Can penile reconstruction affect the ability to achieve and maintain an erection?

Penile reconstruction surgeries, such as phalloplasty and metoidioplasty, typically do not result in natural erectile function. Achieving and maintaining an erection after these procedures can be more complex, and individuals often require additional interventions to enable erections for sexual activity. Here are some important points to consider:

1. Phalloplasty and Erection: Phalloplasty involves the creation of a neophallus (newly constructed penis) using tissue grafts from donor sites (e.g., forearm, thigh). While the neophallus may closely resemble the appearance of a natural penis, it does not contain the same erectile tissue or mechanisms. As a result, phalloplasty does not typically result in spontaneous or natural erections.
2. Metoidioplasty and Erection: Metoidioplasty, which involves creating a neophallus from the enlarged clitoris, may result in some degree of natural erectile function. This is because the clitoris contains erectile tissue, and hormonal therapy often leads to clitoral growth. However, the extent of erectile function in metoidioplasty can vary among individuals. Some may experience partial erections, while others may have more limited functionality.
3. Penile Prosthetic Devices: Many individuals who undergo penile reconstruction surgeries choose to have additional procedures to implant penile prosthetic devices. These devices can enable individuals to achieve and maintain erections for sexual activity. There are different types of penile prosthetic devices available, including inflatable and semi-rigid options, each with its own advantages and considerations.
   • Inflatable Penile Prostheses: These devices consist of inflatable cylinders that are surgically placed in the neophallus. When activated, they create an erection that can be deflated when no longer needed.
   • Semi-Rigid Penile Prostheses: These devices are made of bendable rods that maintain a constant semi-rigid state. They are typically easier to use but do not allow for the same degree of flaccidity as a natural penis.
4. Erection Implants and Additional Surgeries: The decision to implant a penile prosthetic device is often made after the initial penile reconstruction surgery. Some individuals may choose to undergo subsequent procedures to add the implant, while others may do so later if they decide it aligns with their goals.
5. Consultation and Planning: Individuals should consult with healthcare providers experienced in transgender care and gender-affirming surgeries to discuss their options for achieving erections after penile reconstruction. This includes discussing the choice of prosthetic devices and the timing of any additional procedures.