This introduction outlines how erectile function may change following common lower gender‑affirming procedures and what factors shape outcomes.
Two main options chosen by transgender men are metoidioplasty and phalloplasty. Metoidioplasty frees native erectile tissue and often yields a functional erection of about 4–6 cm. Phalloplasty builds a larger neopenis, roughly 5–6 inches once swelling settles, and may need a later erectile prosthesis for firm rigidity suitable for penetrative sex.
Sensation tends to remain excellent with metoidioplasty. After phalloplasty, feeling depends on nerve connection and may return over weeks, months, or longer. Neither procedure produces ejaculation; some people notice clear fluid from Skene’s glands.
Urethral lengthening commonly allows standing urination, though retraining may be needed. Recovery and activity timelines differ by procedure, and the surgical team will tailor plans to each person’s goals. For a practical overview of options and stages, see FTM bottom surgery options at FTM bottom surgery options.
Key Takeaways
- Metoidioplasty preserves native erectile tissue and can allow an erection; size is usually 4–6 cm.
- Phalloplasty creates a larger neopenis and may require a staged erectile implant for penetrative sex.
- Neither option typically enables ejaculation; some may have clear Skene’s fluid.
- Standing urination is often possible after urethral lengthening, with training during recovery.
- Sensation returns faster with metoidioplasty; phalloplasty sensation depends on nerve hookup and may take months.
- Recovery timelines and risks vary; smoking raises complication risk and the team will individualize care.
Quick overview: Erections, sensation, and sexual function after FTM bottom surgery
Metoidioplasty often preserves native nerve pathways, so sensitivity and spontaneous erections are common. Phalloplasty creates a larger neophallus and may need an implant later for full rigidity. These two types of procedures produce different timelines for return of feeling and function.
Typical recovery milestones show gradual return to usual activities in about 6 weeks after metoidioplasty and around 6–8 weeks after phalloplasty. Sensation may start within weeks in some cases, but full return can take months or longer as nerves regrow.
Common postoperative signs include swelling, bruising, itching, and electrical tingling as nerves heal. Temporary numbness can last several months with metoidioplasty and up to 18 months with phalloplasty. Standing urination is possible when urethral lengthening is performed.
- Sexual arousal and orgasm remain possible for most people; location and quality of feeling may shift over time.
- Recovery and safe timing for intimate activity depend on the clinical team and overall healing.
| Procedure | Usual activity recovery | Sensation timeline |
|---|---|---|
| Metoidioplasty | About 6 weeks | Immediate to months |
| Phalloplasty | 6–8 weeks (full sexual activity later) | Weeks to 12+ months |
| Both with urethral lengthening | Variable; retraining for urination | Sensation and control evolve with healing |
For an outline of options and staged care, see FTM bottom surgery options. Research shows strong satisfaction and increases in arousal and orgasm frequency for many people as recovery continues.
Can you get hard after female to male bottom surgery?
Erectile responses change depending on whether native erectile tissue is preserved or a neophallus is constructed. Choice of procedure shapes firmness, sensation, and timeline for return of sexual function.
How erections differ with metoidioplasty versus phalloplasty
Metoidioplasty releases and lengthens the clitoral erectile tissue, often yielding a small functional phallus that becomes erect with arousal. Typical length is about 4–6 cm, which limits penetrative options for some people.
Phalloplasty uses donor skin and tissue to form a larger phallus. The constructed penis does not become rigid on its own; many opt for a later implant to allow firm rigidity for penetration.
Erections versus orgasm: what changes, what stays the same
Orgasmic capacity usually remains after either type. Ejaculation is not expected; some may notice clear Skene fluid following metoidioplasty. Testosterone can enlarge the clitoris before reconstruction, improving baseline tissue size, but erection mechanics depend on released native tissue or an implant.
Timeline for erections and sensation: weeks to months
Sensation may emerge within weeks for metoidioplasty as swelling reduces. After stage one phalloplasty, nerve regeneration may begin around three weeks but often continues over months and can take a year or longer for fuller return.
Urethra lengthening and standing urination
Urethral extension can allow a person to urinate standing, but early stream control can be challenging. Retraining, follow-up, and care of the urethra help refine function over time.
“Expect varied timelines; discuss goals and realistic outcomes with the surgical team.”
- Metoidioplasty: native tissue erects; limited penetrative firmness.
- Phalloplasty: larger phallus; implant often needed for rigidity.
- Urethra: lengthening enables standing urination but requires adaptation.
| Aspect | Metoidioplasty | Phalloplasty |
|---|---|---|
| Erectile source | Released clitoral tissue | Donor skin/tissue; implant later for rigidity |
| Typical timeline | Weeks for early sensation; months for maturation | Weeks for nerve regrowth start; months to 12+ months for sensation |
| Standing urination | Possible with urethra lengthening | Possible with urethra lengthening; retraining common |
Metoidioplasty outcomes: Erection potential, size, and sexual satisfaction
Many people report a small but functional neophallus after metoidioplasty, with preserved nerve response.
Erections from clitoral/erectile tissue and typical length expectations
Metoidioplasty releases clitoral erectile tissue and surrounding tissue to form a compact phallus. Typical postoperative length settles around 4–6 cm once swelling subsides.
