FTM Surgery Options
Surgery is a very big decision to make, and in the UK, you have to be 18 or over to get any type of gender reassignment or gender affirming surgery.
There are many types of surgery you can get as someone born female transitioning to male, or as someone assigned female at birth but identifying as something other than female, such as non-binary.
In this post, we’ll get into:
Top Surgery – Double incision or Peri-Areolar
Types of hysterectomies
Vaginectomies
Bottom Surgery – Phalloplasty or Metoidioplasty
Which means it’s going to be a long one, like our post on Deed Polls, but it feels like the right choice putting similar information in one post, so that’s what I’ll do here.
Access To Surgery
There are several ways to get access to surgery, including privately, overseas, and through an NHS GIC.
You’ll also need signatures from specialists agreeing that you are able to consent to surgery, and that you meet the requirements for surgery. Normally, this will be from either a mental health specialist, a gender specialist, and/or a surgeon.
The number of signatures required depends on the surgery:
Top surgery – One signature
Bottom Surgery – Two signatures
Going private will cost a lot of money, but will be much quicker than the NHS, whereas going overseas and getting surgery somewhere else will be both more expensive, and more time consuming.
Getting surgery through the NHS first requires a referral to a GIC, a diagnosis of gender dysphoria, and a gender specialist who agrees that surgery is the right treatment pathway for you.
In the UK, you don’t necessarily need to be on hormones to get gender reassignment surgery.
This way, at the very least, your medical transition is not forced to go one way. That is – you don’t have to be on hormones to get surgery anymore.
Everybody’s medical transition is different, and there used to be a time where you had to be on hormones to get surgery, and even had to have had surgery to legally change your gender in some countries.
The current way of doing things is still archaic and costly and time consuming, but there are people campaigning to make it better, however long that might take.
Top Surgery
Top surgery is a way of permanently making your chest look flat. People usually use binders to flatten their chest until they get surgery, or maybe forever, if they can’t have surgery at all or don’t want it.
Requirements for top surgery: From GenderGP
1. Persistent, well-documented gender dysphoria.
2. Capacity to make a fully informed decision and to consent for treatment.
3. Age of majority in a given country (if younger, follow the SOC for children and adolescents).
4. If significant medical or mental health concerns are present, they must be reasonably well controlled.
Hormones are not necessary to have surgery.
If you go the NHS route, your gender specialist will do a lot of probing to figure out if surgery is right for you, asking what you expect from surgery, why you want it, and other similar questions.
They’re essentially trying their best to make sure you’re not making a mistake.
Yeah, not all specialists are as good as others, sometimes they try to prevent you from getting surgery, but I’ve rarely encountered a gender specialist who doesn’t ask enough questions, as in the Kiera Bell case, where she transitioned and got top surgery as a young adult, but detrainsitioned, and decided to sue Tavistock for not challenging her enough on her decision to get top surgery.
This badly impacted the community, especially young trans people looking to access hormones, who then had to get court orders every single time a young trans person wanted to get hormone replacement therapy.
I don’t personally think the rest of us should be denied life-saving medical treatment because one person made a mistake, but I’ll admit that transitioning is hard, and making the wrong choice can happen to anybody.
I only bring it up in this post because of the misinformation that came out of that case. The public already thinks that trans people, especially trans children, are being given medical treatment willy-nilly. That’s just not true.
Bell’s case made already difficult-to-access trans healthcare even more difficult to access, which has hurt so many people, so, so badly.
I know that not all specialists are perfect, and you need to do the research and the inner questioning to figure out if surgery is right for you, and you also need to be prepared for the fact that this is a very difficult process to go through. Both from the perspective of how long it takes, as well as how difficult it can be to get professionals to actually treat you.
But top surgery is, like I said, so very life-saving when you put the work into figuring out if it’s the right choice for you. The Bell case made our lives even more difficult than they already were, and it honestly made me feel very hurt, so here I am now trying to give out information instead of misinformation, as many other trans websites and blogs are also already trying to do.
