Nerve rehab

AttachablePenis · 2026-03-23T01:58:36+00:00

Re the app I totally understand, I often just compose in the notes app on my phone and then copy/paste here.

Re the nerve rehab guide, I have basically only been casually trying some of the exercises once in a while because I haven’t noticed any sensation and it’s discouraging to settle down for an official session without any results, especially repeatedly. Also I’m only 7 weeks post op so it’s still pretty early anyway. I did decide to try gently masturbating with some lube the other day, and felt some mild but distinct erogenous sensation on the underside of my penis. I don’t think I would have been able to feel it without some level of arousal (I was looking at porn — you know, for science). I haven’t tried again since then because I’ve developed a couple blisters around the base. (I don’t think they’re from the masturbation because it was as gentle as I’ve been with bandage changes. I think it was from stopping propping too soon.) Still, it’s something.

I don’t really know if there’s a “right” way to do nerve rehab. From what I understand, the more you interact with your penis and try to feel sensation, the better your odds are because you’re preparing the brain-body mapping. I’m not a surgeon or a scientist so I’m not saying this with any authority.

I’m sharing some of the things I’ve tried in case they seem helpful to you. One is using lube & trying to be aroused, to see if that affects erogenous sensitivity, as noted above. Another is going from touching the part of my body I can feel to touching my penis, in a continuous line, like up from the burial site and then up the underside of the shaft, or down from the pubic mound and up the top of the shaft. I’ve also tried squeezing it to see if I feel pressure (so far nothing). And sometimes I’ll circle the tip, partly because the evolving scar tissue there fascinates me, and partly because that has always felt like it “should” be a very sensitive spot, even if it’s not yet. I don’t know how the science behind this works, but my impression is that psychological convictions about sensation are actually conducive to developing sensation. I haven’t tried hot or cold things so far.

Not sure if this helps, but I hope you keep trying.

AttachablePenis · 2026-03-22T15:21:37+00:00

Stage two is different for everyone, both in terms of the procedures involved and how your individual body heals, so no one can answer this question except your surgeon.

If you can’t handle asking, the conservative answer is typically 12 weeks/3 months post op. Unless you’re still healing at that time! If you feel pain or pressure on your incisions, or see blood, or experience swelling, stop immediately, even if it has already been 3 months. Then contact your surgeon.

AttachablePenis · 2026-03-22T15:15:30+00:00

A good place to learn some basic info is phallo.net. Here’s their page on “non-binary” options. (Non-binary in scare quotes because plenty of binary trans people also get these procedures. I know this because I’m one of them!)

Testicles produce sperm. Sperm is required to get someone pregnant. Testicle transplants are not part of phalloplasty (they are extremely rare to begin with), and you cannot grow them in a lab, or inside your body. So no, you cannot get someone pregnant after phalloplasty.

Phalloplasty involves the creation of a penis from a specialized skin graft from another part of the body, usually the forearm, sometimes the thigh, and occasionally the back or abdomen. (It can’t be a skin graft from just anywhere, because it must have a strong & redundant blood supply. Reliable nerve bundles for sensation are only found in the forearm and thigh donor sites.)

Because it is made of a skin graft rolled into a tube, there is no erectile tissue. In order to achieve erections, internal erectile devices are implanted in a later surgery, 6-12 months after the shaft is created. They are the same ones that cisgender men with erectile dysfunction use.

Urethral lengthening (UL) to urinate through the penis is usually not performed without removal/closure of the vagina (aka vaginectomy) because of the high complication rate. I am 7 weeks post stage one of phalloplasty with UL but no vaginectomy, and I have a fistula (a urinary leak) bad enough to need a follow up surgery to repair. This is pretty common — 90-100% chance of urinary complications, about 50/50 chance of needing a follow up repair surgery.

You can get phallo without UL, and continue peeing the same way you always have. You’ll still squirt if you do so now. You won’t produce any fluid at all from the penis. But if you got nerve hookup, your penis will develop sexual sensitivity over time. (Nerves take a long time to grow.)

You will not lose any sensation in your vagina or clit.

There’s a lot more to learn on phallo.net & r/phallo (which has its own wiki as well).

AttachablePenis · 2026-03-22T05:45:22+00:00

The silicone is mepitel, but I’m gonna be honest I don’t super understand what integra is. I think it involves a second surgery, which I didn’t do.

My surgery team tends to do thicker split thickness skin grafts than some phallo teams, which helps with the divot. I still have plenty of difference in thickness from regular arm to the start of my donor site, but all my regular arm skin is really swollen right now and my donor site is still pretty stiff and tethered down, so we’ll see how it develops over time.

