The 8th May 2019, marks nine months since I had the final stage of my phalloplasty surgery and completed my gender transition. Here in the UK, the final stage of Phalloplasty is the insertion of the penile prosthesis. In this blog, I will talk about the healing process, addressing some initial concerns I had and giving an overview of how I am finding the prosthesis. Before we begin, I want to stress that this is a frank and honest discussion of an intimate nature, so do please bear that in mind before continuing to read!
Final Stage Phalloplasty – Insertion of the Penile Prosthesis
On 8th August 2018, I had the erectile device fitted, which completed my phalloplasty surgery. The insertion of the penile prosthesis is the final stage of phalloplasty here in the UK. For a very brief overview of the stages of phalloplasty, here is a very basic explainer vlog I made a while back.
I had been waiting a long time for the final stage because I had a fair few complications. Therefore, it was a huge relief to wake up and find an erection! The particular device I have had fitted is the AMS 700 MS. The AMS is a three-part pump, and I have been fitted with just one cylinder. Its rare for a phalloplasty to be big enough to accommodate two cylinders. My surgery was performed by Mr Zacharakis who is part of the London andrology team here in the UK.
Reflecting on Initial concerns at Three Months Post-op
My last update about the penile implant was at three months post-op. At that time, I had some concerns about the function and comfort of the prosthesis. My main concerns were:
- Even when fully pumped my penis still pointed downward.
- At the maximum number of pumps, my penis still bent at the base.
- I was worried that the lack of stability and rigidity would make penetrative sex problematic.
- I had a sizeable visible lump on my pubic bone where the pump is anchored.
- When I pumped, and when I pulled or pushed on my penis, there was a fair amount of discomfort in my groin area.
• My left testicle was really high up, making the scrotum look like I only had one testicle.
Now, at nine months post-op, I want to revisit these concerns and talk about how things have progressed, as well as how I find using the pump and its successfulness in having penetrative sex.
Healing progression at nine months post-op
I always have to remind myself, that in terms of healing, things change dramatically. It is all too easy, in those first few months, to worry about things but we need a really good chunk of time to heal correctly. Now, things have significantly improved in the six months since my last update.
Phalloplasty and Sexual Function
My initial concerns about my penis not being firm enough were unfounded. I think that initially, I was scared to pump the device too much, whereas now I realise that you cannot over pump. At fully pumped, my penis stands much more erect. Finn jr points straight out, not up at the ceiling, but that’s not uncommon for men. The important thing is he is indeed very firm!
Finn jr can still be prone to bend at the base, this is where the pump is anchored to my pubic bone. However, the bend has not posed a problem, and I have managed to have penetrative sex.
As trans men, we have a huge learning curve, in learning how our new body configurations work and we have nothing to compare it with. I am assured, by gay and straight men alike, that my early fumblings and mishaps are a normal part of the coming of age process!
Working the Pump Device
A large part in finding confidence in Finn Jr’s abilities was in getting to know and trust the penile prosthesis. After a lot of practising, (doctors orders of course )I find using the pump to be easy. I can quickly feel the box, the bulb and the button. Three full squeezes are enough to get him hard and then after a moment or so, I find I can squeeze a couple more times to make him harder. A firm press of the button means he deflates straight away.
Using the pump can be part of foreplay. However, some partners may worry about hurting you. My partner, who is a cisgender guy, cringes at the thought of squeezing my pump! I don’t mind. I can do it discreetly enough that you don’t even know I’ve done it.
Comfortability of the Penile Prosthesis
The lump, where the device is anchored to my pubic bone, is still there but it is much smaller. I can now feel the lump more than I can see it. There is no longer get any pain there when I’m pleasuring myself or during sex. Perhaps the initial pain was where the pump device was settling in and embedding in my pubic bone. It seems to be much more solid there now, and it never causes me any discomfort.
Initially, the testicle with the pump device inside did feel a little odd. It’s a square box, and I worried that I would feel its edges but its never given me any issue. The only time I’ve noticed it is when sat on an exercise bike in the gym. However, any man is going to need to rearrange his testicles to sit comfortably on a bike saddle!