Because yes, people can made mistakes in terms of deciding to transition, but they can’t decide to be transgender. It is innate, and needs to be treated as seriously and with as much respect as cis people get with their own healthcare.
So, your gender specialist will ask you questions, and if they agree that surgery is for you, you’ll be given a list of UK top surgeons to choose from. It often involves travel, so many people choose a combination of the closest surgeon to where they live, as well as researching whose results they like the best.
Once you’re referred, again, it’s the NHS, so the waiting list can be months to years long. Not to bash the NHS specifically - more so the fact that they’re underfunded and understaffed.
It personally took me from my referral in late 2019 to mid-2021 to get my first top surgery consultation. Covid obviously played a role in that, and my first consult was a video consult because we were in lockdown. But waiting times may differ hospital to hospital.
During the first consult, your surgeon will want to see your chest so that they know which surgery technique you’re eligible for. They’ll also ask different questions about your general health, any medications you’re on or expect to be on during surgery, and what type of technique (Double Incision, Peri, etc) you’ll want the surgeon to use.
You’ll be expected to stop smoking prior to surgery, and your surgeon will let you know if you need to lose any weight beforehand, too. This is to make surgery as safe for you as possible, and most surgeons also have certain weight restrictions as to who they’ll operate on.
You’ll get a letter after each consult so that you, your GP, and your gender clinic are all in the loop about what’s happening.
A second assessment is normally 8 or so months after the first one, with the actual surgery 3 or so months later. The second assessment involves nurses taking your weight, as well as blood and urine samples to check that you’re healthy enough for surgery.
Essentially, it’s normally a year from first consult to surgery. The aim is for it to be a year from referral to surgery, but Covid has slowed things down considerably, and each surgery team has their own referral waiting times anyway.
So, there’s a lot to think about with any kind of surgery, but first, let me explain the two main types of top surgery most people will end up getting.
Double Incision vs Periareolar
The only difference between these two types of surgery is appearance and the technique the surgeon uses.
But you don’t always get a choice between the two, as Double Incision is for average to large sized chests, whereas Peri is for much smaller chests. It’s all about what the surgeon has to work with during surgery.
Double Incision will leave you with two quite visible scars, but where they are on the chest, how straight they are, if they’re joined or not, that depends on what you want, and what your surgeon thinks is possible for the size your chest currently is before surgery.
You can view before and after results of top surgery here, but be warned for nudity, of course. Results vary depending on the surgeon you get and the hospital you go to.
With DI, the surgeon cuts across the chest from both sides, which is where the scars come from, and then suctions the breast tissue out through those incisions. This is for average to large sized chests for a reason – the surgeon gets more control with DI over where the nipples end up, as well as overall appearance.
On the other hand, Peri will leave no large scars across the chest, because the surgeon actually cuts around the areola of the nipples, hence the name, to suction the breast tissue out that way, as opposed to through larger incisions. This can only be done on small chests because otherwise you run the risk of unsatisfactory results, including skin sagging at the sides and the chest ending up not looking very flat at all due to too much breast tissue left over.
In a nutshell:
DI positives:
More control of nipple appearance and placement.
Removal of excess skin is easier so decreases the likelihood of poor results.
DI negatives:
Large, noticeable scars – although these can fade with time and good post-op care.
More post-op maintenance – longer and possibly more difficult recovery.
Decreased nipple sensation if you have nipple grafts.
Peri positives:
Minimal scarring.
Easier recovery.
Peri negatives:
Higher chance of needing a revision later on.
Fewer options for nipple placement.
You don’t technically have to keep your nipples at all if you don’t want them, though.
Other top surgery techniques: Keyhole, Buttonhole, Inverted-T/T-Anchor
Essentially – people choose which surgery they want based on the scars they want to end up with, but it also depends on how big their chest is before surgery.
Some people like to have the scars that you get with DI, as they visibly show the journey you’ve gone through during your transition and can remind you of how far you’ve come compared to where you started. Others prefer minimal scarring – they might not like the appearance of big scars, or it might be safer for them to be cis-passing when taking their shirt off.
