Phalloplasty and Metoidioplasty

OHSU offers the highest level of expertise for phalloplasty and metoidioplasty.

At OHSU, you will find:

  • A wide range of gender-affirming options to suit your individual needs and goals.
  • Care from a supportive team of skilled providers.
  • Peer volunteers who can provide support during visits.

OHSU also offers the following bottom surgery options. In addition, we welcome you to request a procedure that isn’t listed on our pages.

Dr Jens Berli in a hospital room
Dr. Jens Berli, an internationally known plastic and reconstructive
surgeon, is passionate about caring for gender-diverse patients.

Preparing for surgery

Please see our patient guide page to learn about:

  • Steps to surgery
  • WPATH standards of care
  • The letter of support needed for some surgeries

Phalloplasty

Dr. Blair Peters.
Dr. Blair Peters

Phalloplasty creates a phallus with tissue from elsewhere on the body. At OHSU, plastic surgeons Jens Berli and Blair Peters work with reconstructive urologists to do the stages of this surgery. OHSU's Dr. Geolani Dy places erectile devices and testicular implants after phalloplasty.

Phalloplasty can be done many ways. At OHSU, we have adopted and modified a method developed by surgeons at St. Peter’s Andrology Centre in London.

Our surgeons have extensive experience, doing more than two dozen a year. They maintain a database of phalloplasty surgeries to aid research and improve outcomes.

They have also published and lectured on phalloplasty nationally and internationally, and they are recognized as world leaders in sensory outcomes.

Phalloplasty, in ideal circumstances, enables patients to:

  • Have a body that more closely aligns with their gender
  • Have a natural-looking phallus with sensation and pleasure
  • Have an erection with an external or internal device, and intercourse
  • Urinate while standing

OHSU phalloplasty resources

Phalloplasty stages and types

We understand that no two patients are exactly alike. Your pathway may include some options and not others. You may choose to keep the vagina, for example. Our supportive care team will discuss what’s right for you.

A phalloplasty may include some or all of these procedures.

  • Creation of a shaft
  • Creation of a urethra within the shaft (shaft urethra)
  • Creation of a segment of urethra, called a perineal urethra, to connect the existing urethra to the shaft urethra
  • Scrotoplasty (creation of a scrotum)
  • Vaginectomy (removal of the vagina)
  • Burial of clitoral tissue
  • Glansplasty (creation of a circumcised-appearing tip)
  • Erectile device implant (inflatable or semi-rigid)
  • Testicular implants
  • Tube-within-a-tube phalloplasty: We use one piece of tissue to form two tubes. One has skin on the outside for a shaft, and one has skin on the inside for the urethra. The tissue usually comes from the forearm. In very thin patients, it can come from the thigh.
  • Shaft phalloplasty: Only an outer tube is created, and the patient continues to urinate from their existing urethra. Patients can still choose to have the vaginal lining removed; creation of a scrotum; and burial of the clitoris. Or they can have a scrotum created while keeping the vaginal canal. All donor sites (where tissue is taken from) are options.
  • Composite phalloplasty: This is an option for patients who aren’t good candidates for a tube-within-a-tube phalloplasty. The surgeon uses two pieces of tissue, usually from the thigh and forearm, to create the shaft and urethra separately.
  • Revision surgery: Patients who had an unsatisfactory phalloplasty done elsewhere can come to us to have it corrected.
  • Radial forearm free flap: This is the most common. We take skin, blood vessels and nerves from the forearm. This provides sensitivity and a natural appearance.
  • Anterior lateral thigh flap: Tissue including skin, blood vessels and nerves comes from the side of the thighs. Whenever possible, the blood supply is left attached (pedicled flap), and only the nerves are cut and reconnected.
  • Abdominal flap: Lower abdominal skin is used for a shaft-only phalloplasty. This technique does not involve nerves, and patients do not have the ability to urinate standing.
Dr. Jens Berli in surgical scrubs.
Dr. Berli, an expert phalloplasty surgeon, is dedicated to providing affirming care.

Phalloplasty: Surgery sequence

Phalloplasty typically requires multiple steps, though there are many variations. Your surgeon will discuss options with you. Steps may include:

First surgery: The plastic surgeon grafts tissue, and forms and attaches the new phallus.

Second surgery, about five months later: Depending on choices, the plastic surgeon and/or urologist:

  • Removes the vagina (this is always done by our urologic team)
  • Connects the urethra
  • Creates a scrotum
  • Forms a circumcised appearance (glansplasty)
  • Places two temporary catheters (thin tubes), one through the phallus and one through the abdomen

Third surgery, about six months later (if a patient chooses these options):

  • Testicular implants placed
  • Erectile device implanted

Recovery and rehabilitation

You will probably be in the hospital for a week after your first surgery. You should limit walking and strenuous activity for up to six weeks. Your second surgery comes with a two-night hospital stay. The implants are offered as an overnight-stay surgery.

Out-of-town patients: Because these surgeries are not widely offered, many patients travel from outside the area. We typically require patients to stay in the Portland area for four weeks after the first surgery and two weeks after the second. Patients also need to return four weeks after the second surgery to have their catheter removed. In addition, we ask patients to be prepared for an extended stay in case complications arise or healing is delayed.

Rehabilitation: OHSU occupational therapy specialists offer arm splints to help manage pain from forearm surgery.

Risks: Phalloplasty is complex, increasing the risk of complications. Risks include a narrowed urethra or urine leaks, infection, scarring, lack of sensation and the death of transferred tissue.

Expectations: It’s also important to have realistic expectations. Appearance can vary depending on your anatomy and tissue.

Metoidioplasty

In a metoidioplasty, a surgeon crafts a phallus from existing tissue in the genital region. At OHSU, this is done by reconstructive urologists.

OHSU metoidioplasty resources

How metoidioplasty is done

A year or two of testosterone therapy typically causes the clitoris to grow, sometimes to 1 or 2 inches. The surgeon can separate the clitoris from surrounding tissue to make it longer and to position it as a phallus.

Patients may choose to have their urethra lengthened and placed in the phallus so they can urinate from their phallus while standing up.

Recovery

Some patients go home the same day, and some spend one or two nights in the hospital. You may need to be off work and avoid travel for a couple of weeks.

Considerations and risks

Metoidioplasty has a lower risk of complications than phalloplasty. Risks include leaking or narrowing of the urethra, and persistent pain or sensitivity.

Results are different for everyone, but these are common:

  • Patients usually retain sexual sensitivity and can have an erection, though penetration may be difficult.
  • It’s possible to have a phalloplasty later on.

For patients

Request services

Other questions and concerns

Refer a patient

Peer volunteers

Learn about our Here4You peer volunteers. We pair patients with a peer, based on availability, for support through surgery.