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Postop Phalloplasty:

Phallus Concerns

Phallus positioning: how should it be positioned?

  • For the first 2 months after phalloplasty, it is generally helpful to position the phallus about 45 degrees from the plane of your body. This can be achieved with a washcloth and/or gauze (helps create a “bean bag” for the phallus). You don’t want to compress the phallus, but you don’t want it to freely hang either; there’s a happy medium of phallus support.

  • When sleeping, do your best to avoid putting undue pressure on the phallus and scrotum. It’s probably safest to rest on your back with the phallus propped up 45 degrees with a washcloth and/or gauze.

  • When walking, it’s helpful to have a washcloth and/or gauze in slightly loose boxer briefs or hospital underwear to achieve the ideal positioning of the phallus.

  • NEVER position the phallus up and towards the side of the groin incision; this may lead to compression of the blood supply to the phallus and lead to loss of the phallus.

Phallus positioning: when can I let it hang freely?

  • Week 1-4: When showering, it is ok to let the phallus hang for about 10 minutes at a time. Otherwise, supporting it as directed above is recommended.

  • After week 4: If all the incisions have healed well and there are no open wounds, and if there's no swelling at the tip of the phallus, it is ok to let the phallus hang. Sometimes intermittent elevation of the phallus is needed if swelling returns after letting the phallus hang for a long period of time. 

    • Swelling of the phallus can be worsened by allowing it to hang; when this occurs, you'll notice the tip of the phallus skin is harder than the rest of the phallus skin. Elevating the phallus will help.  

Phallus swelling: is this normal?

  • Tissue swelling, in general, is very common and frequently a normal part of healing. The severity of the swelling varies from patient to patient.

  • Swelling is very concerning if it occurs suddenly and/or rapidly as it could indicate a blood flow issue. This is often accompanied by color changes as well. Contact your surgeons immediately and head to the ER of CPMC Davies Hospital.

  • Elevating the phallus will help decrease non-concerning swelling.

  • Note: swelling will often be at the tip of the phallus (gravity pulls fluid into the tip); this can subsequently compress the urethra and lead to urinary spraying.

Cold Phallus: is this concerning?

  • A cold phallus can occur on occasion, but as long as there is good capillary refill and no rapid color changes/swelling of the phallus, this is expected. One way to test this is to push your phallus and see how quickly the blood returns to the site you just pressed. It should match how quickly blood returns to your finger when you push your finger. The cold phallus usually warms up in a warmer environment, much like cold fingers will warm up when you go from a cold to warm environment.

  • If the phallus is cold, purple, getting more swollen, and/or has no refill of color when pressed and let go, and/or the refill is very brisk (1 second), go to the ER at CPMC Davies and contact the microsurgeons immediately.



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