Phalloplasty: Sensation & the Nerve Hook-Up

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Reader advisory: this week’s post talks frankly about the medical and physical aspects of sex, and the video contains diagrams illustrating these concepts. Discretion is advised.

A few weeks ago, we introduced you to free flap phalloplasty, which is one type of genital reconstruction (or “bottom surgery”) for transgender men and transmasculine folks. This week, we address one of the primary concerns raised by people considering this surgery: sensation and the ability to orgasm.

One of the most common misconceptions about trans male bottom surgery is that it results in a partial or total loss in sexual sensation. It’s not unusual to hear the sentiment, “I’d consider bottom surgery, but I don’t want to lose my ability to orgasm,” in trans male circles. In reality, free flap phalloplasty can include a nerve hook-up, a microsurgical technique in which nerves taken from another part of the body are attached to the clitoral nerve or other pelvic nerves and embedded into the new penis. This allows the patient to retain sexual sensation and function in the vast majority of cases. “In my experience, about 85% of free flap phalloplasty patients get erotic sensation, and 98% get tactile sensation,” says Dr. Curtis Crane. “And I’ve never had a patient lose the ability to orgasm.”

Although these numbers are promising, and certainly better than common bottom surgery lore, it’s important to remember that nerve regrowth is a slow, gradual process. Nerves must regrow through the axon sheath, and the rate at which this growth occurs is about 1 millimeter per day. At this rate, full sensation can take up to 2 years to reappear after surgery.

This video is captioned in English. To access the captions, click the CC button on the bottom right of the video.