Can penile reconstruction affect the individual’s ability to engage in sexual activities?

Penile reconstruction surgeries, such as phalloplasty and metoidioplasty, can have a significant impact on an individual’s ability to engage in sexual activities. However, the nature of this impact varies depending on several factors, including the type of surgery, individual goals, and any additional procedures or interventions that are undertaken. Here are some key considerations:

1. Phalloplasty and Metoidioplasty:
   • Phalloplasty: Phalloplasty involves the creation of a neophallus (newly constructed penis) using tissue grafts from donor sites (e.g., forearm, thigh). The neophallus does not contain erectile tissue and does not typically achieve natural erections. As a result, individuals may need additional interventions, such as penile prosthetic devices, to achieve erections for sexual activity.
   • Metoidioplasty: Metoidioplasty utilizes the clitoral growth that occurs with testosterone therapy to create a neophallus. Some individuals experience increased sensitivity and the potential for spontaneous erections due to the erectile tissue present in the clitoris. However, achieving and maintaining erections may still require additional assistance, such as prosthetic devices.
2. Penile Prosthetic Devices: Many individuals who have undergone penile reconstruction surgeries choose to have penile prosthetic devices implanted to enable erections for sexual activity. These devices can provide functional rigidity and allow individuals to engage in penetrative sexual intercourse. There are different types of prosthetic devices, including inflatable and semi-rigid options, each with its own benefits and considerations.
3. Sensory Changes: The neophallus may have altered sensory characteristics compared to a natural penis. Some individuals may experience sensory changes, while others may retain or regain sensation to varying degrees. The extent of sensory changes can vary among individuals.
4. Recovery and Rehabilitation: Postoperative care, including wound care, physical therapy, and rehabilitation exercises, plays a vital role in the recovery of sexual function and sensation. Individuals are typically provided with guidance on how to maximize their functional outcomes.
5. Personal Goals and Preferences: The impact on sexual activity is highly individualized and depends on the individual’s specific goals, preferences, and comfort levels. Open communication with healthcare providers is essential to address concerns and explore options for optimizing sexual function and satisfaction.