It is well-known that tactile sensation after phalloplasty is diminished, while erogenous sensation is altered due to embedding of the clitoris.
A person who undergoes a metoidioplasty may have erections and enjoy more sensation in their neopenis. However, the penis will be relatively small in size. A neopenis that results from a phalloplasty is usually larger, though it may be less sensitive. To have erections, a person will need a penile implant.
So, these phalluses tend to be a maximum 5.5 inches long (that's the average length of a phallus in North America). If you choose an ALT (leg) phalloplasty, there's more skin and a longer artery, so a longer phallus can be constructed, up to 8.5 inches. 3. Decide what other surgeries you want: Vaginectomy?
Sensation following anterolateral thigh (ALT) phalloplasty is traditionally viewed as inferior to sensation following radial forearm phalloplasty, potentially due to fewer nerve coaptations performed. Neural anatomy of the ALT is well described, with branches of the femoral nerve innervating the medial flap.
Radial Forearm Flap (RFF) Phalloplasty is the most common type of Phalloplasty. The donor site is thin and supple allowing the flap to be easily tubed and shaped into a phallus, and the relatively hairless skin provides erogenous sensation and often allows urethral reconstruction in a single stage.
Burning/pain with urination (dysuria) when you first start urinating is common and may last a few days to a few months. As long as it's not associated with a weak urinary stream, cloudy urine, and odorous urine, then it is normal.
Phalloplasty is a complex surgery associated with a 51% urethral complication rate, decreasing to 24% even in the most experienced hands.
It is ideal to be on masculinizing hormone therapy (testosterone) for 12 months prior to this procedure. It is ideal to have your body mass index (BMI) less than 40 prior to surgery in order to reduce your risk of additional wound and post op operative complications.
Potential Benefits of Phalloplasty
Patients are more likely to be able to sexually penetrate their partners, although erectile rods are needed to achieve an erection. The phallus is significantly larger than those created through metoidioplasty, although the drawback is the lack of erogenous sensation.
As a whole, less than 5% of transgender men have had procedures to create a phallus (8,32). One survey distinguished between the surgical options, reporting that 3% of transgender men have had phalloplasty and 19% want it in the future, while 2% have had metoidioplasty and 25% want it in the future (7).
In my experience, the average age range for Penile Enlargement Surgery (PES) is from early 20's to 70 years old. Although extremes at each end are not rare. For instance, a person must be 18 years old to give legal consent needed unless one is legally an “Emancipated Minor”.
How much sensation can I expect after MTF surgery? It is possible to experience both feeling and sexual arousal after MTF bottom surgery. When the penile core and fascia are removed, the sensory arousal nerves may be placed in the neoclitoris and clitoral hood.
In general, you can expect total costs of $6,400 to $24,900 for FTM bottom surgery and around $25,000 for MTF bottom surgery (Leis, 2022-a; Leis, 2022-b).
The anterolateral thigh (ALT) flap is a viable and reliable option for phalloplasty. The primary advantages of the ALT flap remain an inconspicuous donor site and flexibility in phallus length.
Phalloplasty Risks
In general, risks include infection, pain, excessive bleeding, and tissue damage.
Your donor site will be covered with a skin graft from your thigh, which will heal on its own. At Boston Children's, this procedure usually takes place during a single, long surgery, which can last between eight and 12 hours.
Metoidioplasty has a lower risk of complications than phalloplasty. Risks include leaking or narrowing of the urethra, and persistent pain or sensitivity.
Metoidioplasty, or “meta” for short, is a good option for those who do not want to undergo Phalloplasty. The average length of a phallus after metoidioplasty is about 4-6 cm. This is long enough to direct a stream while standing.
With most grueling portions of the recovery being the first 2 months, when patients are not allowed to sit for at least 4-6 weeks. Patients are advised to engage in lots of walking. With vaginoplasty alone, you are welcome to lay on your back and sides.
Many people dealing with dysphoria describe it as “being trapped in the wrong body” and in many cases, their feelings are ignored and suppressed. Unfortunately, not facing dysphoria very often causes anxiety, depression, and even suicidal tendencies.
Typical depth is 15 cm (6 inches), with a range of 12-16cm (5-6.5 inches); in comparison, typical vaginal depth in non-transgender females is between 9-12cm (3.5 to 5 inches).
The possible risks of transfeminine bottom surgery include, but are not limited to, bleeding, infection, poor healing of incisions, hematoma, nerve injury, stenosis of the vagina, inadequate depth of the vagina, injury to the urinary tract, abnormal connections between the urethra and the skin, painful intercourse and ...
Despite significant complications as described above, overall satisfaction rates reached 88% [3], remarkably comparable to non-phalloplasty males undergoing PP. Phalloplasty patients have been able to engage in penetrative intercourse in 51–77% of cases [3, 12].