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Failed Surgical Creation of Phalli in Women
Transgender Misadventure Leads to Frequent, Serious Complications
By Peter A. McCullough, MD, MPH
As flags are flying high for Pride Month, I am reviewing the literature on transgender surgeries and bringing you the results. Unfortunately, for women who are attempting to look like a man, surgical creation of a penis has been an elusive fantasy.
Robinson et al, reported on 129 women who underwent attempted surgery to either create a penis or make a sensitive phallus structure for sexual pleasure. 129 patients underwent genital reconstruction surgery. Seventy-nine patients (61 percent) underwent phalloplasty only, 32 patients (25 percent) underwent metoidioplasty only, and 18 patients (14 percent) underwent metoidioplasty followed by phalloplasty.
Patients reported 281 complications requiring 142 revisions. The most common complications were urethrocutaneous fistula (n = 51, 40 percent), urethral stricture (n = 41, 32 percent), and worsened mental health (n = 25, 19 percent). The average erect neophallus after phalloplasty was 14.1 cm long vs 5.5 cm after metoidioplasty (P < .00001). Metoidioplasty patients report 4.8 out of 5 erogenous sensation, compared to 3.4 out of 5 for phalloplasty patients (P < .00001).
Patients who underwent clitoris burial in addition to primary phalloplasty did not report change in erogenous sensation relative to primary phalloplasty patients without clitoris burial (P = .105). The average postoperative patient genital self-image score was 20.29 compared with 13.04 for preoperative patients (P < .00001) and 21.97 for a historical control of normal men (P = .0004).
In summary these surgical complications are far to frequent and very serious. Genital reconstruction surgery in women attempting to create phalli and take on the appearance of a man should be abandoned.
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Robinson IS, Blasdel G, Cohen O, Zhao LC, Bluebond-Langner R. Surgical Outcomes Following Gender Affirming Penile Reconstruction: Patient-Reported Outcomes From a Multi-Center, International Survey of 129 Transmasculine Patients. J Sex Med. 2021 Apr;18(4):800-811. doi: 10.1016/j.jsxm.2021.01.183. Epub 2021 Mar 1. PMID: 33663938.