Thinking About Phalloplasty? Here is One of the Major Complications to Consider!
If you are planning on undergoing phalloplasty, you most likely have heard that it is one of the most complicated gender-affirming procedures on the menu.
That’s because it’s easier to resect tissue than to add to it. And since in phalloplasty, a neophallus is constructed, it is considered a much more complex surgical procedure.
If you think about it, phalloplasty is a relatively recent procedure. The first penile reconstruction was performed in 1936. Only 74 years ago!
According to the research by Hage et al. (1993), to achieve the ideal phalloplasty, one should aim for the following:
A one-stage procedure that can be predictably reproduced.
Creation of a successful neourethra to allow for voiding urine while standing.
Achieve tactile and erogenous sensibility.
Create enough bulk to tolerate the insertion of a prosthetic device facilitating sexual intercourse.
An aesthetically pleasing phallus.
Minimal morbidity.
No functional loss.
Minimal scarring in the donor area.
This is quite a criteria list to fulfill, as each of the above carries potential complications.
And while doctors are getting more skilled at performing phalloplasty procedures, the rate of complications is still high.
This isn’t to steer you away from a much-desired gender-affirming surgery! But to share information that will help you decide if phalloplasty is for you.
If you are trying to choose between phalloplasty or metoidioplasty, you will find this blog post helpful: 7 Benefits of Metoidioplasty in Trans Men!
Given that functionality during sexual intercourse appears to be one of the major goals to achieve for trans men, let’s consider one of the major complications in this area which falls into two categories:
#1 INFECTION
If you are planning on having sexual intercourse or desire rigidity in your phallus, you will need the implantation of an erectile device.
Infection is one of the biggest complications when implanting an erectile device.
That’s because there is an important difference between biological males needing an erectile device and trans men.
In cisgender men, the prosthesis is implanted in the corporal bodies.
The corporal body serves as extra protection against protrusion.
Additionally, it preserves some blood flow, enhancing the effect of the local antibiotics.
In trans men, the prosthesis is implanted in fatty tissue.
This fatty tissue has a low blood supply and lacks corporal bodies needed for protection.
Resulting in an increase in infection.
And while the infection rate has been reduced to around 1% (Carson et al. 2011) in cisgender males, the percentage in trans men is still high.
#2 LIMITED SURVIVAL TIME
In general, in trans men, inflatable devices fail more often than in biological males.
Leading to a limited survival time for the prosthetic device.
This happens for various reasons:
Most cisgender men who undergo implantation of penile devices do so due to erectile dysfunction.
In general, they tend to be older individuals who experience lower sexual libido.
Resulting in reduced frequency of using their implant.
Whereas trans men are younger, on testosterone, and generally have high sexual libido.
Resulting in much more frequent prosthesis use.
Additionally, trans men tend to use prosthetic devices longer due to their younger age.
The risk of implant failure varies on numerous factors, including your age, overall health, the outcome of the surgery, and which implant you decided to go with.
Currently, there is a variety of penile implants available for trans men to choose from. Ranging from non-inflatable, semi-rigid, and 2 or 3-piece inflatable devices.
And if you are curious about the pros and cons of each implant, check out The Ultimate Guide to Penile Implants for Trans Men.
If you are considering phalloplasty, understanding potential complication risks is paramount.
Not only will it help you make the best decision, but it will help you have realistic exceptions of what to expect.
It is important to carefully search for a skilled surgeon trained in phalloplasty procedures. And if you need help, the following resources could be of help to you:
WATCH THE TOP 5 VIDEOS ON GENDER DYSPHORIA
REFERENCES & SOURCES
Carson, C.C., 3rd, Mulcahy, J.J., & Harsch, M.R. (2011). Long-term Infection Outcomes After Original Antibiotic Impregnated Inflatable Penile Prosthesis Implants: Up to 7.7 Years of Followup. Journal of Urology. 185(2): 614-618.
Hage, J. J., Bouman, F. G., de Graaf, F. H., & Bloem, J. J. (1993). Construction of the Neophallus in Female-to-Male Transsexuals: The Amsterdam Experience. Journal of Urology. V6: 1463-1468.
