Phalloplasty
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Phalloplasty is the construction or reconstruction of a penis, or the artificial modification of the penis by surgery. A phalloplasty creates a full-size penis like that of a cisgender man for patients who had a clitoris (such as transgender men and nonbinary people who were assigned female at birth), or a natural but different shape of penis (such as micropenis, epispadias, and hypospadias, which can be intersex conditions), or a damaged or lost penis. With all types of phalloplasty in trans men and transmasculine nonbinary people, scrotoplasty can be performed using the labia majora (vulva) to form a scrotum where prosthetic testicles can be inserted. If the patient has not had a removal of their vagina (vaginectomy), uterus (hysterectomy), and/or ovaries/gonads (oophorectomy), then these can be done at the same time. However, it is not necessary to have had these other surgeries done in order to have a phalloplasty. There are people who have had a penis created by phalloplasty while still keeping their vagina, uterus, and/or ovaries/gonads.
History
The Russian surgeon Nikolaj Bogoraz performed the first reconstruction of a total penis using rib cartilage in a reconstructed phallus made from a tubed abdominal flap in 1936.[1][2][3] The first phalloplasty done for the purposes of sexual reassignment was performed in 1946 by Sir Harold Gillies on fellow physician Michael Dillon, a trans man. His technique remained the standard one for decades. This is documented in Pagan Kennedy's book The First Man-Made Man. Later improvements in microsurgery made more techniques available.
There are different techniques for phalloplasty. Construction of a new penis (sometimes called a neophallus) typically involves taking a tissue flap from a donor site (such as the forearm). Extending the urethra through the length of the neophallus is another goal of phalloplasty.[4].
Temporary lengthening can also be gained by a procedure that releases the suspensory ligament where it is attached to the pubic bone, thereby allowing the penis to be advanced toward the outside of the body. The procedure is performed through a discreet horizontal incision located in the pubic region where the pubic hair will help conceal the incision site. However, scar formation can cause the penis to retract. Therefore, the American Urological Association "considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious."[5]
As of November 2009, there is research in progress to synthesize corpora cavernosa (erectile tissue) in the lab on rabbits for eventual use in patients requiring penile construction surgery. Of the rabbits used in the preliminary studies, 8 of 12 had biological responses to sexual stimuli that were similar to the control, and four caused impregnation.[6]
Penile implants
Phalloplasty requires an implanted penile prosthesis to achieve an erection. Penile prostheses are implanted devices intended to restore the erectile rigidity in biological amen and to build a neophallus (new penis) in trans men. Penile implants were used in