Frequently asked questions

Female-to-male

What methods of phalloplasty do you use and what are the functional results?

We perform phalloplasty with a so-called free forearm flap. The patient can urinate standing up after the operation on the 12th day. Sexual sensitivity is preserved because the clitoris (clit) is not removed in our method. All surgical steps are performed in one session.

Why do you perform all surgical steps in one session?

This procedure, the all-in-one surgery, significantly reduces the duration of the entire inpatient stay, and of course also the number of surgeries. An essential consideration is also the rapid restoration of full working capacity. It is always claimed that the risks increase due to multiple surgery, but with careful organization, good teamwork and very great experience, it is possible to perform individual surgical steps with several surgical teams at the same time without extending the total surgical time. One-stage surgery also avoids scarring adhesions in the vaginal area, which are disadvantageous in a second operation. If the breast is removed at the same time, we can use the excess skin for coverage and, if necessary, do without other skin removal sites (fewer scars). Not to be forgotten are stress factors that are eliminated when the patient has to undergo surgery only once.

Do you work with microsurgery?

Yes. In phalloplasty, the penoid is formed from skin and subcutaneous tissue, including nerves and blood vessels of the forearm (called the forearm flap) in a microsurgical surgery.

How many surgeries are necessary until a final result?

At Klinik Sanssouci Potsdam, two surgeries are necessary for complete female-to-male gender reassignment: The first surgery includes removal of the uterus (hysterectomy), removal of the ovaries and fallopian tubes (ovarectomy, adnectomy), removal of the breast (mastectomy), removal of the vagina (colpectomy), and penoid reconstruction (phalloplasty). In a second surgery (about eight to ten months after the first surgery), an erectile prosthesis and a silicone testicle are implanted into the newly formed scrotum.

How long does a patient have to stay in the clinic?

For the first surgery, during which the penoid reconstruction (phalloplasty) takes place, you will need to plan for about 14 to 16 days of hospitalization.

What is the sensitivity of the penoid (neophallus)?

The sensitivity, i.e. the sensation of the penoid, corresponds to normal skin sensitivity, comparable to the sensitivity of the skin on the forearm. Sensitivity is achieved by the ingrowth of nerves about eight to ten months after the initial surgery. Some erotic sensitivity, starting from nerves of the clitoris, is also possible.

What happens to the clitoris? Will it be removed or how will this important organ be preserved?

During the phalloplasty surgery we preserve the clitoris completely and with it the sensitivity and sexual experience. We achieve this by only removing (deepithelializing) the clitoris from its epidermis, placing it at the base of the penoid and only covering it with skin so that arousal is possible as before the procedure. We do not consider the removal of the clitoris to be useful.

Have serious problems occurred at the forearm collection site?

No. In the first days and weeks after the phalloplasty surgery, the hand may swell a little and become thicker. Then you should keep it elevated. We also recommend regular exercise of the hand. Serious, for example motor (movement) problems have not occurred – even fine motor movements of the hand are not affected.

Where are scars found on the penoid and are they visible?

The only scar that will be visible on the penis is on the back of the penoid, so it will not be visible from the front.

Is there an acorn buildup? And when does it take place?

Yes, glans reconstruction (glansplasty) is performed as standard together with phalloplasty in the first procedure.

Male-to-female

Will a sensitive clitoris be created and how is it done?

Microsurgically, while preserving the blood vessels, a clitoris is constructed from a portion of the glans (penis) in such a way that it is sexually aroused and placed in a typical location.

Are additional surgeries performed at the same time and what are they often?

If desired, we perform breast reconstruction, i.e. implantation of a silicone prosthesis, in the same session. If desired, a thyroid cartilage reduction is also possible. These procedures extend the total operation time only insignificantly.

Will follow-up procedures be necessary and how often?

Due to invagination of the original penile skin for the construction of the neovagina, there is often a fold at the posterior vaginal entrance, which we leave intraoperatively in order not to endanger blood circulation and thus good healing of the penile skin in the pelvis. Therefore, in about 30% of our patients we perform a widening of the vaginal entrance about 3-6 months after the initial procedure. During this procedure, small labia are formed at the same time and, if desired, the clitoris is reduced in size. As a rule, the clitoris is created during the initial operation in such a way that the safety of blood circulation and sensitivity are ensured, so that for many patients the clitoris primarily appears to be somewhat large. This is corrected during the follow-up surgery.

Are other procedures performed in your clinic for optical adaptation to the female gender?

Reduction of the larynx can be performed. Likewise, nose correction and other procedures from the repertoire of aesthetic plastic surgery are possible.

When is sexual intercourse possible after surgery?

There is no set rule, but medically it is possible to have normal sexual intercourse about 6 weeks after surgery.

Where are visible scars found?

There are scars only on the labia majora, which are formed by reduction of the scrotum.

At what point is vaginal dilatation possible and do you use a so-called stent?

After surgery, a loose tamponade is inserted into the neovagina, which is replaced on the 5th to 6th day. Careful stretching with a small dildo is possible about 10 to 14 days after surgery. It is not necessary to use a stent.

Can there be problems with sexual intercourse after surgery?

Every transsexual patient should keep in mind that the pelvis of a man is much smaller and narrower than usually the pelvis of a so-called biological woman. In addition, the pelvic floor muscles are usually more strongly developed and not as soft and stretchy as in bio-women. For these reasons, it is not uncommon for muscular constriction to occur, which can persist over a longer period of time and can also lead to difficulties during sexual intercourse. Consistent stretching and relaxation is helpful in this case.