A neophallus is a surgically constructed penis, created through a procedure known as phalloplasty. This procedure involves harvesting a flap of tissue, including skin, subcutaneous tissue, nerves, and blood vessels, from a donor site on the patient’s body. The harvested tissue is then shaped and transferred to the genital area to form the new penis. A neophallus aims to provide an appearance consistent with a natal penis and can allow for male-typical urination, sensation, and sexual function, often with subsequent procedures.
Reasons for Neophallus Creation
Neophallus creation is undertaken for various reasons, including gender-affirming care, congenital conditions, and acquired circumstances. A primary motivation is gender-affirming care for transgender men and non-binary individuals seeking physical alignment with their gender identity. This surgical pathway helps alleviate gender dysphoria, a distress from a mismatch between gender identity and sex assigned at birth.
The procedure also serves reconstructive purposes for individuals who have experienced significant trauma, such as injuries from accidents or burns. When a penis is partially or entirely lost due to cancer or disease, neophallus creation can restore form and function. This aims to improve quality of life and address the physical and psychological impact of such losses.
Neophallus creation is also performed to correct congenital conditions. Examples include aphallia, a rare condition of penile absence, or severe cases of micropenis, an atypically small penis. Other congenital conditions like epispadias or hypospadias, where the urethral opening is not at the tip, can also require reconstructive surgery to improve urinary function and appearance.
Surgical Approaches
The creation of a neophallus involves several surgical approaches, with different donor sites and techniques. One common method is Radial Forearm Flap (RFF) phalloplasty, which uses a tissue flap, including skin, nerves, and blood vessels, from the forearm. This flap is then rolled and shaped to form the neophallus. Microsurgical techniques connect blood vessels and nerves to the groin area, facilitating blood supply and potential sensation.
Another approach is Anterolateral Thigh (ALT) phalloplasty, using tissue from the thigh. This method can be suitable for individuals who prefer no forearm donor site or have insufficient tissue there. Similar to RFF, the ALT flap contains skin, fat, and sometimes muscle, with its own blood supply and nerves connected to the recipient site. While ALT may result in a thicker neophallus, it offers a less conspicuous donor site scar.
Metoidioplasty is a distinct approach that modifies existing genital tissue instead of creating a new phallus from distant tissue. This procedure involves releasing and straightening the hormonally enlarged clitoris to form a small phallus. While it typically results in a smaller neophallus compared to flap-based techniques, metoidioplasty can offer good tactile sensation and the possibility of standing to urinate, often without extensive microsurgery or a separate donor site.
Function and Sensation
Functional outcomes of neophallus creation vary based on surgical technique and individual healing. A primary functional goal for many patients is the ability to urinate while standing, achieved through urethral lengthening. This process involves extending the urethra through the neophallus, allowing for male-typical voiding.
Sensation in the neophallus is a significant consideration, including erotic and tactile feeling. During phalloplasty, surgeons connect nerves from the harvested tissue flap to existing nerves in the genital area. This nerve connection aims to provide varying degrees of sensation, though quality and extent differ among individuals. Some patients report sexual sensations in the neophallus, while others primarily experience tactile sensation.
The capacity for penetrative sexual activity is often a desired outcome. A neophallus, in most cases, does not achieve natural erection due to the absence of erectile tissue. To enable penetrative sexual activity, subsequent procedures are required, such as penile implant insertion. These implants, malleable or inflatable devices, provide the necessary rigidity for intercourse.
Recovery and Post-Surgical Considerations
The recovery process following neophallus surgery is a multi-stage journey, requiring patience and medical guidance. Immediately after the initial surgery, patients typically experience a period of hospitalization for several days to a week for monitoring of the neophallus’s blood supply and healing. During this time, pain management and wound care are priorities to ensure recovery of both the neophallus and the donor site.
Initial healing involves managing swelling, bruising, and discomfort; patients often limit physical activity for several weeks. The initial recovery timeline can extend for several months, with gradual improvement in comfort and mobility. Regular follow-up appointments monitor progress, address any complications, and plan for subsequent procedures.
Many individuals undergo additional staged procedures to achieve desired aesthetic and functional outcomes. These may include scrotoplasty, creating a scrotum from labial tissue, and testicular implant insertion for a more natural appearance. A glansplasty, sculpting the neophallus tip, may also be performed. For penetrative sexual function, erectile device insertion, such as an inflatable penile prosthesis, is a common later stage.
Long-term post-surgical care involves continued wound management, physical therapy for mobility and sensation, and ongoing monitoring for complications like urethral strictures or fistulas. Patients also learn to manage the neophallus, including hygiene practices. The journey is highly individualized, with outcomes and timelines varying based on surgical technique, individual healing, and the number of staged procedures chosen.