transmen

For some, having a penis can be one of the best confidence boosters, especially for men. However, due to myriads of reasons ranging from medical issues to biological circumstances, some people do not have the privilege of having an erect penis. A solution in modern healthcare is phalloplasty, which allows patients to have penile implants as a gender-affirming process and as a way to solve erectile dysfunction.

In this article, we explore phalloplasty as a solution to non-erect penis, and the lack of it especially for Transmen. The risks, benefits, challenges and surgical aftercare protocols are outlined to help you get the most out of what you need to know about phalloplasty.

What is a Phalloplasty?

A phalloplasty, also called penile implant, is a medical procedure used to treat erectile dysfunction and to rejuvenate sexual function. Erectile dysfunction is diagnosed by the inability to have and maintain an erection that is erect enough to have sexual intercourse. According to medical news, men and Trans men should not worry as an estimated 30 million men of middle age and over suffer from erectile dysfunction.

Who is it for?

Men who have erectile dysfunction can benefit from the miraculous wonders of a phalloplasty. Especially for men who have tried different medications and they have failed. For trans men who want a penis, a phalloplasty can be an effective way to gender-affirm one’s self so their anatomy matches their identity. Other times, men who suffer from penile deformity diseases such as Peyronie’s disease, which is caused by scarring and migration of the penis, can have a phalloplasty. Overall, phalloplasty is not limited to a specific demographic of people.

Surgical Details

The surgical components of a phalloplasty entail two main techniques;

● The penoscrotal approach

The penoscrotal approach entails an incision beneath the penile tissue, where the three pieces of penile implants are placed. The pump is also placed using the incision through a direct approach. The penoscrotal approach is the most commonly used method.

● The infra-pubic approach

The infra-pubic approach follows an incision in the pelvic region sitting above the penis. There are no scrotal cuts; hence, the surgeon will begin the pump manipulation implant sooner. As a result, the inra-pubic approach takes less time than the peno-scrotal approach surgery.

Types of penile implants –inflatable vs. semi-rigid

● Semi-rigid implant

A semi-rigid implant comes with a pliable rod, which causes an erection at all times. Transmen who opt for the semi-rigid penile implant will direct the penis away from the crotch region to receive an erection and will bend it back to the crotch area if they want to hide the erection.

● Inflatable Implant

The inflatable penile implant comprises a prosthetic device that has a cylinder to produce a natural erection. The inflatable penile sometimes comes with 2-3 internal devices that include a pump used to pump and squeeze the fluid, which serves to create an erection while maintaining penile rigidity. The reserve part of the penile implant situated in the lower abdomen also ensures that we have enough pumping fluid that is partly responsible for erections.

After penetration, as a transman, you will let the valve inside the scrotum lose to drain the fluid back to the reservoir, which returns the penis to a flaccid state. One advantage of the inflatable penile implant over the semi-rigid penile implant is its ability to create a firmer erection.

Pre-surgery Precautions

The following precautions are given to prepare you for your phalloplasty;

● Physical exam

A physical exam will assess your health and medical history. Your organ functioning will be evaluated so your surgeon can have a level starting ground for your phalloplasty. Any medical issue with your genital areas should be shared with your healthcare provider.

● Genital hair removal

Your healthcare provider will direct you to genital hair removal, which occurs months before your surgery. The surgery is invasive, and thus, a clear working area will help surgeons move with precision during your phalloplasty. Genital hair removal also helps keep your crotch area hygienic.

● Patient Education

You will likely be counseled and educated on phalloplasty, including its benefits, risks, and aftercare. Aspects such as lifestyle choices, diet, and impact on general health will be discussed. Patient education is a way to keep you informed about what to expect during and after surgery.

● Mental health evaluation

Healthcare providers are tasked with ensuring that the patient seeking a phalloplasty is of sound mind to warrant a phalloplasty. They will also educate the patient on the impact of a phalloplasty on one’s life. Consent sheets are also signed to validate the patient’s need for a phalloplasty.

Post-surgery care

Post-surgery care after a phalloplasty will entail spending time in the hospital for at least five days. Some Trans patients stay longer if there are concerns about the success of the surgery. As a result, a patient will remain in the surgery post-care unit if they have an infection, have blood flow issues, experience bleeding and have difficulty eating due to pain or nausea.

Pain management

You will be provided with the following medications following your surgery;
● Pain medications such as aspirin to mitigate the pain
● Stool softeners
● Medications to mitigate nausea
● Antibiotics to mitigate infection

Urination with a Catheter

A patient will be given a suprapubic catheter, often placed in the penis will allow the patient to drain urine to the bladder after the first few weeks of the surgery. This is specially managed by the urology department of the hospital that you visit. A red catheter is always provided to help keep the new urethra in place. This is removed before your discharge from the hospital.

