Prosthetics after genital surgery
After genital surgery for masculinisation, prosthetics can be placed. Prosthetic testicles are possible after metoidioplasty and phalloplasty. Erectile devices are possible after phalloplasty. In order to place the prosthetics, another operation will be needed. However, perhaps you do not — or not yet — wish to be operated on, again. On this page, you will find information about the various options that do not involve surgery and about the functions of the various prosthetics.
No operation (yet)
Perhaps you do not or not yet wish to undergo surgery for placing prosthetics or you are on a waiting list to have one fitted. You can also or in the meantime make adjustments to your body; these are known as the non-medical options.
Instead of an erectile device, there are other ways that may enable penetration; it may be possible to get the penis hard enough using a 'normal' tight condom. There are also special condoms, such as a exocondom or a firm penis sleeve. These devices will fit over your penis.
An exocondom consists of a silicone shell and a hardened top. This allows you to strengthen the penis allowing penetration. You can have an exocondom custom-made so that it fits perfectly and meets personal preferences. The price will be around 350 euros. One of the providers is Vigo Group.
A penis sleeve is pulled over the penis making it possible to penetrate. Penis sleeves come in many shapes, materials and sizes. Prices can, thus, vary enormously. Several providers can be found via Google.
About prosthetic testicles
Prosthetic testicles are placed in the scrotum. If you are considering such prosthetics, they could be fitted at least six months after your most recent genital surgery. In addition, there needs to be sufficient room inside your scrotum for these prosthetics and you must still be able to urinate properly, which will be assessed by your physician.
Clarifying explanations about testis prostheses can be found in Amsterdam UMC's animation video.
A safe operation and the best result requires that you are not (or no longer) a smoker and have a healthy body weight (BMI values of between 18 and 30). To calculate your BMI yourself, please see the website of the Netherlands Nutrition Centre: Voedingscentrum.
Possible complications during or after the procedure
Complications may arise during or after placement of such prosthetics — even though the operation was performed correctly. Possible complications are post-operative haemorrhaging or infection. A prosthetic may also spontaneously work its way out, which is called erosion. In most cases, the prosthetics then have to be removed. If necessary, they can be replaced at a later stage.
Sometimes, after the operation, the prosthetics may turn out to be in an incorrect position within the scrotum. This may cause complaints. A correction can be made to improve this.
About the erectile devices
An erectile device can be placed inside the body after phalloplasty. This means that it is invisible from the outside. Erectile devices will generally lasts between 5 and 10 years. The urologist and sexologist will talk with you about your wishes, your sexual functioning, and your expectations concerning the prosthetics.
Clarifying explanations about erectile devices can be found in Amsterdam UMC's animation video.
Preconditions erectile devices
If you are considering an erectile device after your phalloplasty, this can be done no sooner than at least one year after your most recent genital surgery. In addition, you must be able to urinate properly and your penis must have a suitable size for the device to work properly. The physician will assess your urinary function and size.
Before the operation, you will also have a consult with a psychologist specialised in sexology. This can be the psychologist who is guiding you in this process. During this consultation, you will discuss the surgical technique that you are interested in and whether the required operation is feasible given your psychological and physical condition.
A safe operation and the best result requires that you are not (or no longer) a smoker and have a healthy body weight (BMI values of between 18 and 30).
After the operation, the erectile device may try to work its way out. It is therefore important that you have feeling in the tip of your penis, which increases the likelihood that you will notice the pressure against the skin, early on. After phalloplasty, it may take at least a year before sensation is restored in the penis. A sensitivity test can be used to assess whether sensation has been sufficiently restored.
Types of erectile devices
There are different types and brands of erectile devices. Some are designed specifically for trans men who have undergone phalloplasty (e.g. Zephyr Surgical Implants).
There are two types of devices:
- ‘Flexible’ erectile devices. This prosthetic device is also called 'semi-rigid' or 'inflatable'. It consists of a rod that can be bent into the desired position. It can be straightened and bent, manually. If you would also like to have prosthetic testicles, these must be placed, separately.
This type of erectile device is easy to use and lasts a long time. A disadvantage is that the penis is always slightly hard, which can be more difficult to hide, for example in tight trousers or swimming trunks. This type of prosthetic also involves continuous tension on the skin, which increases the risk of the device protruding through the skin.
