Do phalloplasties actually work?

[SilverTapz]

After wondering about this for a while, I ended up searching phalloplasty online and ended up on a Reddit page where people post their progress. I had never seen one before an was curious, I guess. It was actually quite shocking. People with what looks like no muscle left on their forearms, someone with a necrotic 'scrotum', someone where the stitches were wide open and the tip has turned black and left a gaping hole etc etc. People seem to be commenting saying that they look great, they've made the right decision etc, but honestly they look absolutely butchered. It's scary. And I guess my question is, do they actually function? Some of these people are so young and it's scary what they've done to their bodies. I can't help but think a lot of them will regret the decision. Is it mainly cosmetic? Can they orgasm? Honestly just very shocked by what I've seen!

Sensory outcomes are complex ... we conclude that outcomes often do not match expectations, which causes dissatisfaction in a proportion of participants ... discuss the considerable probability of having to face shortcomings with regard to the esthetic and/or functional outcomes as well as a reduced sensibility and long recovery time

pmc.ncbi.nlm.nih.gov/articles/PMC8498953/

The objectified sensitivity of the neophallus, measured by the SWM test, was significantly reduced compared to that of the donor-site, with the proximal part being more sensitive than the distal part. While we found evidence that sensation improves over time, it remains unknown, when sensory recovery stabilizes and at what level. Several previous studies showed that sensory recovery of the neophallus after nerve coaptation is possible for various flap techniques, but the overall tactile sensation recovery remains suboptimal in all presented techniques.

(It was noted that the trans men thought the sensitivity was better than it really was. The researchers put this down to improved self-image.)

pmc.ncbi.nlm.nih.gov/articles/PMC8498953

Provided that patients have experienced clitoral orgasm before surgery, clitoral transposition does not result in a subsequent loss of ability to achieve orgasm with direct stimulation of the clitoris site.

In our experience, many patient’s report lack of familiarity with their genitals (e.g., use for sex, exploratory touching). Such lack of familiarity may predict for poorer sexual function post-op: two of the three patients that had never experienced orgasm before surgery reported an inability to achieve orgasm after their surgery.

pmc.ncbi.nlm.nih.gov/articles/PMC4708164/

Lowest scores in satisfaction were observed for the sexual functioning of the neophallus, with 34% satisfied to very satisfied participants.

https://www.sciencedirect.com/science/article/pii/S1743609521003027

Most reports give very high levels of satisfaction, including sexual satisfaction (80% - 95%). Reading many different sources, though, it seems that only satisfied patients opt in to the follow-up studies. Most of the studies only covered 10 or 20 participants - the one showing 34% sexual satisfaction had 102.

As Scott Newgent explains, these surgeries are brutal, very experimental and come with no guarantees.

I used to follow Exulsanic on Twitter. She's a detransitioner and she often links to transmen talking about being surprised by the reality of their surgery. She's also, over the years, covered the tragic downhill of several transmen who post on Insta and TikTok. I can recall at least three deaths. At least one of them involved a young women whose never-ending urinary infections and slow loss of kidney function led to deep depression and, it was surmised, sepsis.

Just as everyone, when asked how often they have sex by someone doing a survey, says two or three times a week (because who wants to admit they go weeks at a time without, or have it twice a day?) I think there's phenomenal pressure on those who've had surgery to tell the world it's wonderful. Otherwise they look like fools. I see quite a few quotes lifted from Reddit forums where, when they think the world isn't watching, they talk more realistically about the downside and the surgical failures. Infections seem to be rife.

Most of you probably knew this but, before reading the studies I linked above, I'd never been clear on what they do with the clitoris. One would hope they could somehow stick it at or near the end of the 'penis' but I couldn't imagine how that might work.

Answer: they don't. They loosen and move it a bit, then wrap the flesh roll around it. A large nerve is re-routed from (usually) the thigh, popped inside the sausage, and attached (hopefully) to one of the clitoral nerve bundles. Ideally the re-sited nerve will 'learn' it's now part of the clitoris and transport sensations through the length of the phallus. If this ever does happen it will take years. Until then, the best sexual sensation a patient can get is by stimulating the base of the sausage, where the clitoris is buried.

I tried looking at how the clitoris is loosened, and how much of it makes it to the new position. But I got too squeamish.

I think there's phenomenal pressure on those who've had surgery to tell the world it's wonderful. Otherwise they look like fools.

They must also desperately need to convince themselves that they have done the rights thing.

We have heard from detransitioners or from people still transitioned but who tend to be campaigning for better quality of care that those in the support groups or social groups don’t want to talk about any negativity.

They shut down people who are trying to talk about their complications. whether it is surgical, or side effects from hormones or just doubts about what it all means. I think there are many people out there who feel rejected by the group (the ones who pride themselves on how inclusive they are!) and those people are the ones who are very vulnerable. I remember reading posts once from a male transitioner in Canada who felt failed because of reaching the end of the treatment options only to discover that none of it made him feel better.

He was still male and would never really be the female person all the messaging from groups and allies said. That it all relied on existing in a bubble where everyone acted in support but it never was true. And I believe he applied for assisted death because of the complications and the severe mental health.

There are plenty of personal accounts though of the lack of support in the groups for discussing negative health impacts. It seems like the groups are there to celebrate themselves and their medical outcomes, and to become ‘chosen families’ after encouraging people to go no-contact.

Awful isn't it. Very sad.

Sounds very cult like. Harmful.

“Sounds very cult like”

It has been said before. Strangely, anytime it used to be said on MN up to about a few months ago, it was deleted. In fact, I expect it would be deleted sometimes now too.

You then have to add it to the question list.

What type of group monitors and enforces language of others, while denying they are acting in an authoritarian and totalitarian manner?

Add it to this one

What type of group uses such poor quality academic papers and studies to support their demands and shape policy based on a philosophical belief about someone’s identity that doesn’t reflect material reality?

What an awful discussion. It's relevant that this is being done to young people as their relationship experiences may be limited - often with little or no sexual experience - let alone the concept of becoming a parent.
So informed consent to having their sexual organs butchered, sexual feelings and potential fertility removed seems unlikely.

It is a horrific discussion. And I known of several personal friends who are parents of teens who have discussed their fears for their children regarding these types of medical treatments with me because I asked how they were going. This is sadly not rare.

Look what happened to James Caspian, an academic who wanted to conduct proper researchers into trans regret following a conversation with a leading surgeon who performs these operations.

The surgeon had told him that a number of patients had come to him wanting to reverse the surgery and Caspian thought this deserved proper scrutiny, because more knowledge, more understanding helps everyone, no!?

Apparently not, his university shut the whole thing down, and he couldn't raise the funding he needed.

Shameful.

Yes, I remember that now. It was really disappointing because a well run study such as that would be useful