There is no right or wrong choice as to whether you want larger scarring or no scarring at all, and it all really depends on the person.
Your surgeon will normally try their best to come to a compromise with you about what their capabilities are vs your expectations, vs what they already have to work with.
Questions for your surgeon:
Can I screen record our consult (if online) to look back on it for information later?
Will I need antibiotics?
Will I get any care instructions written down?
Will I need drains?
Will my [personal medical condition, if any] impact anything?
Can my scars be… [ask about what appearance you want your scars to have]?
Will I need drains?
Will I need a compression vest post-op?
Can I see photos of other results?
How long will I need to stay in the area?
What can I do beforehand to make my recovery time better or that could help produce better results? (such as exercises or diet)
What kind of help may I need from other people?
Does the aftercare often need/require a second person to help?
What top surgery technique does the surgeon have more experience in? Which would they recommend for me?
What are my options if I am not satisfied with the results of the surgery?
How far away from now could my surgery be?
Will I need to visit the hospital before the actual surgery day?
Will I need a Covid test? If so, when?
Will I have to stay overnight in the hospital?
Can you explain the different methods of nipple placement? Which one would be right for me?
Can you explain different methods of DI and Peri?
When would my post op appointment be?
When would I get my drains removed?
How long would I need to wear my post-op binder for?
What are the possible complications of top surgery? Who do I contact and how do I contact them if something goes wrong? What happens if I have a complication?
How common are revisions for the surgery? How long would I have to wait to get them if I had complications?
How long is recovery time usually?
Do I need to go off of T?
Does the surgeon use glue or stitches?
Does nipple sensation ever come back?
Do I need to shave my chest/armpits before surgery?
What kind of scar care do you recommend?
Do you provide post op binders or do I need to buy them myself?
Do I have a choice as to how my scars might look?
How long will I be under?
Is there an on-site pharmacy for post-op meds?
When will my post-op appointments be?
What do I need to do at the hospital in any other consults before surgery?
Important Links:
Recovery
After you get surgery, recovery is just as important as everything else.
Maybe even more important.
Between a few days to a week later, you’ll have a post-op consult with your surgeon or a member of their team, most likely a nurse, to check on how everything’s healing. They’ll also take out any drains if you ended up having them put in after surgery. Some surgeons use drains, others do not.
You might have another 3 month or 6 month post-op consult as well to keep an eye on things.
You should also hopefully have the contact details of your surgeon so that you can get in touch if you have any worries about your recovery, considering most people have to travel a few hours away from home to get top surgery.
It could take up to three months to completely recover to the point where you’re fully mobile and can do normal day-to-day activities, as well as start exercising again, which you should avoid for at least those first few months to make sure you don’t stretch your scars too much. Not exercising too soon also prevents you hurting yourself as well.
For some people, it only takes a few weeks, or sometimes even less than that, to really heal up and get back to normal. But that depends on the type of surgery you’ve had, as well as your body, because everyone heals differently.
Swelling can take anywhere between 2 weeks to 6 months to a year to fully calm down. So, if you’re not happy with your results, you might just have to be patient with it.
I know, it sucks, but you won’t really know what your chest will look like fully healed until around a year has passed.
There are things you can do to aid your healing, although each surgeon will have different suggestions to the last.
It’s always best to follow the instructions given to you by your surgeon. The suggestions below are just what other people have found useful for their own recoveries.
