Penile Implants for Transgender Patients: Expert Surgical & Recovery Guide

One of the primary challenges in penile implantation for transgender men is the differences in anatomy between a cisgender penis and a phalloplasty. Unlike a natural penis, a phalloplasty lacks certain anatomical structures, such as the corpora cavernosa, which are traditionally used to house implant cylinders.

To ensure a successful implant surgery, preoperative evaluation must include:

• Assessing the quality of the phalloplasty – Ensuring the structural integrity of the neophallus is crucial. Any unresolved complications from prior surgeries, particularly urethral strictures or fistulas, must be addressed beforehand.
• Evaluating the urethral reconstruction – Since urethral complications are common, ensuring a stable and functional urethra before implant surgery is vital.
• Managing patient expectations – Unlike cisgender men, transgender patients may experience different implant outcomes regarding sensation, rigidity, and penetration ability. Clear communication about realistic expectations is key.

Postoperative care begins before the surgery. Patients who are well-counseled on their implant type and functionality tend to have smoother recoveries.

Key postoperative considerations include:

• Hospital Stay – Most patients stay overnight with a catheter and surgical drain to prevent hematomas.
• Inflation Protocol – Unlike in cisgender implant surgeries, transgender implants are often kept partially inflated for 1-2 weeks to maintain shape and prevent contraction. Patients are advised to wear loose clothing (e.g., sweatpants) during this period.
• Activity Restrictions – Patients should avoid strenuous activities and exercise for several weeks to prevent complications or device displacement.
• Long-term Maintenance – Regular activation of the device (inflating and deflating every 1-2 weeks) ensures proper function and prevents tissue shrinkage.

Traditional penile implants are designed for cisgender men, where the implant cylinders are inserted into the corpora cavernosa. However, in transgender men, the neophallus lacks these structures, requiring innovative techniques:

• Creating space for the cylinders – Since there are no natural corpora cavernosa, surgeons must dilate soft tissue carefully while avoiding damage to the phallus’s vascular structures.
• Securing the implant – Stability is crucial. The implant base is typically fixed to the pubic bone to prevent migration, ensuring rigidity suitable for penetration.
• Enhancing tissue support – Some surgeons use vascular grafts or customized prosthetic components to reinforce the implant and reduce the risk of extrusion or erosion.

Penile implants for transgender patients require ongoing care to prevent complications and ensure long-term functionality.

• Regular cycling of the implant (inflation/deflation) helps maintain penile shape and function.
• Scar tissue management is critical, as excessive fibrosis can reduce implant effectiveness.
• Infection prevention – While rare, infections can occur. Maintaining proper hygiene and monitoring for redness, swelling, or fever is essential.
• Handling mechanical failures – Implants are highly durable, but should be checked periodically for leaks or pump malfunctions.

Many transgender men seeking penile implants have undergone previous gender-affirming surgeries. These prior procedures may introduce complexities such as:

• Scar tissue from previous phalloplasties – May affect implant placement and necessitate additional tissue reconstruction.
• Nerve function considerations – Sensation varies widely among patients. Some may require additional nerve grafting to optimize function.
• Managing urethral complications – Urethral strictures or fistulas must be resolved before implantation to minimize post-op complications.

The psychological aspect of penile implants is just as crucial as the physical outcomes. Patients should receive comprehensive counseling on:

• Realistic sexual function – The implant provides rigidity, but may not restore full sensation if nerve endings are not well-integrated.
• Partner communication – Educating partners on the implant’s functionality and limitations can reduce anxiety and enhance intimacy post-surgery.
• Sexual rehabilitation – Patients may benefit from gradual reintroduction to intimacy and pelvic floor therapy.

The field of penile implants is rapidly evolving, with new advancements that could further benefit transgender patients.

• Custom-designed implants – Companies are developing implants tailored specifically for transgender anatomy, improving fit and function.
• Enhanced sensory feedback – Research into nerve integration techniques could restore more sensation to the neophallus.
• Biodegradable scaffolds – These may help create better structural support within the neophallus, reducing risks of migration or extrusion.