Phallus-Preserving Vaginoplasty
ART Surgical and Dr. Angela Rodriguez provide gender-affirming care for non-binary and transgender individuals in San Francisco, California and across the country. For each procedure, including phallus-preserving vaginoplasty, Dr. Rodriguez meets with each patient to understand their goals and needs.
What is Phallus-Preserving Vaginoplasty?
Phallus-preserving vaginoplasty is a surgical procedure performed as part of gender-affirming care. Sometimes referred to as penile preserving vaginoplasty or Salmacian surgery, this type of vaginoplasty creates a neovagina while preserving the existing penis. It’s often an important consideration for individuals who wish to maintain the option of using their penis for sexual function or other reasons.
Specific techniques and procedures are determined by the individual's preferences, goals, and medical considerations. Non-binary and transgender individuals often work closely with their healthcare team to determine the most suitable approach for their gender affirmation journey.
Who is the Best Candidate For Phallus-Preserving Vaginoplasty?
Phallus-preserving vaginoplasty is a gender-affirming option for individuals who want to create a vagina while keeping the penis intact. This procedure may be a good fit for non-binary and transgender individuals who wish to affirm their gender without undergoing a full penectomy. Many patients choose this approach to maintain sexual function, personal comfort, or alignment with their gender identity.
The decision to pursue phallus-preserving vaginoplasty is highly personal and can be influenced by factors such as anatomy, sexual goals, urinary function, and overall health. Individuals considering preserving vaginoplasty should have detailed discussions with experienced gender-affirming surgeons and mental health professionals to determine whether this approach aligns with their needs and long-term goals.
How is Phallus-Preserving Vaginoplasty Performed?
During phallus-preserving vaginoplasty, the surgeon typically uses the penile skin and tissue to construct the neovagina. The procedure involves inversion of the penile skin to form the vaginal canal. The testicular tissue is often used to create the labia minora. The glans of the penis may also be used to create a clitoral hood, simulating the appearance of the clitoral area. If there isn't enough skin available between the penis and scrotum to create the desired depth of the vaginal canal, a skin graft sourced from the hip, lower abdomen, or inner thigh may be used.
Preparing for Phallus-Preserving Vaginoplasty
Preparing for phallus-preserving vaginoplasty involves medical, logistical, and emotional planning. The first step is scheduling a consultation with an experienced gender-affirming surgeon to discuss your goals, expectations, and any concerns. Understanding the procedure and recovery process can help you feel more confident and prepared.
Your care team will guide you through required medical and mental health evaluations to ensure you are physically and emotionally ready for surgery. These assessments help identify potential risks and confirm that this approach aligns with your gender-affirming goals. If you are on hormone therapy, your surgeon will also review your current regimen and provide guidance as needed.
Before surgery, it’s important to follow all preoperative instructions, including recommendations around medications, smoking, alcohol use, and overall health. You should also plan for travel, accommodations, and post-surgical support. Having a reliable support system in place can make recovery smoother and less stressful.
What to Expect During Vaginoplasty Recovery
Recovery after phallus-preserving vaginoplasty is an important part of the healing process and requires close attention to post-op care. Most patients stay in the hospital for one or two days during monitoring. Pain, swelling, and bruising are common at first and will gradually improve. A temporary urinary catheter may be used to support healing during the early recovery period.
Once home, proper wound care and rest are essential. Your surgeon will provide clear instructions on cleaning the surgical area and managing discomfort. Activity restrictions are common during the first few weeks, including avoiding heavy lifting, strenuous exercise, and sexual activity. These limits help protect healing tissues and reduce complications.
Emotional support is also an important part of recovery. Many patients experience a range of emotions before and after surgery, including gender dysphoria, and having a trusted support person available can make recovery easier. Follow-up appointments with your surgeon will allow your care team to monitor healing, adjust hormone therapy if needed, and provide guidance on scar care and next steps.
Every recovery experience is unique. Following your care team’s instructions and communicating any concerns will help ensure a safe and successful healing process.
To learn more about phallus-preserving vaginoplasty and how Dr. Angela Rodriguez and her team will guide you through the process, book a one-on-one consultation.
Phallus-Preserving Vaginoplasty FAQs
The length of phallus-preserving gender-affirming surgery can vary. It depends on the specific techniques used and each patient's unique goals. On average, the procedure may take several hours. During this time, the surgical team carefully reshapes penile tissues. They also create proper alignment for both function and appearance. Because every body and surgical plan is different, your surgeon will provide a more accurate estimate of how long your surgery is expected to take. Be sure to ask any questions during your consultation.
Choosing the right vaginoplasty depends on your goals, anatomy, and personal preferences. The most common types include penile inversion vaginoplasty. This uses penile and scrotal skin to create a vaginal canal. Some patients may also consider a vulvoplasty. This creates external genitalia without a vaginal canal. Other options may include penile-preserving surgery or Salmacian surgery. Each option has different benefits, recovery needs, and long-term outcomes. Discussing your goals openly with your surgeon is the best way to determine which procedure is right for you.
Like any major surgery, gender-affirming procedures have some risks. Potential complications can include bleeding and infection. Poor wound healing, changes in sensation, or issues with urinary or sexual function are also possible. However, serious complications are rare. Most patients have safe outcomes when surgery is performed by experienced surgeons in accredited facilities.
Insurance coverage for phallus-preserving gender-affirming procedures can vary. It depends on your plan and provider. Some insurance companies cover gender-affirming surgeries. However, the specific types of procedures included may differ. Policies and requirements are not the same for everyone. It's important to check directly with your insurance provider to understand what is covered. They will also tell you what documentation may be needed, and whether pre-authorization is required. Your surgical team may also be able to assist with submitting information. Your doctor can also help you navigate the approval process.
The cost of phallus-preserving gender-affirming surgery can vary. It is based on the specific procedure, the surgeon's expertise, and the hospital or surgical center. It is also based on whether your insurance provides coverage. Without insurance, bottom surgery procedures can range from tens of thousands of dollars. Additional costs may include anesthesia, hospital stays, and follow-up care. If insurance covers part or all of the procedure, out-of-pocket expenses may be significantly reduced. Every situation is unique. Patients are encouraged to speak with their surgical team and insurance provider. These conversations will help you get a clear estimate of costs and financial responsibilities.