Phalloplasty

Phalloplasty builds a penis with a masculine appearance using the patient's own tissues, allows sensation to touch and, when the urethra is extended to the glans (the tip of the penis), the ability to urinate standing up. Building the penis and taking the skin cause lasting anatomical changes and permanent scars: phalloplasty should not be considered easily reversible.

Before phalloplasty, Dr Manon Belhoste and the anaesthetist give instructions on fasting, treatments and preparation, which must be followed. Strictly stopping smoking and nicotine is required: they impair circulation in small blood vessels and increase the risk of poor healing, blood clots and necrosis, which matters particularly in microsurgery. When the urinary canal is built into the flap (a piece of skin moved with its blood supply), permanent laser or electrolysis hair removal of the area concerned may be requested. The donor site and its circulation are assessed before the procedure, and the chosen site may need to change if anatomical or vascular conditions are unsatisfactory.

After phalloplasty, the colour, temperature and circulation of the reconstructed penis are closely monitored in the first few days, along with the drains and urinary catheters. The protocol includes about five days of bed rest, before movements are gradually resumed. Catheter care, dressings and intimate hygiene follow the instructions given by the team. Physiotherapy and occupational therapy for the arm may start before discharge, then continue at home to improve mobility, the graft and strength.

A penile prosthesis is needed to achieve the mechanical rigidity that allows penetration. The penile prosthesis is a later operation, with its own risks.

When the plan includes the ability to urinate standing up, the urethra can be extended to the tip of the reconstructed penis. Phalloplasty without full urethral lengthening remains an option. The junctions between the urethral segments are particularly exposed to urine leak through an abnormal opening (fistula) and to narrowing (stenosis).

Phalloplasty can be done in a single operation. Sometimes, for organisational reasons or at the patient's request, it is done in several stages (urethral lengthening and removal of the vagina in the 1st stage, construction of the phallus in the 2nd stage). Testicular implants and penile implants always need separate operations, some time after the phallus is built and once healing is well advanced.