The penis is an external male sex organ which is a tubular structure protruding out of the body just above the scrotum.  Needless to say it is most characteristic sex organ in a male. So women who are transitioning to male not surprisingly prefer a construction of the penis on them. This helps them converting their identity completely as a man and also helps them achieve satisfaction through sexual activity.

Phalloplasty or metaidioplasty is the creation of a new penis or the artificial modification of the penis.

Special preparation for phalloplasty:

If you are having phalloplasty, there are two issues that need to be dealt with much in advance of your surgery.

1. Removal of hair on graft sites:

You should discuss with your surgeon whether or not you need to have electrolysis to remove hair on any of the donor sites. Electrolysis is optional for the skin that will be used to form the shaft of the penis, but compulsory for skin that will be used to lengthen your urethra (as hairs can result in infections and urinary tract stones).

Some surgeons suggest to complete electrolysis at least 3 months before phalloplasty for better preparation and focus on the surgery.

2. Quitting smoking

Regular smoking affects duration of wound healing, skin quality, and other aspects of healing after surgery, so surgeons strongly encourage their patients to quit smoking in advance of surgery.

You will not be restricted for phalloplasty if you are a regular smoker or if your surgeon thinks you are unstable or a smoke addict and are likely to start smoking soon after surgery, because the likelihood of the tissues of the new penis wearing out or dying is much higher if you smoke. Therefore quitting smoking for a minimum of 6 months is mandatory for phalloplasty.

Pre surgery Events:

• You will most likely be admitted to hospital the day before your surgery for preliminary tests and observation.
• There will be blood tests, and you will likely to do ECG to measure your heart function; if they suspect your lungs are unhealthy you may have a chest X-ray.
• You will also have a “bowel prep” to clean out your intestines of faeces and urine.
• You will be prevented from eating or drinking after midnight the night before you have surgery. The abdominal or pubic region and the donor region area will be shaved.
• After your surgery, you will be monitored regularly by the surgeon and the nurses as you come out of the anaesthetic.
• You will also be given medication to prevent excess bleeding and blood clots for the first five days.
• If you are having urethral extension done (required as part of phalloplasty, optional with metaidoioplasty), a tube will be placed to extract urine from your bladder out through your lower abdomen.
• This tube is generally removed in the first week.

PROCEDURE:

A donor skin source is located. Usually the forearm is considered as donor skin source.

A flap of skin or blood vessels or nerves is removed from the forearm and rolled into a ‘tube within a tube’ like structure.

Then the new penis is attached to the groin on top of the clitoris through microsurgery.

Further surgery on the ed part is done to make it look like the penis head.

Six months later tattooing of the head can be done to create a visible partition between the head and the shaft.

Then a skin graft is taken from another part of the body, usually from the thigh and is used to cover the graft area of the forearm or the donor skin source.

Post surgery Events:

• Generally people start to feel more physically normal during the second week after surgery, but it can take a longer time to fully heal, and there can be pain and soreness or numbness for a long time in the parts that were operated on.
• After phalloplasty you will have to follow up with the plastic surgeon and urologist frequently in the first couple weeks after surgery, and periodically after that.
• The surgeon will then check your new penis for healing, blood flow, and ability to urinate and ability to erect.
• Your donor forearm will also be checked for healing and for normal functioning and sensation.
• The skin graft donor site will be covered with a sheet of special gauze which becomes absorbed into the scab of the wound.. It may be gradually cut or trimmed away as it lifts up from its corners over the following weeks.
• You can slowly become more active as you recover and can go back to your normal routine when you feel well enough to do so. This usually 6–8 weeks but every case is different and it may take longer too.
• You should avoid any strenuous activity till you have fully recovered as sudden increase of the heart rate will have an ill effect on it.

There is another technique for the construction of phallus other than phalloplasty known as metaidioplaty.

PROCEDURE:

In this method testosterone is given to the person to make the clitoris grow approximately for one to three inches.

This process involves cutting the ligament that holds the clitoris in its position. Its position is normally under the pubic bone. Some of the surrounding tissue may also be cut. The clitoris is then freed up so more of it is protruding out and is showing.

This technique is sometimes also called clitoral free up or clitoral release.

Some more modifications may be done to further enhance the result. Such modifications are:

• Fat may be removed from the pubic mound and the nearby skin maybe pulled upwards. This brings the new penis farther forward and prominent.
• Flaps of skin of the labia minora maybe wrapped around the new penis to make it bigger in size.

The only drawback of this technique is the resultant new penis is rather small in size as it is only the enhancement of clitoris which is naturally small in size. So the new penis doesn’t help if you want to have penetrative sex as it is not big or strong enough. Apart from this the new penis will get erect on its own when you are sexually aroused. Also, sexual sensation in the new penis is very good as the clitoris which is the main organ of sensation in females is not impacted much.

Also in this process there is minimal scarring unlike phalloplasty.

Risks or complications associated with this surgery:

• You maybe dissatisfied with the length of the penis. It may be shorter than expected. There may also be some dissatisfaction related to the shape of the new penis. It may not look realistic or it may not have an attractive shape.
• There maybe some change in sensation: numbness, continued softness, or hypersensitivity. Also there may be decreased ability to have orgasms or less intense orgasms.
• Change in urine spray or flow. Also leakage of urine is a very common problem after phalloplasty.
• wearing out or total death of the tissue used to create the new penis.