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.