Penile Reconstruction and the Role of Surgery in Gender Dysphoria

Gender dysphoria is the distress that occurs when there is a mismatch between birth-assigned gender and expressed gender. Penile reconstruction may ameliorate the risk of suicide due to mental illness, social harassment, and isolation commonly experienced by these individuals. The ideal aim is to allow micturition while standing and penetrative intercourse with full sensation, but there is no universal agreement on the ideal flap design. Contemporary options for penile reconstruction include metoidioplasty and phalloplasty using either a pedicled or free flap. The most common flap currently performed is the radial artery forearm free flap. Secondary procedures following phalloplasty may include glansplasty, scrotoplasty, and insertion of penile and testicular prostheses. Patient summary: Penile reconstruction is offered to transgender men as part of their transition from female to male. Penile reconstruction may ameliorate the high risk of suicide due to mental illness, social harassment, and isolation commonly experienced by these individuals. Many techniques can be used for penile reconstruction with good outcomes, but none can fully satisfy all the needs of individuals seeking penile reconstruction.