Transgender men may choose to have gender-affirming surgery, such as metoidioplasty or phalloplasty. These may provide sensations and functions including erections and urinating standing up.
Gender-affirming procedures require recovery time and may alter people’s experience of sex, use of contraception, and use of protection.
This article discusses how long a trans man should wait to have sex after gender-affirming surgery.
It also looks at what a person can expect during sex after these procedures and other sexual health tips.
Recovery times after surgery can vary for each individual, so it is important that people follow the specific advice of a healthcare team.
People may need to avoid or restrict sexual activity, heavy lifting, and exercise during this recovery time. They will need to consult a doctor about when it is safe to have sex.
People who have had a phalloplasty may be able to return to their usual activities 6–8 weeks after surgery. It may take longer than this before people can do certain activities, including sex, heavy lifting, and driving. A doctor will let people know when they can safely have sex.
A metoidioplasty involves cutting the ligaments around the erectile tissue or clitoris. This releases it from the pubis to make it longer. A person can expect an average length of 4–6 centimeters.
People with a metoidioplasty will not ejaculate during orgasm due to the absence of certain structures such as the seminal vesicles and prostate. The urethra may release a clear fluid from the Skene’s glands, though.
For those undergoing a phalloplasty, the size of the penis will depend on their body. Those with less fat will have a penis with less girth compared with those with more fat. However, the typical size will be 5–6 inches after postoperative swelling decreases.
It will not be possible to ejaculate.
A person can also choose the size of the testicular implants with the advice of a healthcare professional.
After both procedures, it is possible to urinate while standing.
The sensations a person experiences will depend on the type of surgery.
According to a
However, the article states that clitoral lengthening results in postoperative reports of excellent sensation and erection.
People with a metoidioplasty will still experience sexual arousal and orgasm. In a 2014 study, 97 participants who had undergone metoidioplasty reported complete satisfaction with the quality of erection and sensation. There were no reports of any issues with sexual arousal, orgasm, or masturbation.
The study also referred to earlier research in which people reported the following improvements after gender-affirming surgery:
- sexual satisfaction with a partner increased from 50% to 81.9%
- orgasm frequency increased from 45.5% to 77.8%
- frequent sexual arousal increased from 40% to 60.9%
- frequent masturbation increased from 20% to 78.3%
According to Johns Hopkins, those opting for a phalloplasty will develop a surgical plan with their healthcare team to decide which procedures they wish to undergo.
- creating a penis
- lengthening the urethra
- creating the glans, or tip, of the penis
- creating a scrotum
- removing the vagina
- inserting testicular and erectile implants
The surgeon will use skin from a donor site. A donor site is an area that doctors will take skin, fat, nerves, and blood vessels from to create a penis. Possible donor sites include the arm, leg, or back. If preserving sensation is important to people, a surgeon may suggest a donor site with good nerve innervation.
Nerve quality will differ with each donor site, so people may choose a donor site based on their desired outcome. If sensation is important to people, they may choose the arm as a donor site as this provides the highest availability of nerves.
Nerve “hook up” allows people to have sensation by using nerves from a donor site such as the arm and connecting them to nerves in the pelvis.
There are fewer nerves available in the legs, and if people use the back as a donor site, they are unlikely to have any sensation.
Alongside people’s preferences, doctors also have to consider other factors such as overall health, fat distribution, nerve functionality, and blood flow.
Following stage one of a phalloplasty, nerves may start to regenerate 3 weeks after surgery, but this may take longer for some people. In some cases, sensation may take up to a year or more to return.
If penetrative sex and maintaining an erection are important, people can have an erectile prosthetic. There are usually three stages to a phalloplasty, and during the third stage, a doctor can implant an erectile prosthetic device, which allows people to maintain an erection.
It is possible to have an orgasm after phalloplasty.
Using protective barriers during sex can help prevent people from passing on or contracting sexually transmitted infections (STIs).
According to the Terence Higgins Trust, people can use an external condom over a penis after metoidioplasty or phalloplasty. People can use a new condom if they are having sex for more than half an hour, with a new partner, or changing between vaginal or frontal sex and anal sex.
Internal condoms are the safest choice for people with a metoidioplasty. If people are taking testosterone, it can reduce fertility but is not an effective contraceptive. If people want to prevent pregnancy, they will need to use condoms consistently or use another contraceptive method such as the:
All of these options are safe to use alongside testosterone.
During recovery from a metoidioplasty, people may expect the following:
- some bleeding following surgery
- swelling in the genital area for up to 6 weeks post-surgery
- bruising from the abdomen to the thighs, which can last a few weeks
- itching and minor electrical sensations as the nerve endings heal
- numbness around surgical scars, which may last several months
- difficulty urinating when standing for the first weeks after surgery
- scarring in the genital area, which will fade with time
During recovery from a phalloplasty, people may expect the following:
- bleeding that may occur in the first 48 hours following surgery
- swelling in the penis, scrotum, and pubic area for the first 1–4 months
- bruising from the abdomen to thighs may occur in the first few weeks
- itching and minor electrical sensations as nerve endings heal
- difficulty urinating when standing for the first weeks after surgery
- numbness in the penis and scrotum, which will go within 18 months of surgery
- scarring from the procedure and donor site
People will need to follow any post-surgery hygiene advice from their healthcare team.
After a metoidioplasty, people may need to apply antibiotic ointment to any surgical scars to prevent infection and change gauze dressings following surgery. People will need to follow a doctor’s advice for when they can bathe the genital area after a metoidioplasty.
After a phalloplasty, people can follow a doctor’s advice, which may include:
- covering the skin graft when bathing to keep it dry
- sponge bathing for the first week following surgery
- gently washing the penis with warm, soapy water and patting dry, beginning one week after surgery
- avoiding submerging the genital or donor site in water until a doctor advises it is safe
If people have had a skin graft from the arm, they may be able to get it wet 3 weeks after surgery.
People will also need to attend any checkups following surgery to ensure the healing process is going well.
People will need to follow the advice of their healthcare team for proper healing and to check when they are safe to have sex following a metoidioplasty or phalloplasty.
People can expect to still have sexual arousal, erection, and orgasm after lower gender-affirming surgery. Sensation may depend on the type of surgery people have and surgery recovery times.