Penetrative sex feasibility and alternatives
Because girth and length are limited, penetrative sex is often not feasible. External aids, specially designed devices, and sexual positions that emphasize surface stimulation are practical options. Some people later choose staged phalloplasty if penetration is a primary goal.
Reported arousal, orgasm, and satisfaction rates in research
Published research shows high satisfaction with erection quality and sensation. A 2014 study of 97 participants reported complete satisfaction with erection and feeling. Earlier work noted increases in partner satisfaction (50% to 81.9%), orgasm frequency (45.5% to 77.8%), and frequent arousal and masturbation.
“Erection quality and sensation often improve after this procedure.”
- Typical length: 4–6 cm once healed.
- Excellent sensation is common thanks to preserved nerves.
- Penetration may be limited; discuss options and staged procedures with the clinical team.
| Outcome | Expectation | Notes |
|---|---|---|
| Erection source | Released clitoral tissue | Preserved nerves support reliable erections |
| Length | 4–6 cm | Measured after swelling resolves |
| Sexual satisfaction | High reported satisfaction | Research shows gains in arousal and orgasm |
Phalloplasty outcomes: Sensation return, implants, and penetrative sex
A larger neophallus created in phalloplasty relies on nerve reconnection and staged steps for full function. Donor skin, fat, nerves, and vessels from the arm, leg, or back form the reconstructed organ. The arm often offers the best nerve availability for sensation.
Nerve hookup and sensation timeline
Nerve regeneration may begin around three weeks after stage one. Early tingling and subtle feeling can appear then. More robust sensation often builds over many months and may take a year or longer for fuller return.
Maintaining an erection with an implant: when and how
Penetrative sex usually needs an erectile prosthesis placed in a later stage. Surgeons typically wait about six months between stages to allow soft tissue healing and lower migration risk.
How inflatable implants work
An inflatable penile implant uses a cylinder in the phallus, a reservoir, and a scrotal pump. Compressing the pump transfers fluid into the cylinder for rigidity. A deflation control returns fluid to the reservoir. Patients learn device operation at the six-week post‑implant visit.
Potential risks and complications
Implants in a neophallus carry higher risk than in cis men. Known issues include infection, mechanical failure, erosion, migration, shape changes, chronic pain, and injury to nearby structures. Some problems require device removal or replacement. Scrotoplasty with testicular implants can improve appearance and offer a pocket for the pump, but it adds procedural complexity.
“Clear expectations about staged procedures, healing time, and complication risks help people decide with their surgical team.”
| Topic | Typical timing | Key notes | Risk/management |
|---|---|---|---|
| Nerve return | Weeks to 12+ months | Arm donor flaps often best for sensation | May remain reduced; follow-up with surgeon |
| Implant placement | Stage three, ~6 months after prior stage | Inflatable system: cylinder, pump, reservoir | Risk of infection, migration; may need removal |
| Penile size | After swelling | Typically ~5–6 inches | No ejaculation; discuss expectations |
| Scrotoplasty/testicular implant | Concurrent or delayed | Enhances appearance; houses pump | Adds surgical risk; surgeon plans placement |
Recovery, healing, and timing for sexual activity after surgery
Most people experience a staged recovery that moves from rest in the first days to more activity over weeks and months.
Activity and sex timelines: days, weeks, and months by procedure
Metoidioplasty often allows a return to light routines within about six weeks. Full sexual activity, heavy lifting, and driving remain on hold until the surgeon clears movement.
Phalloplasty usually needs 6–8 weeks for routine tasks. Swelling and bruising may persist for weeks, and sensation can take many months to improve.
Early bleeding is most likely in the first 48 hours after larger reconstructions. Numbness, tingling, and electric sensations are common while nerves regrow.
Post-op care: hygiene, pain, swelling, and lifestyle factors
Wound and urethra care focus on infection prevention and staged removal of catheters and dressings. Sponge baths are typical at first; grafted skin should stay dry until the team permits wetting.
Pain control aims for comfort without masking complications. Report worsening pain or unusual drainage promptly for possible device removal or further management.
Smoking slows healing and raises complication risk. Many clinicians advise stopping well before and after the procedure to support better health and faster recovery.
“Follow-up visits are crucial for urethral checks, safe dressing removal, and stepwise guidance on resuming intimacy.”
- Expect staged activity: light days, expanding over weeks, and sex only after clearance.
- Protect grafted skin and the surgical area; avoid soaking until cleared.
- Attend regular follow-ups to monitor urethra issues, dressing removal, and progress in healing.
Conclusion
Choosing a reconstruction requires weighing size, sensation, timelines, and possible complications.
Metoidioplasty often preserves native erectile tissue and yields strong sensation with a smaller penis. Phalloplasty creates a larger phallus that usually needs a later implant for firmness suitable for penetrative sex.
Urethra lengthening frequently lets men urinate standing, though retraining and follow‑up are common. Implants carry device risks; some problems may need removal or revision.
Research shows high satisfaction when expectations match goals. Close communication with the surgeon and team, attention to health, and clear questions about erections, sex, and standing urination improve long‑term outcomes.
Discuss options, risks, and timelines at consultation so the chosen surgery fits the person’s goals and body.
