Phalloplasty: Meaning, Procedure, Benefits, and Risks

The transferred tissue is shaped into a penis and connected to blood vessels. Surgeons may also connect nerves to support sensation.

A person’s phalloplasty plan may include:

• constructing a penis;
• extending the urethra for possible standing urination;
• creating a scrotum;
• inserting testicular implants;
• closing the vaginal opening;
• placing an erectile implant later;
• preserving erotic sensation through nerve connections.

Not every person chooses all these procedures.

• phallo-, relating to the penis or phallus;
• -plasty, meaning surgical formation, repair, or reconstruction.

Phalloplasty may be uncountable when describing the procedure generally:

• Phalloplasty is a complex reconstructive surgery.
• The hospital provides consultations about phalloplasty.

It may be countable when referring to particular operations:

• The surgeon performs several kinds of phalloplasty.
• He underwent a staged phalloplasty.

Common expressions include:

• undergo phalloplasty;
• consider phalloplasty;
• prepare for phalloplasty;
• recover from phalloplasty;
• perform flap surgery;
• construct a neophallus;
• lengthen the urethra;
• place an erectile implant.

The surgeon shapes this tissue into a penis and transfers it to the genital area. Microsurgery may be used to connect the flap’s blood vessels to vessels at the new location.

Nerves may also be connected to support the development of touch or erotic sensation over time.

The area from which tissue is taken is called the donor site. It usually requires closure with a skin graft or another reconstructive method and leaves a scar.

Radial Forearm Flap

A radial forearm free-flap phalloplasty uses tissue from the forearm.

Possible advantages include:

• relatively thin and flexible tissue;
• suitable blood vessels and nerves;
• easier shaping of a urethra within the penis;
• potential for good sensory nerve connection.

Possible disadvantages include:

• a highly visible forearm scar;
• need for a skin graft;
• changes in sensation;
• reduced strength or movement in rare cases;
• donor-site healing complications.

Anterolateral Thigh Flap

An anterolateral thigh phalloplasty uses tissue from the outer thigh.

Possible advantages include:

• a less visible donor-site scar;
• substantial tissue for penis construction;
• preservation of the forearm.

Possible limitations include:

• tissue may be too thick for some surgical goals;
• additional thinning procedures may be needed;
• urethral reconstruction may be more difficult;
• sensation may develop differently.

Abdominal or Back Tissue

Some surgical approaches use tissue from the abdomen or back.

These methods may offer different scar locations or tissue characteristics, but they may have limitations involving sensation, urethral construction, thickness, or the need for additional stages.

The choice of donor site depends on anatomy, body composition, circulation, scars, health, personal priorities, and surgeon experience.

Penis Construction

The first stage usually creates the neophallus from donor tissue and connects its blood supply.

Urethral Lengthening

The urethra may be extended through the new penis so urine can leave near its tip. The aim is often to support standing urination.

This step may be completed during penis construction or during another stage.

Scrotoplasty

Scrotoplasty creates a scrotum, often using tissue from the outer labia.

Testicular implants may be inserted during the same operation or after the scrotum has healed.

Glansplasty

Glansplasty creates a defined head, or glans, at the end of the penis. It is often performed after the main penis has healed.

Erectile Implant

Because the transferred tissue does not normally become naturally rigid enough for penetration, an erectile device may be placed later.

The implant may be:

• an inflatable device;
• a bendable or semirigid rod.

Implants are usually delayed until healing and sensation have progressed sufficiently.

It may allow a person to urinate while standing, but successful standing urination cannot be guaranteed.

Important urinary complications include:

• urethral fistula, an unintended opening through which urine leaks;
• urethral stricture, a narrowing caused by scar tissue;
• urinary spraying;
• dribbling;
• infection;
• difficulty emptying the bladder.

Repair surgery may be needed if these problems do not resolve.

The original clitoral tissue is commonly preserved and may be positioned at or near the base of the neophallus. This can help preserve erotic sensation and orgasmic ability.

Possible outcomes include:

• protective touch sensation;
• erotic sensation;
• ability to experience orgasm;
• comfort during sexual contact;
• penetrative ability after an erectile implant.

Sensation varies, and no particular level of feeling or sexual function can be guaranteed.

An implant may therefore be used to create firmness for penetration.

Potential implant complications include:

• infection;
• mechanical failure;
• displacement;
• pain;
• erosion through tissue;
• need for removal or replacement.

An implant may improve penetrative function, but it is optional and is normally placed only after earlier surgical stages have healed.

