How Is an Erection Achieved After Phalloplasty?

Phalloplasty is a genital-affirming surgery that constructs a penis with a natural and functional appearance, enabling trans individuals to urinate while standing and feel that their genital appearance aligns with their gender identity. It is important to emphasize that not all trans men choose to undergo this type of surgery as part of their transition.

For those who do, one of the most common questions about phalloplasty – and one of the greatest challenges – concerns erection. The neophallus lacks the corpora cavernosa that makes a cis penis rigid, meaning it cannot become erect on its own.

To enable penetrative sexual activity, prosthetic or external devices are required to provide the necessary firmness and stability.

The placement of a penile prosthesis is the most frequently used method to achieve the rigidity required for penetration. It is not performed during the first stage of phalloplasty, as the tissues are still inflamed and healing.

When desired by the patient, the prosthesis is implanted in a separate procedure—usually during the second or third surgical stage—once the area has healed. It is a short outpatient surgery of about 30 minutes, and there are several options available:

• Remain in a state of semi-erection permanently.
• The patient manually positions the penis for intercourse.
• They are simpler devices with fewer mechanical complications but may cause skin irritation or extrusion (implant exposure).
• Less natural in appearance and comfort compared to hydraulic prostheses.

• The most advanced and functional option.
• They consist of a hydraulic system with a fluid reservoir, usually placed in the testicle.
• When activated by pressure, the fluid moves into the neophallus, producing an erection.
• After intercourse, the fluid returns to the reservoir, returning the penis to a flaccid state.
• They offer greater naturalness and control but require more complex surgery and may experience mechanical failures over time.

Not all trans individuals wish to—or can—have a penile prosthesis. In such cases, external devices can be used to enable penetrative intercourse.
 This method generally involves two rings: one placed at the base of the penis and another near the glans. A rigid rod is inserted between them, providing the necessary firmness and stability for penetration.

Although this method does not create an erection per se, it allows for sufficient rigidity to maintain satisfying sexual intercourse.

To facilitate the use of this system, the IM GENDER surgical team creates a groove in the glans during phalloplasty, similar to the natural sulcus of a cis penis. This groove helps secure the distal ring and prevents displacement during use.

Choosing between a malleable prosthesis, a hydraulic prosthesis, or external devices depends on several factors, including the patient’s expectations and goals, the anatomical characteristics of the neophallus, the desired degree of naturalness, and financial considerations, as hydraulic prostheses are typically more expensive.

Each patient should receive an individualized evaluation to determine the best strategy, always prioritizing safety, functionality, and long-term well-being.

At IM GENDER, we work alongside an experienced urologist specialized in penile prosthesis placement.

After phalloplasty, erection does not occur spontaneously, but modern medicine offers several ways to achieve the required rigidity. From malleable prostheses to sophisticated hydraulic systems, and even external devices, each person can find the option that best suits their needs and allows them to experience their sexuality fully.

At IM GENDER, our surgical innovation and extensive experience with hundreds of procedures allow us to support every patient through this process, offering solutions tailored to their needs and expectations.