What you’ll need for recovery:
Comfort:
Slip on shoes
Button-up shirts/hoodies/shorts/joggers
Swim trunks for bathing
Lots of pillows
Airplane pillow
Tailbone pillow
Bendy straws
Step stool
Simple food, only drink water
Long scrub brush
Wet wipes (unscented)
Laptop table/tray table
Back scratcher
Entertainment:
Films/shows
Walks for exercise (daily)
Books/computer/video games
Podcasts
Medical:
Pain meds (Tylenol, not ibuprofen)
Silicon strips, gauze squares, medical tape, alcohol wipes for cleaning
Bio oil for scar care
Cough drops
Stool softeners/laxatives
Benadryl
Pill container/checklist to keep track/alarms
Hand sanitizer
Anti-nausea meds
Bromelain
Gloves
Anti-bacterial handwash
Two compression vests for washing
Grooming:
Dry shampoo
Second change of clothes for hospital just in case of overnight stay
Spray-on deodorant
Long-reach comfort wipe
Loofah on a stick (seriously - it helps)
Bar soap (both for washing in sink before being allowed to shower for days/weeks)
Washcloth
Day Before Surgery:
Pack second change of clothes
Wash with antibacterial soap, wash hair and everything else thoroughly
Re-read pre and post-surgical instructions
Write down any last-minute questions you might have
Day Of Surgery:
Shower one last time with antibacterial soap
Pack pillows, charging cables
Bin (for nausea)
Neck pillow
Get prescriptions before surgery to bring to surgery
Other Considerations:
Eating more fibre
Keeping up on pain meds
Elevating arms and legs
A bidet might be useful for staying clean in hard-to-reach places
You might need some drain holsters if your surgeon uses Jackson Pratt drains
Get in some walks, even if it’s just around the house
Don’t sleep flat, stay elevated
You’re not usually allowed to shower until the drains and nipple bolsters are gone
Milk of magnesia is useful for potential post-surgery constipation
Ask your doctor about bad signs to look out for in case of infections
You might have to wear a post-op binder for at least 3 weeks after surgery, maybe even an extra week for safety
If on antibiotics, you should ask for something to prevent yeast infections if you’re prone to getting them
Vaseline can be good for nipple grafts and incisions
Okay, so, that’s a lot to consider. But hopefully I’ve armed you with enough information that you’ll want to go and do even more research on the topic of top surgery, as well as figure out which top surgery technique you’re interested in. Or even if you’re interested in top surgery at all.
Now, moving down the body…
Hysterectomies
There are several types of hysterectomies, the difference between each being which part of the female reproductive system is removed.
The different types are: (From the NHS website)
Total hysterectomy – The womb and cervix (neck of the womb) are removed. This is the most common type of hysterectomy.
Subtotal hysterectomy – The main body of the womb is removed, leaving the cervix in place.
Total hysterectomy with bilateral salpingo-oophorectomy – The womb, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy) are removed.
Radical hysterectomy – The womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue. This is rare and comes with a higher complication rate.
What do each of these different parts do?
Womb (uterus) – The womb is where a baby starts developing, and the lining of the womb is shed during a period if it doesn’t get fertilized by sperm.
Cervix – This is the neck of the womb, where the womb meets the vagina; the cervix is the lower part of the womb and not a separate part.
Vagina – This is a muscular tube just below the cervix where blood comes from during a period.
Fallopian tubes – Tubes that connect the womb to the ovaries, helping eggs travel from the ovaries to the uterus.
Ovaries – Small organs by the fallopian tubes that release an egg every month, if the egg is unfertilized this leads to bleeding and thus, periods.
Why Would I Want a Hysterectomy?
Hysterectomies are often done to prevent or remove health issues in cis women. They can be difficult to get if you’re a healthy trans person assigned female at birth, but it isn’t impossible.
Common reasons for getting a hysterectomy:
To treat heavy periods, long-term pelvic pain, non-cancerous tumours (fibroids).
To prevent ovarian cancer, uterine cancer, cervical cancer or cancer of the fallopian tubes.
To prevent pregnancy.
To stop periods from ever happening again - Taking Testosterone doesn’t always stop periods in some people.
To lower the dysphoria of having female parts.
To get a Vaginectomy – Hysterectomies are often necessary to get a Vaginectomy, as it can be difficult for a doctor or surgeon to get to the female reproductive system if you end up having any health issues later down the line if a Vaginectomy has already been performed.
As one of several surgeries prior to getting a vaginectomy and bottom surgery, either Meta or Phallo.