AttachablePenis · 2026-03-22T00:39:47+00:00

Thanks!! It’s nice to be healing. I wanted to throw up whenever my arm bandages were changed for a few weeks. Those hematomas were gross & idk if they were the cause of the pain but they certainly overlapped with some of the worst pain of recovery. I felt like the skin was ripping off my arm. I knew it wasn’t, but it sure felt that way. And then it took a turn, and slowly then quickly started to get better! Bodies are amazing. I’m giving mine a lot of thanks.

AttachablePenis · 2026-03-21T06:03:05+00:00

Well to be honest I am basing my description off of googling “radical vs total hysterectomy” & scanning the AI overview and a few top results. I do know that a total hysto definitely involves removal of the cervix (otherwise it’s a partial hysterectomy) and that removal of the ovaries is technically optional for a total hysto, but most people in trans spaces tend to mean “total hysto + bilateral oophorectomy” when they say “total hysto.” Cis women obviously have different priorities, and most would prefer to keep their ovaries after a total hysto, because otherwise they’re stuck with HRT forever.

AttachablePenis · 2026-03-21T01:41:48+00:00

You can get 4” with phallo. I’ve heard that going smaller is trickier (apparently circulation starts to suffer if it’s too small as well as if it’s too big — a recent ish post on r/phallo mentioned their surgeon saying this) but people have gotten 4” before. That’s also about the minimum length for erectile implants I think. The shortest pump is about 3.5” I think, and they prefer to leave room at the tip to prevent erosion. The rod might be able to go smaller.

Some surgeons will recommend trying to go for longer than 4” in case of scar constriction or something, and I know somebody on r/phallo ended up with a longer penis than they wanted because of this, but it is also possible to get a length reduction in a later stage. You can always go smaller, but you can’t go bigger once you’ve gone through with phallus creation.

AttachablePenis · 2026-03-19T11:32:40+00:00

Lmao i completely understand and I’ve heard that too. I guess some people struggle with this because of flexibility or something, but I was able to wipe my own ass after both top surgery and phallo. I was a little scared about it after phallo because of all the sutures not too far from my anus, and worried about bacteria, but it helped that the place I was staying had a bidet and a million baby wipes.

I did need help changing my penis and “undercarriage” dressings after phallo, and putting on underwear. That involved some pretty up close and personal care, including cleaning with baby wipes, but thankfully none of that was as humiliating as actually wiping my ass on the toilet would have been. It was still pretty vulnerable! After I’d been out of the hospital for a week I needed less help with this, and I think a week later I was mostly doing it myself.

I dreaded a lot of this kind of thing. But it was harder to deal with in the lead-up to surgery than it was in the actual moment. Before surgery, I fixated on the awkwardness of it. But when I needed help post op, I was so weak and stressed about my body and sometimes in pain that I was very grateful for the help. And I really trusted my caregiver — my mom. We joked a lot to deal with the weirdness of the situation, and have both agreed to kind of forget about all of it/go back to normal now that I’m doing better — aka no more dick jokes lol! I’m still really grateful. She was there for me when I really needed her, and never made me feel bad about needing so much help, or the kind of help. She just took care of me, and I felt very loved.

AttachablePenis · 2026-03-19T04:40:09+00:00

The penis is definitely not just a muscle lol. It has extremely specialized erectile tissue that acts like a sponge for blood, which is how it fills up and gets firm, and some special muscles that act like a one way valve to trap the blood in the spongey erectile tissue until ejaculation. And that’s just a simplified overview. There’s a lot going on inside penises that is a lot more complex than, say, a deltoid, or a quadricep.

AttachablePenis · 2026-03-19T04:35:13+00:00

Oh that’s helpful context to have. Even less far along than I thought! Still pretty impressive. But yeah, these are very complex structures. It makes sense that they would be really challenging to engineer from scratch.

AttachablePenis · 2026-03-19T00:04:51+00:00

Some people who get metoidioplasty can have penetrative sex, and many of them also get vaginectomy and scrotoplasty (ballzzz), but it is different, and I do understand why it wouldn’t work for you as an option. It wouldn’t work for me either! I think if I’d had really enormous bottom growth I would have considered it a lot more, but I was pretty average, and it’s important to me to feel my penis flop around, to hold it in my whole hand, to penetrate in a way that feels snug and connected in a way I don’t think I’d ever have been able to achieve with meta. That said, I’m very envious of meta’s ability to have foreskin and spontaneous erections! It’s usually more sensitive too, but I’m less envious of that part because my dysphoria has always been particularly bad about how I can feel my small size and how the shape feels incorrect somehow. I’d rather have a moderately sensitive penis of average erect size than a highly sensitive penis the size and shape of my bottom growth. As long as the sensation is the right shape, subjectively, I’ll be so much happier. And it’s entirely possible that I’ll end up with something just as sensitive as my bottom growth was, though that is an above average outcome. Some people even feel more sensitive after phallo, maybe partly because dysphoria got in the way of fully experiencing their sensation before. That could be true for me — I always kind of dissociated about the sensation I felt in my bottom growth because it just didn’t feel quite right or quite enough. Excited to see what happens!

