If you’re reading this, you probably know what a phalloplasty is. If you’re not familiar, phalloplasty is the surgical creation of a phallus/penis/neo-phallus (different people use different words) using donor tissues from other parts of the body. We have a write up in our surgery series and have some tips for physically preparing for bottom surgery here. In this blog, we want to talk about getting ready for your hospital stay and immediate recovery time.
“Phalloplasty” is really a set of procedures rather than one single operation, and you may need to have multiple hospital stays, as the procedures may need to be done in stages. But, there is a great deal of opportunity to choose how you want your body to function and what you want it to look like.
These choices include:
- Do you want to move your urethra? Moving your urethra is not required – you can leave it where it is.
- If yes, the opening where urine (pee) leaves the body is moved from directly flush to the body below the phallus to the end of the phallus.
- This adds complexity and risk to your surgeries.
- A vaginectomy and hysterectomy are generally required when the urethra is moved.
- It may also change what flap(s) and surgical technique the surgeon is comfortable using.
- If no, hysterectomy and vaginectomy are not required.
- If yes, the opening where urine (pee) leaves the body is moved from directly flush to the body below the phallus to the end of the phallus.
- Hysterectomy
- Removes the uterus
- Oophorectomy
- Removes the ovaries
- Vaginectomy
- Removes and closes the vaginal canal (front hole)
- If you opt for a hysterectomy, you don’t have to have a vaginectomy, but if you opt for a vaginectomy, you will have to have a hysterectomy. Biologically, the uterus needs an outlet to be able to shed lining. Here’s our blog on vagina-preserving phalloplasty.
- Monsplasty
- Changes the shape and prominence of the mound between the bottom of your abdomen and genitals
- Glansplasty
- Sculpts a “head” to the penis. Done after the shaft is created.
- Scrotoplasty
- Creates a scrotum
- Can also get testicle implants
- Penile Implants
Tissue donor sites include:
- Thigh
- Forearm
- Back
- Abdomen
The procedures you choose will impact your hospital stay and your healing times. See phallo.net for a discussion of the different types of phalloplasty and things to think about. OHSU (Oregon Health & Science University) has an excellent informational booklet on phalloplasty. We also love Dr. Colt St. Amand’s getting ready for surgery video series.
If you choose a forearm, thigh, or back flap, your hospital stay will be several days. Your stay after an abdominal flap will be shorter.
If you choose hysterectomy/oophorectomy, these are typically done a couple of months before the shaft is created.
If you choose implants, these are typically done several months after the shaft is created.
Shaft creation, urethral lengthening, scrotoplasty, monsplasty, glansplasty and vaginectomy are typically done in one or two stages four to six months apart.
Stage 1: creation of the shaft using tissue from your donor site and creation of a urethra in the shaft, if chosen.
Stage 2: connecting your existing urethra to the new urethra, vaginectomy, and additional procedures such as scrotoplasty and glansplasty.
Skin graft procedures to help the flap donor site heal are typically done a couple of weeks after shaft creation.
For this checklist, we’re thinking about these two stages where a lot of big changes are happening to the exterior genitals.
Your Hospital Stay
After shaft creation, expect to be in the hospital for about a week.
You will be on bed rest, flat on your back for at least the first full day after surgery.
On days two and three, you’ll get out of bed and stand (then get back into bed.)
On day four, you may be able to walk some to the bathroom instead of using a bedpan. Other walking will be extremely limited.
On day five and beyond, you’ll be encouraged to walk more, but still very little.
Your stay after urethral connection will be shorter – just a couple of nights. However, you will have a catheter in place for four to six weeks.
You’ll be in bed a lot. Much of this time you may be resting or sleeping: your body is doing a lot of big work! You’ll also be on pain meds. You may want to bring something to keep you occupied while you’re not sleeping or doing in-bed PT, but you might not have a lot of extra energy or focus.
Phalloplasty Checklist for your Hospital Stay:
- Your phone
- Headphones for listening to music or phone calls
- Other personal electronics if desired
- Chargers with a long cord – there might not be an open outlet near your bed.
- Earplugs and an eyemask for sleeping, especially if you are a light sleeper
- Moisturizers for hands, face, lips, and body
- A small personal fan
- You may have a heat blanket. Usually, we recommend bringing cozy tops and maybe your favorite snuggly blanket because hospitals are notoriously cold. Check with your surgical team to find out if you should plan for cooling off or warming up.
- An art bin or other organizer for your bedside table.
- A back scratcher
- A reacher-grabber
- A favorite comfort item: a squishy, pillow, blanket, etc.
- Keep-me-occupied items
- Loose, soft clothing to go home in. Front-close shirts, bottoms without zippers, and shoes that don’t need to be tied will be easier to get on and off. You may wish to go home in a robe: you will have bulky bandages. Your ability to bend at the hips will be limited.
- You’ll have access to the hospital cafeteria, but a small supply of some favorite snacks may be enjoyable.
Once You Are Home:
After shaft creation, your activities will be extremely restricted for about three weeks and then limited for at least three more.
- No sitting for four weeks.
- Very limited walking for three weeks.
- Very limited lifting.
- No other activities.
You will be healing in two sites: your genitals and your donor site. You will be able to shower, but your donor site will need to stay dry for a few weeks. If you choose a forearm donor site, you will have a splint.
Supplies That May Be Helpful To Have On Hand:
- 5” by 9” medicated gauze pads (Xeroform abdominal pads)
- 4” by 4” gauze pads
- Fluffy rolled gauze (Kerlix)
- Long sterile cotton swabs
- Medical tape
- Antibiotic ointment
- Hydrogen peroxide
- Mild, hypoallergenic soap
- Ice packs
- Lots of mesh or loose-fitting underwear
- Absorbent pads for underwear
- Extra bath towels – you’ll be instructed to shower twice a day
- A peri or squirt bottle for directing water rinses into crevices and folds.
- Hand-held shower head
- Shower chair
- Cleaning supplies for your environment
- Bed pads (“chux” come in disposable and reusable forms!)
- Thermometer
- Non-latex exam gloves
- A reacher/grabber tool
- A hand mirror to better see your new anatomy
- A cane or walker
- A cart for moving items between rooms
- Prepared meals for when your caretaker is away. Easy snacks for taking meds like applesauce, crackers, and nutritional drinks can be super helpful and help you get sufficient nutrition for healing.
- Bendy straws!
- Compression glove, if forearm donor site was used
Medical supply stores are a great option for purchasing wound care supplies in larger quantities and less expensively than a neighborhood drug store. Your surgeon will provide specific details about what medical supplies they’d like you to have at home.
OHSU recommends that you have a caretaker on call 24/7 for the first five weeks and someone staying with you for the first three weeks. Ideally, your caretaker will also be able to be present during your hospital stay so that they can learn how best to care for you.
What to Watch Out For While You Are Recovering
This is not a complete list – your surgeon will also go over what to look out for.
- Sudden swelling or pain
- A fever or chills
- Heavy bleeding from incisions that doesn’t stop
- New or sudden bruising near your incisions
- Wound discharge changes that smell bad or look different
The emotional journey after surgery can be intense and have ups and downs, as well as what you feel physically. It is normal to have complicated feelings after surgery and to be tired. Your body is using a lot of energy to heal. Give yourself space and grace and lean on your support team.
Do you have darker skin? Read our blog about differences in surgical complications and hematoma risk for Black or darker-skinned patients.
Do you have sensory or chemical restrictions? Read our blog on preparing for hospital stays when you have allergies or sensitivities!
Also read up on physical pre-habbing for bottom surgery!
Download our Phalloplasty Checklist!
