Concerns About Internal Erectile Prostheses Among Transgender Men Who Have Undergone Phalloplasty

Abstract

Background: Transgender men who undergo gender-affirming phalloplasty have limited options for attaining sufficient rigidity for sexual penetration.

Aim: The goal of this study was to understand interest in and concerns about internal erectile prostheses among transgender men who had undergone phalloplasty.

Methods: As part of a pilot study of an external erectile device, transgender men (n = 15) were surveyed about their interest in, and concerns about, getting an internal prosthesis. Descriptive analyses were performed for structured questions and content analysis was used to analyze open responses.

Outcomes: Measured outcomes included closed- and open-ended questions assessing patient attitudes about internal erectile prostheses.

Results: Before starting the study, approximately half the men stated they were interested in getting an internal device, 20% said they weren't, and 33% said they didn't know. More than half of this postphalloplasty population stated they were somewhat or very concerned about the need for additional surgery (73%), side effects (pain, damage to the phallus; 100%), and the risk of device failure (100%). An additional 47% stated they were somewhat or very concerned about cost and 33% stated they were somewhat or very concerned about finding a surgeon.

Clinical implications: There is a need to develop appropriate alternatives to current internal prostheses for penetrative function after phalloplasty.

Strengths & limitations: Generalizability of results is limited by the fact that data are from men who had enrolled in a pilot study to test an external erectile prosthesis, and as such were explicitly interested in exploring nonsurgical alternatives to attain an erection. The combination of quantitative and qualitative data demonstrates that transgender men's concerns about internal prostheses are grounded in the current evidence.

Conclusion: Transgender men who have undergone phalloplasty have substantial concerns about the risks of getting an internal prosthesis and there is significant interest in alternatives to current devices. Boskey ER, Mehra G, Jolly D, et al. Concerns About Internal Erectile Prostheses Among Transgender Men Who Have Undergone Phalloplasty. J Sex Med 2022;19:1055-1059.

Keywords: Erectile Prosthesis; Gender-Affirming Surgery; Phalloplasty; Sexual Function; Transgender Men.