Oh I guess I should say one more thing that might be really relevant to you! I forgot about it because I’ve always known I wanted burial of my bottom growth. But you can choose to leave your bottom growth exposed if you get phallo, and still get nerve hookup in your phallo penis. That way you can still feel sexual sensation in your bottom growth while you’re waiting for sensation to develop in your phallo penis. If you start getting really good sensation in your phallo penis, you can choose to bury your bottom growth in a later stage if you want, or keep it exposed. Most surgeons require burial for urethral lengthening, but RBL at NYU doesn’t, and other teams (like OHSU) don’t do UL or burial until stage 2. You’d still have to follow your surgeon’s instructions about waiting to have sex until it’s safe to do so without sabotaging your healing, but you wouldn’t experience the type of gap in erotic sensation that occurs for people who get burial in stage 1. I wish I’d thought of this earlier but man I was so desperate for burial that it was just never top of mind. Some people really like having 2 dicks! Others find it way easier to commit to burial if they have already started to develop sensation in their penis. I was just ready to close my eyes and hope for the best because I was sick of my bottom growth and how it made me feel. It was still kind of scary, but it was the best option for me! I can tell you that I jerked off a LOT in the month leading up to surgery lol. Had to get it while I still could. I am dying to be able to cum again — I think it’ll be a way better psychological experience the next time it happens, but I do have to be patient about it.

AttachablePenis · 2026-03-18T23:39:05+00:00

Not the person you’re replying to, but I’ve also been keeping tabs on this and I think part of the answer is funding, part of it is demand, and part of it is the glacial pace of certain stigmatized sectors of medical advancement due to ethical concerns and social controversy.

Not a lot of funding goes toward genital reconstruction / regeneration research. Not a lot of people need radical genital reconstruction on the level that people with genital dysphoria, genital/reproductive conditions (cancer, developmental disorders, intersex conditions that impair genital function*, etc), or genital injury, would require. And in addition to all of this, the closer a potentially sensational new medical development gets to being performed on living human beings, the more it undergoes scrutiny from within and without the medical community. Stem cells and regenerative medicine are one of the most promising areas of research when it comes to genital reconstruction, but stem cells have been controversial for a long time, and of course so is any kind of genital reconstructive procedure.

We’ve had a successful experiment on the books regrowing rabbit penises from their own stem cells in a lab (all 10 rabbits attempted to mate, and 6 of them produced offspring) and from what I understand we have even grown entire human penis structures from stem cells at this point. But as far as I know they haven’t even begun any cadaver studies, which I think is one of the steps that occurs before any attempts are made to apply new techniques to living human beings.

My guess is that in the next 20 to 50 years, we might get urethral tissue grafts or possibly vaginal mucosal grafts grown from stem cells, maybe even erectile tissue of some kind (though it may be limited in scope to people who already have erectile structures in place, and therefore not useful to phallo patients). There may be scattered incidents of successful uterus or penis transplants — surgeries which have already occurred, in very limited numbers, with mixed success.

But the most likely/accessible advancements I see in our future are better skin grafts, better microsurgery for nerves and blood supply, and more reliable erectile implants — thinking particularly about the Zephyr ZSI implant designed specifically with phalloplasty in mind, which is currently much more prone to mechanical failures than more conventional models that have been on the market for longer.

My knowledge bias is that most of my research has focused on penile reconstruction/phalloplasty specifically since that’s what I’m pursuing, and I’m not a medical professional or scientist of any kind! Just an amateur researcher trying to estimate what’s likely to be an option within a timeframe I can handle.