Appearance of the Penis when Flaccid
I love how my penis now has much more substance because of the pumps cylinder which runs through my phallus. Before the erectile device, Finn Jr was unnaturally bendy, whereas now, he has much more shape and fullness. The top part of the cylinder has a bulb designed to reinforce the glans. The bulb remains hard which means the head of my penis now has much more definition.
I had some initial concerns before the device was fitted that the cylinder may make housing Finn Jr in my pants, more difficult. The reason I was concerned, is because as transgender men we are showers, not growers, our penis is always one size, just soft or hard. I was worried at first that having more substance from the device would make it even bulkier to pack. Although I did have to get used to there being a bit more substance and therefore have to find a new way to carry him, it’s not been an issue.
Appearance of the Penis when Erect
Due to the way that the device is anchored to my pubic bone, Finn Jr does point rather distinctly left! It’s as if they have had to pin the device slightly across my pubic bone, meaning that it is impossible for the device to stay pointing forward. When Finn Jr is flaccid, he points downward, but as soon as the pump lets in saline solution, the firmness then forces the cylinder to the left. It does not affect the function, and so I have decided that it just adds character!
Appearance of the Testicles and Scrotum
Despite the odd shape of the pump, I’ve not had any issues with noticing that it is a box shape rather than a round testicle in my ball. I am perfectly happy with my right testicle. The left, which has a testicular implant inside, I am not so satisfied with. The left is incredibly high up. It’s inline and almost on top of my pubic bone. It’s not uncomfortable but there are times when it is not entirely comfortable either.
My left testicle, being so high, means that my scrotum does not look right. The combination of how it looks and the annoyingness of its placement means I would ideally like a revision. However, I am currently hesitant to go through any surgery, even minor. I am, however, going to contact Mr Christopher, just to see what my option might be.
What Would I Change?
I would like to have a better-looking scrotum, with both testicles hanging the same way. I would also like the device to be anchored straighter as this would give more firmness at the base. However, neither of these issues affect the function of the pump.
The testicle is something I may consider changing, depending on how invasive a procedure would be. I feel I would feel more comfortable with it lowered as sometimes I feel like I have a satsuma in my jeans pocket.
The pump I would not change at all. It works fine and is not worth the risk to change, simply for the sake of a straight penis. Besides, it will have to be replaced within ten years anyway as they do not have a long life. I am likely, to choose the flexible rod when the pump fails, mainly because of my age but I will discuss that another time.
Managing expectations of Phalloplasty
Phalloplasty is all about managing expectations and getting to a place that’s ‘good enough’. Otherwise, we could spend our lives changing little bits here and there and never being happy. No penis is perfect. Penis’ come in all manner of different shapes and sizes and point in funny directions or have bends in them. As for Phalloplasty, it’s never going to be a cis penis no matter how many advancements the surgeons make. I believe that part of preparing for Phalloplasty is acknowledging that fact and working out what ‘good enough’ means for you.
For me, good enough meant being able to have a penis I could pee with and have penetrative sex with a partner. As long as it looked good enough to stand next to other guys at a urinal, and make me smile when I looked in the mirror, that was good enough for me.
Was Phalloplasty Surgery Worthwhile?
Phalloplasty surgery is more of an epic adventure quest than a journey and requires a great deal of preparation and planning. It has been a tough three years from start to finish. However, it has been very worthwhile. My lower dysphoria is almost non-existent. That which remains is more due to confidence in my male self than in my appearance. These days I love looking at my naked body in the mirror, despite its many flaws. I am 45 years old, and gravity has taken its toll alongside far too many tubs of ice cream. I am also covered in scars from my various surgeries. However, to me my body is perfect. To at last look in the mirror and see nothing but the man that I am and always have been, speaks volumes in the successfulness of this incredible surgery.
Please do feel free to leave any comments or questions. You are also more than welcome to contact me for advice or info, I am always happy to help.