- Hydraulic erectile devices. These devices require a small balloon to be placed in the lower abdomen, which contains a fluid, and a pump that is placed in the scrotum. Squeezing the scrotum makes the penis hard. By pressing on the tip of the pump the prosthetics deflate again, bringing the penis back a flaccid state.
The pump is also a filling for the scrotum. If you also want prosthetic testicles, you will only require one testicle to be placed.
This type of erectile device can simulate both a flaccid and hard state. In addition, it reduces the tension on the skin and therefore also decreases the likelihood of the device protruding through the skin.
Possible complications during or after the procedure
Complications may arise during or after placement of such devices — even though the operation was performed correctly. Possible complications are post-operative haemorrhaging or infection, in which cases the device usually needs to be removed. Once the area has healed properly again, the device can be reinserted. You may furthermore also experience pain in the pubic region or you may feel where the device is attached.
The device may also malfunction, dislocate or spontaneously work its way out because of the amount of pressure on the skin. In such cases, the device will need to be removed. However, at a later stage, a new attempt can be made to reinsert it. The tip of the penis may droop if the device is too short. This may lead to problems with penetrative sex.
A hydraulic erectile device can also cause complications in the abdomen, such as haemorrhaging, infection or damage to surrounding organs.
1. 'Flexible' erectile device
2. Hydraulic erectile devices
The operation
You will be screened by the anaesthetist at least one week before the operation, to make sure that anaesthesia can be induced, safely. On the day of surgery, the surgeon will first come to see you to discuss where the incision will be made. In doing so, any existing scars will be used as much as possible.
Health insurance
At the time of writing (2022), the placing of erectile devices is covered by Dutch health insurers. The reimbursement amount for prosthetic testicles differs per insurance company. In case of doubt, please contact your health insurance company, in advance.
Aftercare
After surgery, you are advised to wear your penis in upright position for the first two weeks. You should not swim, take a bath or go to the sauna for the first two weeks after surgery. This is to prevent the stitches from dissolving too soon and the wounds from opening up. Brief showers are allowed. You will visit the outpatient clinic for a check-up after four weeks, and you are advised to refrain from sexual intercourse until after the outpatient check-up.
In cases of pain and discomfort, paracetamol is recommended. However, if the pain increases or there is swelling or redness around the area of the surgery, please contact your clinic/physician.
Secondary corrections
If, after the operation, you are not completely satisfied with the appearance or function of your genitals, then please discuss this with your plastic surgeon or urologist. They will be able to tell you whether another operation could lead to improvements. An example of such a secondary correction is a correction of the urethra, to improve the flow of urine or to eliminate leaks. A correction of the scrotum may also be desirable if the scars are very visible or if the scrotum is too small or asymmetrical.
Generally speaking, secondary corrections are not performed within the first 6 months after surgery. It is recommended to wait at least one year.
Examples of secondary corrections
Urethra correction
If the urine flow is in a wrong direction or there is narrowing of the urethra (stenosis), a correction may be helpful. There could also be leakage from the urethra that needs to be repaired. Discuss the treatment options with your plastic surgeon and/or urologist. In principle, urethra corrections are covered by health insurance.
Shape of the penis / creating a glans
If the shape of your penis is not as desired, or if the glans has not been created yet, this can be done as a secondary correction. A glans can also be tattooed on the tip of the penis; this is a minor procedure performed under local anaesthesia. Discuss the treatment options with your plastic surgeon. Contact your health insurance company to find out more about reimbursement.
Correction scrotum
A correction of the scrotum may be desirable, if the scars are very prominent or if the scrotum is too small or asymmetrical. Discuss the treatment options with your plastic surgeon.
If necessary, prosthetic testicles can be placed in the scrotum at a later date. Please contact your health insurance company for information about reimbursement.
Erectile device
If, for you, penetration during sex is very important, but this is not functioning properly, then it may be possible to have an internal erectile device fitted — no sooner than at least one year after the operation. This is possible only if the following preconditions are met: (1) There must be feeling in the penis up to the tip. This can be assessed by way of a sensitivity test. (2) urinary function must be good. Erectile devices are covered by most health insurance companies as they fall under the basic health insurance policy.
More information about erectile devices can be found here
Prosthetic testicles
Prosthetic testicles can be placed in the scrotum at a later date. Whether or not this procedure is covered by health insurance varies per insurance company.
More information about prosthetic testicles can be found here
This text was edited on 18-10-2022
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