Gender-Affirming Phalloplasty

Phalloplasty for transgender and gender diverse individuals is a complex procedure that involves construction of a phallus and, oftentimes, a urethra. Surgical goals may include an aesthetic phallus and scrotum, standing micturition, and the ability to engage in penetrative intercourse. Procedures include metoidioplasty (lengthening of the hormonally hypertrophied clitoris), urethral lengthening, pedicle or free tissue transfer, monsplasty, penile and/or scrotal implants. An individualized approach helps tailor the procedure to patient-specific goals. Complications include flap and/or urinary sequelae. Despite challenges, satisfaction and quality of life improvements remain high.