Physical Recovery Process Following Phalloplasty

I’d like to know more about the physical and emotional recovery process from phalloplasty…

TW discussion of wounds, and other injuries

Here’s the link to my primer to lower surgeries.

I’ve previously written in humourous terms about my recovery process, and expanded on stigma and horizontal hostility towards lower surgeries.

I elaborated on dysphoria in the lead up to and in between lower surgeries as well as post-op depression here and things that help me build resilience to it here.

I’ve written about Sex Following Lower Surgeries, as well as anxiety I experience with cis queer women, STBBI and PrEP considerations.

I can’t think of anything to add on the psychosocial side of things, but let me know if there is something else you’d like to know.

Physically, your mileage will vary. It depends on one’s overall health history, choice of surgical technique (e.g. pedicle vs free flap), what was done, using which donor site(s), how much of it was combined, and how it healed. The order in which things are done can vary a great deal pending surgical team and technique. About the only constant is that the penile implant, for those who get one, will be the last thing done to minimise the risk of infection to the rod(s).

Following discussion with countless guys, it is safe to say there is no universal agreement on what hurts most. For some it’s the closure or removal of the frontal cavity, for others it’s the penile implant, and there are those who say something else entirely. Whatever it is, don’t be stubborn about it, do everything you can to manage your pain as well as possible. There’s no gold star for enduring more than others, and it can lead to some of the worse complications. If like me, you have a high pain threshold, look for other signs that your body is struggling, you may think it’s a blessing but following surgeries, it can backfire to miss or dismiss an earlier cue of discomfort.

Personally, the worse of my pain was due to an allergic reaction to one of the post-op medications following stage 1. If there can be said to have been a silver lining, it was that it took a week or so for the reaction to manifest. The worse of the pain from colpocleisis was behind me, and while my donor site was still very tight and sore, no contest the worse was the feeling that my skin through out my body was on fire. I spent a lot of time in cold water and taking antihistamine to flush out the offending medication.
Good news: this is a rare occurrence; I don’t know anyone else who’s experienced this following lower surgery.

The second worse pain I experienced was the 1st time I deflated my penile implant. In discussing with other guys who have inflatable rods, it’s clear there’s a fair bit of variation with this surgical process. Mine was left partially inflated following surgery. A few weeks later, it was deflated for the 1st time. The pump is of course placed right next to the incision made to insert it, with the net result being that a fairly fresh incision, or the skin immediately next to it is being squeezed very hard. Your scrotum is still tender and swollen from the surgery, when this insult to injury occurs. Bring a stress ball, possibly a gag ball, and remember the nurse cares about you even as you see stars from the intense pain.
Good news that comes too late: the pain dissipates fairly quickly, but there’s no way around it. Also, the pain decreases the more the incision heals and the post-op swelling comes down, eventually it’ll be painless.

The third worse pain I experienced were bladder spasms. Thank goodness, I didn’t experience them every time I had a catheter, just the once. This was a pain I didn’t pick up on fast enough, and I nearly wrecked myself, literally. They’re quite common when we have a Foley catheter in for a while, and it’s our bladders trying to expel it. In theory, the catheter balloon that keeps it inside the bladder prevents that but it doesn’t mean some urine won’t circumvent the catheter and thus be running along a newly created urethral extension. The pee will probably come out looking more brown than yellow, not from kidney failure, thank goodness, but from mixing with the blood in your healing urethra.  If the spasms aren’t managed via medication soon enough, your internal urinary sphincter might expand enough, in which case the catheter balloon, which is designed to be bigger than your urethra while in your bladder, will be tearing through your newly created urethral extension.
Take away: at the first sign of a tug after you’ve finished emptying your bladder via the flip valve or bladder cramping -> tell your surgeon, even if you’re managing the discomfort reasonably.
Once you start taking the most commonly prescribed medication to handle it, graft a water bottle to your hand to deal with the dry mouth until your catheter’s removed.
Bad news: this is a common problem following urethraplasty.

A pain that wasn’t intense but persisted a long time were to my donor sites. Whichever donor site is used, the penis must have proper blood circulation. The artery relocated to this end used to serve a function. They obviously don’t remove the only artery supplying blood at your donor site, but you may find the first year or so you get pins and needles there much more frequently, especially when exercising. Eventually your body learns to compensate as much as it can and the problem largely dissipates, but none the less, it will take less to get pins and needles in your donor site than before.
A related problem is the loss of sensation to donor sites. This may be partial numbness in some areas or total in others. I’ve known more than 1 guy who ended up with some nasty burns and cuts to their donor sites from not feeling injuries as they occurred and finding out too late. You have to become mindful that you won’t necessarily be able to tell if you’re getting injured and act accordingly.

Otherwise, do your best to abide by all the post-op care instructions, don’t push yourself too much too soon, and make good art through the worse of the recovery.