Phalloplasty: Long-Term Care

Phalloplasty is a very complex surgery and is often done in multiple stages, depending on treatment aims. Given the scope and scale of this work, complete recovery is a long and extensive process that can take anywhere from 12 to 18 months.

Many changes occur during this time, and successful outcomes may require significant lifestyle and health adjustments. If you’re considering phalloplasty, it’s absolutely essential to understand what’s involved in long-term care after the procedure.

Benefits of Surgery

Primarily, phalloplasty allows transgender men and transmasculine people to affirm their identity and helps them effectively cope with gender dysphoria, in which a person does not identify with their assigned sex at birth.

This psychological condition can cause significant distress; however, it’s not considered a disorder, per se.

The long-term success of this procedure, then, relies on care and attention to both mental and physical health. What should you keep in mind? Here are some quick tips:      

Maintain Follow-Up Appointments

Following the initial recovery from phalloplasty, which is usually six weeks, you’ll need to keep up with subsequent medical appointments. It may take the penis, itself, six to 18 months to return to baseline, and there’s also the graft site on either the forearm, inner thigh, or side of the back to consider.

After initial follow-up appointments, you’ll need to come back in for regular appointments (or schedule them with your primary care physician), every three to six months to check up on progress.

Keep up With Physical Therapy

Essential to the process of recovery from this surgery will be physical therapy, which typically starts three weeks after the procedure.

Patients with skin grafts on the forearm and inner thigh will require sessions to restore strength and mobility to these areas. For those with the former, regular therapy sessions are necessary for two to three months, with work on the inner thigh sometimes taking longer.

Consider Mental Health Counseling

Given the many changes occurring in the body, not to mention a prior history of gender dysphoria, stigmatization, or other issues, mental health can be affected by this surgery.

Throughout the process of gender affirmation, psychological assessment and counseling are necessary steps. Some of this work occurs with your healthcare provider in the hospital; however, if issues move outside of their scope, you may be referred to clinicians specialized in gender affirmation cases. 

While the road to complete recovery may be lengthy, it’s important to remember that you’re not alone. Keep an eye on how you’re feeling both physically and mentally during this time, and don’t hesitate to reach out for help.

Possible Future Surgeries

As mentioned, phalloplasty is best understood not as a singular surgery, but as an individualized set of procedures that vary based on treatment goals. Depending on what you want your penis to be able to do, this treatment may need to be broken into multiple stages.

Alongside the primary surgery that forms the penis, there are a number of additional procedures that may be considered, including:

• Scrotoplasty: As with the penis itself, grafted donor skin is used to form a scrotum.
• Testicular implant: Prosthetic testicles, usually saline-filled sacs, can be implanted towards the end stages of healing following scrotoplasty.
• Urethral lengthening: Also known as “perineal urethroplasty,” this surgery allows healthcare providers to create a functioning urethra for the penis, allowing you to stand up to urinate.
• Perineoplasty: This procedure seeks to correct scarring and deformity in an around the anus and vagina.
• Hysterectomy and oophorectomy: These procedures involve removing the uterus and ovaries.
• Vaginectomy: Removing the vagina may also be considered alongside phalloplasty.
• Glansplasty: This optional procedure involves surgically forming a head for the penis.
• Erectile device insertion: A special prosthetic device that allows the penis to become erect can be implanted.

The healthcare provider will need to ensure that the original procedure has succeeded before considering these sub-surgeries.

Patients may also opt for other plastic surgeries alongside phalloplasty and hormone therapies to aid in gender affirmation; these can significantly alter physical appearance. These include:

• Chest masculinization: Also known as “top surgery,” this procedure removes breasts and reshapes the chest to make it look more masculine.
• Forehead lengthening: A special procedure can be used to raise the hairline.
• Cheek augmentation: This involves using a number of procedures to change the shape of the cheeks.
• Facial reshaping: A number of procedures can alter the shape of the jaw, nose, or chin.
• Adam’s apple enhancement: Some transgender men or transmasculine people may opt to have their Adam’s apple enlarged.

During consultation for your phalloplasty, you’ll get a sense of what your options are and can assess them based on your treatment goals.

Lifestyle Adjustments

As with any major surgery, ensuring the long-term success of phalloplasty may require making some significant changes in lifestyle. Many of these need to start happening prior to surgery and continued afterward.

Before starting up or restarting an activity, make sure to get your healthcare provider’s approval. What should you keep in mind? Here’s a quick breakdown.

Physical Activity

As directed, you’ll want to avoid lifting objects heavier than 20 pounds (or 5 pounds with your arm that had a skin graft), bending excessively, sitting on the penis, or strenuous physical activity for the first six weeks after surgery.

In the early going, patients should try to take 10-minute walks four times a day. Once cleared for moderate activity, it’s beneficial to get regular exercise as this promotes better rehabilitation and overall health.

Sexual Activity

Generally speaking, you’ll need to refrain from sexual activity for at least six weeks following surgery. As with most other activities, make sure your surgeon says it’s OK before engaging in any kind of sex with the penis.

Depending on the specific techniques used to perform the phalloplasty, it may take six to 18 months before you feel sexual sensation in the region. Take it slow and stop any activity that is causing pain.

Smoking

As a matter of course, you’ll need to be off of tobacco products for at least one month prior to surgery as well as for at least one month afterward. Given the numerous ways that smoking is harmful to health, you’re of course best off quitting entirely.

Diet

Aside from the period you spend in the hospital, there are not many dietary restrictions associated with phalloplasty. However, to ensure the best outcome, you may be asked to boost vitamin and protein intake, with the latter being particularly important as your body heals and strengthens.

As you recover, and in general, you should also ensure that you’re drinking enough water, and avoiding excessive alcohol use.

A Word From Verywell

There’s no doubt that phalloplasty, especially as part of the gender affirmation process, is major and transformative surgery. And while the scale of the changes following this procedure is significant, it’s important to note that, largely, patients view this work as essential and are satisfied with results.

Adjusting to life following initial recovery from surgery is no small task; it requires care on the part of the patient as well as significant medical oversight. If you’re considering this procedure, know that you aren’t alone; alongside family, friends, and medical staff, there’s a community of those who’ve undergone this procedure.

If you’d like to learn more about this procedure or are seeking support during this process, organizations like the National Center for Trans Equality and the Trans Lifeline can help.