MYTHBUSTING
There are a lot of myths and half-truths that are repeated when we talk about genital surgery. Let’s talk about them.
MYTH #1: MY PENIS WON’T HAVE ANY SENSATION
Broadly speaking — yes, we can.
Nerve hookups, or coaptations, happen during free flap surgeries like RFF, ALT, and MLD phalloplasty, where the nerves in the flap are connected to nerves in the genital area in order to help the new penis develop sensation. Other surgeries attempt to retain the sensation that the skin and tissue already had, whether that's a pedicled flap like abdominal phalloplasty, or a surgery like metoidioplasty, where there is not a large flap being moved from one part of the body to another.
For those of us who get phalloplasty with a nerve hookup (again, RFF, ALT, MLD), some of us recover most or all sensation in their penis after surgery. Others have some sensation. Some of us may not gain any sensation. Depending on the type of flap used to create the penis, we might be more likely to only experience certain types of sensation. We don't have great data on this because there have not been any studies thus far that follow a large number of phalloplasty patients for a long time after they've had surgery to see how their sensation grows and develops.
We similarly lack data for those who have had metoidioplasty. What we do know is that it is less common for those who have metoidioplasty to not have sensation in their penis after recovering from surgery. However, it is commonly believed that there is no risk to sensation for metoidioplasty, but this is not true. Any surgery runs the risk of sensation loss in the area.
An important piece of sensation is the mind-body connection. Our brains have a lot to do with how we feel pleasure, and making an effort to intentionally work on embodiment after surgery can be helpful in feeling connected to one's penis and experiencing pleasure, regardless of the "success" of the nerve hookup.
MYTH #2: IT’S NOT PERFECTED YET / I SHOULD WAIT UNTIL THE TECHNOLOGY GETS BETTER.
Nothing in medicine is perfect.
Things are always improving, not just with these surgeries, but with medical care in general.
The thing to know is this:
Improvements made in the future will likely not drastically change the offerings available now.
And, even if things do change significantly, it doesn’t mean that if we get surgery now, we won’t be able to benefit from these improvements down the line.
It’s okay to wait if we don’t want to get surgery now, but waiting specifically because we want the current surgery offerings to get better may delay us from getting a surgery that we could benefit from now. It may be the case that we just don’t know enough about what is possible to truly know if the available surgeries will not meet our needs. That’s why learning more and talking to people who are also looking into these surgeries, preparing for them, and who have already had surgery can be really helpful.
MYTH #3: I CAN’T KEEP MY VAGINA.
We can (sometimes)!
This is a bit more complex than just a yes/no answer.
The cool thing about metoidioplasty and phalloplasty is that they are modular procedures. However, the options we have are limited mainly by 1) what kinds of procedures we want and 2) which surgeons are willing to do what we want.
If we want urethral lengthening, then many surgeons will also require that we get a vaginectomy, as there is more of a chance of urinary complications without one. But this does not mean that it is impossible to keep our vagina if we want urethral lengthening — it just means we may have to spend more time seeking out a surgeon who is willing to do it.
If we do not want urethral lengthening, then most surgeons will not require a vaginectomy. And, those that do are not really keeping up with the times, and we should probably consider not going to them anyway.
MYTH #4: IT’S TOO EXPENSIVE / SURGERY ISN’T ACCESSIBLE.
This is not necessarily a myth — surgery being inaccessible or too expensive is an unfortunate truth for many of us. However, it is important to know that this is not true across the board. In the United States, many Medicaid plans, Marketplace plans, and private insurance plans cover metoidioplasty and phalloplasty. Some plans even cover associated travel and lodging as well.
Large hospital systems also often have financial aid programs that can cover some or all of our healthcare costs if we do not make or have much money. And there are also organizations that provide grants for surgery access.
So, while surgery can be costly or we may not have a surgeon nearby that we can easily access, there are ways for many of us to be able to access surgery, and it’s worth exploring more to find out if we truly are unable to access surgery.