Penis, Scrotum and Skincare

The following tissue aftercare procedures will help with your healing after a phalloplasty
a. Keep penile incisions dry and sterile
b. Keep the penis in a high position and support it at all times. Bending the penis or sitting on it is not allowed.
c. Watch out for penis discolourations, temperature changes, swelling or drainage.
d. Avoid lifting heavy weights or strenuous physical activities

Erectile Functionality

How phalloplasty achieves an erection

A phalloplasty will give you an erection as a trans man as it pumps saline fluid into a reservoir. The result is an average-looking erection that can be used for sexual intercourse. You can use the semi-rigid phalloplasty any time of the day to achieve erection. For men who suffer from erectile dysfunction a phalloplasty will provide you with an erect penis which will improve your sexual experience with your partner.

Success rates and patient satisfaction

As a transman, it is safe to know that penile implants can restore sexual performance. Yale Urology department cites this success rate for men who choose to have a penile implant, especially if other interventions have previously failed. Additionally, for trans men who go for penile implants, the success rate is at 95%, as it allows the user to engage in sexual activity at any time. Hence, phalloplasty is a safe and worthwhile procedure for trans men who want to gender reaffirm themselves.

Challenges and considerations

As with any other medical surgery, there are challenges with penile implant procedures.

Challenges

● Mechanical failure

For trans men who opt for inflatable prostheses, sometimes they may stop inflating, causing mechanical dysfunction. Although medical experts have cited that this is not dangerous, revision surgery can be time-consuming. On the bright side, mechanical failure occurs mainly after the surgery and can be corrected by removing the penile implant and replacing it with another. For instance, data shows that.

● Risk of Infection

Although a rare occurrence, medical cases of infections have been recorded. Infections always occur within six weeks, and antibiotics alone do not mitigate the problem; hence, the patient must undergo another revision surgery where the implant is removed. The infections, which can range from mild to moderate, require the penile implant to be removed and sterilized.

● Incorrect implant size

Other times, implant size significantly affects how well-successful a penile implant occurs. When the implant is too short, one is likely to experience a head-hang on the penis. If the implant is too long, it will erode nearby penile tissue. Even so, incorrect sizing can be corrected even though it is a rare occurrence.

● Reservoir movement

In some cases, the reservoirs holding the saline water in an inflatable penis can migrate to other parts. This makes it hard to achieve the correct erection. If this occurs, surgery to relocate the pouch to the proper location is needed.

Considerations

● Age

Age is not a factor for anyone who wants to have a phalloplasty. However, for Transmen who are below 21 years of age, getting guidance from caregivers and healthcare professionals can be an excellent way to start.

● Lifestyle factors

As a transman, a phalloplasty is not the only thing you need to keep your reproductive prowess in that state. Consider healthy lifestyle factors such as diet, hydration and good mental health to ensure you have a good time with your phalloplasty.

● Type of implant

Be it the semi-rigid or the prosthesis, consider which type of implant works well with your financial budget and overall life.

Testimonials from Trans men

Here are a few testimonials from people who have successfully had a phalloplasty;
If we are going to appreciate phalloplasty testimonials, it is prudent to mention Lurence Michael Dillon from England (1960) who is heralded as the first transgender man to undergo phalloplasty. Dillon, who was a doctor and author, was among the first users of masculinizing hormone replacement therapy before having a successful phalloplasty in 1946.

One ancient testimonial dates back to the 1980’s in which one transman had unsuccessfully tried to have a functional penile implant through surgeries. In this instance, the healthcare practitioners gave him a device like the Elator which helped him gain a functional penile tissue which was vital in helping him boost his self-esteem and his sexual prowess.

Phalloplasty has been successful as it has led to the rise of many successful phalloplasty procedures. For instance, the Erektor device has also provided successful penile implants to transman who asserted that this device helped him engage in sexual intercourse with limited surgeries.

Advice for those considering phalloplasty

● Go for consultation

Consultations are important parts of your phalloplasty and consequently, you are likely to meet one or more plastic surgery doctors who will train and inform you on the best experience. Your concerns such as your gender identity, hormone therapy, mental and primary care will also be evaluated.

● Diet Changes

You are advised to partake in diet changes in the month up to your surgery. One is constantly advised to take enough protein to help in healing. Nutritionists advise patients to take albumin protein which is important for overall health healing. Multivitamins are also added to the diet to help fasten healing.

● Laboratory tests

It is integral that one takes laboratory tests which include complete blood count (CBC) tests to check on your blood level and components. A comprehensive metabolic panel test (CMP) and screening is also advised.

● Type of surgery

Always consider the type of surgery before you have your phalloplasty. Your preferences will decide which kind of bottom surgery to have based on your financial situation and the type of phalloplasty you want.

Conclusion

Phalloplasty is one of the many ways a trans man can gender-affirm themselves. For cis men who have erectile dysfunction, consider phalloplasty as a solution to rejuvenate one’s sex life and overall life experience. Phalloplasty is not devoid of risks and challenges, such as the risk of infection and poorly performed surgery. Hence, checking in with one’s medical provider is crucial to see if symptoms such as penile discolouration, swelling, or infection suffice. Always seek professional health before and after surgical procedures involving phalloplasty.