Phalloplasty is a gender-affirming surgery requested by many trans men. However, it is important to understand that this technique is not completed in a single surgical procedure.
For this reason, dividing phalloplasty into strategic stages makes it possible to maximize safety, reduce complications, and achieve a functional, aesthetic, and erogenous result that is as natural as possible. This aspect is essential for men who decide to undergo this procedure, as it allows them to more accurately understand what the final outcome of phalloplasty will be and how it will evolve. Below, we detail the entire process of this gender affirmation surgery.
Urethroplasty: Can you urinate standing up after phalloplasty?
This is one of the most common questions. The answer is yes, but it requires a precise technique. Urethroplasty is the reconstruction of the urethra to extend it to the tip of the penis so that a trans man can urinate standing up. This is one of the most delicate steps in phalloplasty.
Although it is technically possible to perform urethroplasty in trans men during the same surgical procedure as neophallus creation, clinical experience and international evidence show that dividing the surgery into two stages significantly reduces the risk of fistulas and strictures, which are the most frequent complications of urethroplasty.
Additionally, performing this surgery in two stages allows surgeons to work on already healed and better-vascularized tissues, facilitating a more precise connection of the urethra to the tip of the neophallus.
For this reason, IM GENDER usually recommends completing urethroplasty at a later stage, when the neophallus vascularization has stabilized and the tissue is in better condition for fine and functional reconstruction.
The final goal is for the patient who undergoes phalloplasty to be able to urinate standing up comfortably and safely, with reconstructed anatomy that is durable in the long term.
How is phalloplasty performed at IM GENDER?
At IM GENDER, phalloplasty is divided into two phases:
Phase 1 of Phalloplasty
Complete urethroplasty is performed but kept “de-functionalized” (not connected to urinary flow) to prevent urine from affecting initial healing.
During these months, the person urinates through a temporary stoma located under the scrotum.
Phase 2 of Phalloplasty
After this period, once the tissues are vascularized, definitive reconnection is performed and the temporary stoma is closed. This allows urination through the neophallus under safer conditions.
Testicular prostheses
The placement of testicular prostheses is also usually performed in two stages, although it depends on anatomy, tissue thickness, and medical assessment.
The first stage, in which only one prosthesis is placed, is usually carried out together with urethroplasty. The second prosthesis is placed weeks or months later, depending on the evolution of the first stage.
Performing it this way offers advantages for achieving an optimal final phalloplasty outcome:
● Reducing tension on newly reconstructed tissues.
● Improving implant integration.
● Decreasing the risk of extrusion or infection.
● Facilitating the design of a more natural-looking scrotum.
Penile prosthesis
For those who wish to achieve an erection, a penile prosthesis is an optional phase. The neophallus obtained after phalloplasty does not have corpora cavernosa like a cis penis, so it cannot achieve a natural erection. To achieve this, a penile prosthesis must be implanted in a short outpatient surgery lasting approximately 30 minutes.
The penile prosthesis—malleable, semi-rigid, or inflatable—is never placed in the initial stage, as it requires the radial forearm phalloplasty (or chosen technique) to be fully consolidated. Its function is to allow penetration during sexual activity, and it requires that:
● The neophallus is fully healed.
● Sensitivity is stabilized.
● The tissues have sufficient internal strength to support the implant.
● There are no active fistulas or strictures.
For this reason, implantation is usually performed months or even more than a year after neophallus creation. After phalloplasty, some trans men do not want an internal penile prosthesis; there are other options such as external devices that allow penetration.
Neophallus micropigmentation
The aesthetic finish of the neophallus takes time and often involves post-phalloplasty aesthetic refinements. Why? Because phalloplasty uses skin and fat from the patient’s forearm, which has a different color and lacks the anatomical venous structures of cis male genital skin.
To improve the aesthetic appearance of the trans penis, specialized medical micropigmentation techniques can be used. This makes it possible to recreate more appropriate coloration and structures, design the superficial dorsal vein, and harmonize the overall appearance.
Although it is not mandatory, many patients choose it because it significantly contributes to a more realistic phalloplasty outcome.
Donor site treatment and care
The donor site of the flap (usually the forearm) is an essential part of phalloplasty recovery. Its evolution may also require complementary treatments such as:
● Laser therapies to improve scar texture and appearance.
● Micropigmentation to match skin tone.
● Lipotransfer or volume techniques in cases of depression or irregularity in the arm.
The goal is not only neophallus functionality, but also the patient’s overall well-being and satisfaction with the final phalloplasty result.
Why choose staged phalloplasty?
Phalloplasty, understood as comprehensive genital reconstruction, requires long-term planning. It is not a single surgery, but a series of successive interventions that:
● Respect the body’s biological timelines.
● Aim for the lowest possible complication rate.
● Optimize sensitivity, urinary function, and aesthetics.
● Ensure that every decision is made with information, autonomy, and support.
At IM GENDER, this process is supported from day one by a multidisciplinary team with more than 25 years of experience and a high level of specialization.
Understanding surgery as a set of successive interventions is the best guarantee of health. This approach respects your biological timing and optimizes sensitivity and urinary function. With more than 25 years of experience, our multidisciplinary team accompanies you through every phase of phalloplasty with rigor and empathy.
Do you have questions about the stages of phalloplasty? Request an initial consultation and we will design your personalized surgical plan to achieve the desired phalloplasty outcome.
