G.U. Recon Mang Chen MD  2019  

G.U. Recon Clinic

45 Castro St. Ste 111

San Francisco, CA 94114

Office: 415-481-3890

Fax: 309-328-3827

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Postop Phalloplasty:

Phallus Concerns

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.

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, it is ok to let the phallus hang.

  • Important note: 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 decrease the skin swelling.  

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 surgeon 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 hands 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 microsurgeon immediately.

 

GLANSPLASTY CONCERNS

The ridge and area behind the ridge of my glans looks weird. What could it be?

  • Ridge: anatomically called the corona, may sometimes turn black. If this occurs, this skin will eventually slough off.

  • Skin graft: placed behind the corona, may blister or bleed at the edges. If bleeding is dark and small volume, this is expected and should resolve within a week. If bleeding is bright red, hold pressure as indicated previously. If a blister forms, they may pop or get absorbed over time. These areas will slowly slough, and get replaced with the ingrowth of new skin. It may require an additional 1-2 weeks of wound care (applying ointment daily, keeping it clean) to expedite new skin growth.

  • Scabs: frequently occur over the graft site and will slough in about a week. If they haven’t by then, they may be gently peeled off.

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