So that you don’t need to go through smear tests – You can only avoid getting smear tests if you get the type of hysterectomy where the cervix is removed. (Total hysterectomy)
It might be possible to not get a hysterectomy and still have a vaginectomy, but this is very rare.
Which Type Of Hysterectomy Is Right For Me?
This can depend on your reasons for getting a hysterectomy in the first place.
If you need a hysterectomy to deal with specific health issues, it may be obvious which type you need based on where the issue is located, such as a radical hysterectomy to remove a dangerous, rapidly spreading cancer.
It’s best to ask a surgeon to explain to you the different types of hysterectomies and which one they think would best suit your case, as well as doing some research into what type of hysterectomy you would want the most.
A lot of trans people or trans men get everything taken out through a total hysterectomy with bilateral salpingo-oophorectomy, which is almost as common as a total hysterectomy. Getting a total hysterectomy with bilateral salpingo-oophorectomy will reduce the risk of certain cancers, or even eliminate the risk entirely, but it will also mean that you have to be on some sort of hormone replacement therapy for the rest of your life, whether that be Testosterone or Estrogen.
This normally isn’t a big issue, as most trans people already plan to be on hormone replacement therapy forever before they’ve even started hormones, so that the effects of hormones are permanent, as some effects or taking HRT go away if hormones are stopped.
In terms of surgical technique, getting a hysterectomy laparoscopically is normally the best method with the smallest amount of complications for most people.
How Do I Get a Hysterectomy?
Like how most trans medical care is done in the UK, you’ll normally have already been referred to an NHS GIC, who will have assessed you and agreed that a hysterectomy is right for you. You can be referred for a hysterectomy either through a GIC or a GP.
You might also be able to get a hysterectomy privately, but this can be very costly.
Some people prefer getting a hysterectomy this way because it can be difficult to convince doctors to operate and remove parts of the female reproductive system if there are no health issues present, such as heavy bleeding from periods or signs of cancer. This can be tiring, especially after having already been on lengthy waiting lists to get access to a GIC and other trans medical healthcare in the first place.
This is, again, very much up the individual.
Recovery
Like many things do, how difficult and lengthy recovery is depends on the type of hysterectomy you get, as well as whether it’s done laparoscopically, vaginally, or otherwise.
Alongside changing and developing technology over the years, most people get a hysterectomy laparoscopically, which is much easier on the body and has a much shorter recovery time than other types of surgical techniques.
Things you might need:
Tylenol – For the pain.
Laxatives – For any possible post-surgery constipation.
Stool softeners – Again, for the constipation.
Sweatpants/loose gym shorts – Putting any sort of physical pressure on your hysterectomy incisions is a bad idea, so be prepared to wear loose clothes for a while.
Hand grabber – It might be hard to reach things higher or lower than you for the first few months.
Pillows – To keep yourself elevated.
Blankets – For warmth, especially right after surgery.
You might also need certain things from the top surgery recovery list.
Recovering from a hysterectomy is different to any other surgery. It might take up to 3 months to fully recover, much like top surgery, but you might end up with a catheter for a day or so because different medications might make it hard for you to tell if you need to pee or not.
You might feel totally fine after a hysterectomy, but it can be dangerous to try to do normal day-to-day activities for the first few months because there’s still a lot of internal healing going on that you can’t see.
So don’t try to do things that your surgeon has advised you not to do just because you feel fine – you might end up hurting yourself or delaying your recovery.
Things To Consider & Possible Complications
While trying to decide whether or not you even want a hysterectomy in the first place, or what type of hysto you want, there are a few things you need to think about first:
Getting both ovaries removed means you won’t have any ‘backup hormones’ – You’ll have to take either Estrogen or Testosterone for the rest of your life, because the body needs one or the other to lower or prevent the risk of osteoporosis.
The type of hysterectomy you get is irreversible once you’ve had surgery – You’ll want to carefully consider all your options when choosing if you want a hysto, as well as which type of hysto you want. Once it’s done, there’s no going back.