Phalloplasty

• uses tissue transferred from another body area;
• generally creates greater length and girth;
• leaves a donor-site scar;
• commonly requires several surgical stages;
• may support penetration after an erectile implant;
• carries substantial urinary and reconstructive risks.

Metoidioplasty

• uses testosterone-enlarged clitoral tissue;
• creates a smaller penis;
• usually preserves natural erectile ability;
• generally does not require a large external donor site;
• may involve fewer or less extensive reconstructive steps;
• may not provide sufficient size for penetration.

Neither surgery is universally better. The choice depends on priorities involving size, sensation, urination, penetration, scars, recovery, risks, and available expertise.

• hysterectomy;
• removal of the ovaries or fallopian tubes;
• vaginal closure;
• other reproductive-organ procedures.

Some of these steps permanently affect fertility or the ability to carry a pregnancy.

Before irreversible procedures, a person may consider information about:

• egg freezing;
• embryo preservation;
• future pregnancy;
• genetic parenthood;
• contraception;
• reproductive-organ screening.

Phalloplasty itself does not automatically require removal of every reproductive organ, although surgical plans vary.

Laser hair removal, electrolysis, or both may be recommended. The surgical team should provide an exact treatment map because removing hair from the wrong area may be unnecessary, while leaving hair in an internal surgical area can cause complications.

Hair clearance may take many months and should be planned well before surgery.

• detailed surgical consultations;
• review of functional and appearance goals;
• physical examinations;
• donor-site assessment;
• fertility counseling;
• hair removal;
• medical testing;
• stopping nicotine;
• arranging transportation and home support;
• preparing for limited mobility;
• planning time away from work or school.

A person should understand that phalloplasty may involve repeated operations, long recovery periods, and possible revision procedures.

Recovery may involve:

• pain and swelling;
• urinary catheters;
• dressings and drains;
• limited walking or activity;
• donor-site wound care;
• restrictions on lifting;
• delayed return to work;
• repeated follow-up appointments.

Healing continues over months. Later stages are normally scheduled only after earlier surgical areas have recovered sufficiently.

• bleeding;
• infection;
• blood clots;
• wound separation;
• delayed healing;
• scarring;
• numbness;
• chronic pain;
• reduced donor-site function;
• urinary fistulas or strictures;
• implant complications;
• dissatisfaction with appearance or function;
• need for revision surgery.

A particularly serious risk is partial or complete flap loss, which occurs if the transferred tissue does not receive enough blood. This can require urgent surgery or removal of damaged tissue.

Severe pain, fever, heavy bleeding, worsening swelling, unusual color changes, inability to urinate, or foul-smelling discharge requires prompt medical attention.

• reduced genital dysphoria;
• increased gender euphoria;
• a penis with greater length and girth;
• possible standing urination;
• possible penetrative function;
• greater comfort with nudity or intimacy;
• anatomy that feels more consistent with gender identity.

Benefits vary, and a successful outcome should be measured against the individual’s goals rather than one universal standard.

• anatomy;
• gender identity;
• sexual function;
• fertility;
• surgical scars;
• urination;
• medical complications.

Others should not ask invasive questions, request photographs, disclose surgery, or discuss genital details without permission.

Knowing that someone underwent phalloplasty does not create a right to information about penis size, implants, sexual activity, or previous anatomy.

The penis becomes naturally erect after phalloplasty.
Not usually. An erectile implant may be needed for penetrative firmness.

Standing urination is guaranteed.
No. Urethral complications or functional limitations may occur.

Phalloplasty always removes the vagina or reproductive organs.
No. The combination of procedures is individualized.

Sensation appears immediately.
No. Nerve healing may take months, and outcomes vary.

Every transgender man needs phalloplasty.
No. Genital surgery is entirely optional and does not determine gender validity.

1. Phalloplasty creates a penis using tissue transferred from another body area.
2. He compared phalloplasty with metoidioplasty before choosing a procedure.
3. Does phalloplasty always include urethral lengthening?
4. Their phalloplasty was completed through several surgical stages.
5. The surgeon discussed donor-site scars before the phalloplasty.
6. Phalloplasty may allow standing urination, but urinary complications can occur.
7. An erectile implant may be placed after the phalloplasty has healed.
8. Understanding phalloplasty helps readers compare gender-affirming genital surgery options accurately.

It may reduce physical dysphoria or increase gender euphoria. However, no genital surgery is required for someone to be a man, masculine, transgender, or nonbinary.

Understanding phalloplasty helps readers discuss penis construction, donor tissue, sensation, urination, sexual function, and surgical risks without treating one anatomical outcome as necessary for gender validity.