Don’t let anyone rush you into a hysterectomy because they seem to know more than you – If something doesn’t feel right to you, trust your gut instinct and delay things if you need to.
Do as much research as possible around hysterectomies – Watch YouTube videos and look around places like Reddit (r/ftm) to find out about other experiences of getting a hysterectomy and if that’s something you feel okay with going through.
You may experience urinary issues for a few days from the catheter, ask your surgeon about any issues you’re having if you’re worried about them or they’re particularly bad.
Be prepared for some gas pain and potential bloating after surgery.
Potential complications: (From the NHS website)
General anaesthetic complications
Bleeding
Ureter damage
Bladder or bowel damage
Infection
Blood clots
Vaginal problems
Ovary failure
Early menopause
Some of these complications can happen to anyone during any surgery involving an area near the urinary tract or the bowels. This isn’t just limited to hysterectomies.
None of this is to convince you not to get a hysterectomy, as bad as I might be making it sound. It’s the opposite – you need to be informed enough to decide whether you want to go through possible complications and all of the work around getting surgery.
I personally think that anyone with a good enough support system can cope with surgery, and even if you’re going through this alone – you’re never really alone. There are different online communities and subreddits that you can look at for help and advice for anything related to being trans, as well as DMCs’ Resources page, for quick access to all of the links from all of our blog posts.
Please feel free to reach out in the comments section of our blog posts, through email, or talk to other trans people online and in person to ask for help with any issues you might be having.
Vaginectomy
A vaginectomy removes the vagina and closes up the vaginal walls. A hysterectomy is normally done at the same time or as a prior surgery.
Bottom surgeries such as Phalloplasty or Metoidioplasty are also often done at the same time to reduce or avoid urethral complications from just getting a vaginectomy alone.
From metoidioplasy.net:
What is a Vaginectomy?
A Vaginectomy is a Colpectomy plus a Colpocleisis, but the general term Vaginectomy is more commonly used.
Colpectomy: Removal of the vaginal lining (epithelium).
Colpocleisis: Fusion of the vaginal walls, which creates support for pelvic organs.
Essentially, a surgeon will take out the vaginal canal, cauterise the inside, and then sew up the outside so that there’s no hole there anymore. This means there’s no chance of bleeding from that area because you have to have your uterus taken out via a hysterectomy prior to a vaginectomy (the surgery site can bleed after surgery though) and a lot of trans men get a vaginectomy as part of bottom surgery to really reduce lower dysphoria.
You should be left with a male-looking, flat perinium, which lies between the anus and the urethra. Cis men have a flat perineum because they don’t have a vagina, where the flat perineum is what you should be left with.
Unless you don’t get urethral lengthening, which is where the urethra (what you pee out of) is redirected higher up. If you don’t get UL, you’re left with some vaginal depth, which is not ideal as a trans person who might not want any part of the female reproductive system left over.
Some trans men or people assigned female at birth don’t get a vaginectomy. This can be because they don’t have bad lower/genital dysphoria, or actually use their vagina sexually and get pleasure from doing so.
Every trans person is different, and you’re allowed to enjoy your body. Dysphoria can be different for everyone and doesn’t always involve every body part or secondary sexual characteristic like the chest or the vagina.
It might be a surprise to some people, but not every trans person walks around hating every part of themselves, although it’s fine if you do have a lot of dysphoria, because some people just do, and that’s exactly what treatments like HRT and surgeries are for.
Possible Complications Of a Vaginectomy
As with any surgery, there are a number of things that you need to consider and know about beforehand:
Urinary fistulas or infections.
Post-op bleeding, possibly requiring the use of pads or liners.
Catheter issues, which also increase risks of infections.
Bowel issues such as constipation from pain medications.
Positives of a vaginectomy:
The vaginal hole is closed up, resulting in a male-looking, flat perineum.
Things like discharge and periods are no longer an issue.
Smear tests and physical examinations are no longer necessary.
Lowers complications of bottom surgery and urethral lengthening.
Lowers or gets rid of dysphoria.
Chances of urinary or other types of prolapse are removed.
Chronic pain issues from the female reproductive system may be reduced or removed
Recovery
Depending on if the vaginectomy was combined with a hysterectomy, or other bottom surgeries, recovery and time off of work all depend on a multitude of factors, as well as how well your body heals compared to others.
Things like heavy lifting, bending down, or even horseback riding may be difficult for a few weeks or months. Certain things such as sitting down may be painful for even longer, or permanently, but this is rare.
Bottom Surgery
There are two types of bottom surgery, Metoidioplasty and Phalloplasty. Both are very big surgeries, and you should do as much research as possible to find out if one of them is right for you.
Leo Mateus explains how both types of surgeries work through illustrations on YouTube, so I’ll leave it to him for this topic:
Okay, so, generally Meta is safer and less complex than Phallo. It has less stages to it and uses what growth you already have from Testosterone to create a penis that you can pee out of.
Phallo requires skin grafts on the other hand, either from the forearm or the thigh. This extra skin is used to create the length that you can get from Phallo, which is why more people are more likely to choose Phallo over Meta, as the overall length is longer, and the appearance is more like a cis penis than with Meta, where things are generally a lot smaller and can’t be used for penetration during sex, if you want that.
Peeing standing up is a big reason people go for either type of bottom surgery, but is less guaranteed with Meta because it’s harder to clear your fly with a shorter length penis than the longer one you’d get from Phallo.
If you want surgery purely to pee standing up, Phallo is a better option, but has a higher chance of complications.
Complications also arise if you don’t get a Vaginectomy with either Meta or Phallo, as the urethra will have to be rerouted anyway, and if you keep your vaginal opening then more compications are likely to arise, but some surgeons will allow you to do so.
Sexual sensations are very different depending on which type of surgery you get. With Phallo, you would need one of many implants, and wouldn’t be able to get erect on your own without them.
With Meta it’s the opposite – you can feel sexual sensations on your own without the need for implants, which can have their own complications and require their own surgeries and recoveries for you to go through.
Testicular implants require their own surgeries, and are purely for aesthetic reasons, such as a more cis-passing penis. They won’t allow you to be able to produce your own sperm. For me personally, I think they’d just get in the way of things like sitting, but other people like the implants because they reduce lower dysphoria.
Just to break everything down:
Phalloplasty:
Is the creation of a penis through the use of skin grafts and multiple stages of surgery.
Has a higher rate of complications because of the need for multiple stages.
Produces a penis that appears more cis-passing, is longer in length and girth.
Gives you a better chance of peeing standing up.
Will require pumping or similar techniques to get erect as it is unable to allow you to do so alone.
Metoidioplasty:
Is the creation of a penis using the clitoral growth from taking Testosterone and is normally a single-stage surgery which doesn’t require skin grafts.
Has a lower rate of complications because of the lack of stages needed.
Produces a penis that is smaller in size but less likely to pass as cis.
Gives you less of a chance of peeing standing up, but it is still possible.
Will allow you to naturally get erect without the use of any aids.
Both surgeries:
Require a stay in hospital.
Require the use of a catheter.
Have similar risks and complications.
Should ideally be performed with a prior hysterectomy and then a vaginectomy to avoid a higher chance of complications.
Often involve Urethral Lengthening, which allows you to pee standing up.
As you can see, both Metoidioplasty and Phalloplasty have positives and negatives to them that differ depending on personal preference and willingness to go through multiple surgeries and stages.
It all depends on the person, which is what I’ve been saying about every surgery I’ve mentioned in this post – because it’s true!
Conclusion
You should do further research into the different things you’ve read about today, as well as talking to professionals such as surgeons and gender specialists, to really understand if you want surgery, which surgery you want, and why.
Hopefully I’ve given you a good enough starting point and talked about some things that other places on the Internet might skip over. You don’t see a lot of vaginectomy talk online, for instance.
As always, everything linked to in this post will be on our Resources page for ease of access.