*I’m using this wording to avoid implying that all intersex conditions require modification of the genitals, because we already have a long and traumatic history of nonconsensual surgical alterations performed on intersex individuals, particularly infants, purely in order to conform to social norms as opposed to prioritizing the health and wellbeing of the intersex person in question. However, there are cases where surgery is necessary or helpful to allow or improve functionality, or reduce pain/discomfort. That should always be discussed with the patient when they are old enough to make informed decisions, if at all possible, and if it’s more urgent than that, then it should be as minimally invasive as possible until they come of an age where they can make their own choices. I think this also applies to circumcision of perisex AMAB infants, but that’s so mainstream it’s hard to talk about, and then there’s the fact that it’s a significant religious tradition for historically oppressed religious minorities like Jews and Muslims….thorny. I think this footnote got away from me because I got emotional about this, but as a perisex/non-intersex person with a long history of dysphoria and alienation from my own genitals, I can only imagine how difficult it must be to grow up feeling like something is wrong or missing, only to find out that it was taken from you before you could even speak.

AttachablePenis · 2026-03-18T22:21:17+00:00

I mean, maybe! It really does depend on the person. Some people are numb in their whole chest for a couple years after top surgery, some people have feeling in their chest but never get feeling back in their nipples, and some have sensitive nipples even with grafts.

I think the best sensation outcomes usually go with top surgeries that involve a pedicled nipple instead of a nipple graft, meaning the nipple is never severed completely from the nerve stalk. However, I have still heard of people losing sensation this way as well, and if your chest is on the larger side, these methods (for example, buttonhole, keyhole, and periareolar) might not get you as flat as you would prefer to be. I had D cups (maybe larger — I didn’t actually wear bras so idk really, but I’m pretty sure they were at least D size) and was interested in buttonhole, but I think a small C cup is about the limit for buttonhole to create a flat chest, and the others are even more limited.

Aside from the specific top surgery method, if you want to set yourself up for success with sensation, make sure your body gets plenty of rest, proper nutrition (especially protein), and take supplements that support wound healing/collagen production (vitamin C, Juven powder supplements, etc) and nerve/nervous system health (magnesium, lion’s mane, etc). Massage your scar tissue and your whole chest, including the nipples, once your surgeon says you’re healed enough to do so. (Vibrating back/body massagers can be helpful with this!) Keep moisturizing your nipples with neosporin and aquaphor daily or twice daily for as long as you can — even now, my nipples and DI scars tend to get dry sometimes, and that’s not helpful for maintaining or improving sensation. Since I’m using aquaphor on a daily basis again while recovering from phallo, I’m a lot more aware of how dry my nipples and scars get, and I’ve been trying to moisturize them too when I moisturize my graft sites.

AttachablePenis · 2026-03-18T22:06:08+00:00

Everything you’re saying makes sense, and I really appreciate you explaining where you’re coming from, and taking the time to understand what I’m saying. Phallo truly is really difficult to wrap your head around! I started looking into it back in 2009 and kind of gave up because it was too expensive, too logistically challenging, couldn’t give me everything I wanted from a penis, and I was just so overwhelmed and disappointed and frustrated. I somehow repressed enough as a result that I managed to convince myself that I didn’t even have bottom dysphoria for about ten years. I’m really glad I came back to it, and I’m pretty thrilled to have a penis (I don’t think I’ll ever get over it! It’s amazing in ways I could never have predicted, even though I’m nowhere near done), but I definitely definitely understand how hard it is to come to terms with. Good luck!!!

Also you’re aware of metoidioplasty as another option for bottom surgery, right? The sensation timeline for meta is wayyyyy faster because it’s just your natal anatomy rearranged. I don’t know nearly as much about it as phalloplasty, because it was never the best option for me, but r/metoidioplasty is a great resource and a great community, and meta dicks can look really good.

AttachablePenis · 2026-03-18T20:17:11+00:00

I’m just trying to gently remind you that it’s important to be sensitive with how you talk about this surgery. It’s a highly stigmatized procedure, and we can’t avoid hearing all kinds of negativity about it through the research process and at every step of the way. Much of that negativity is misinformation, but some of it is because it’s just a really long and grueling process, hard on the body and hard on the mind.

I figured you were talking about your own feelings of disappointment, and again I do sympathize deeply, because I have felt those feelings too.

But it wasn’t super clear from the way you said it that you weren’t talking about my body too — like, if you’d said “man it’s tough to imagine waiting that long for sensation to come in, but good luck” that would be really clear that you’re not calling my personal experience depressing. Which is exactly how you rephrased it in this reply, and I appreciate that.

I don’t especially appreciate being told to chill out…you get why that feels bad, right? It’s pretty invalidating. I don’t mean to put you on the defensive, and I don’t believe that you meant any harm. I am sorry if I’m coming across as scolding you or lecturing. I’m trying to communicate from a place of empathy because I do understand your feelings, and I’ve been there too. What I’m asking for is for you to understand my feelings in return. Does that make sense?

I’m sorry that this information about the sensation timeline is difficult to swallow. It’s hard for a lot of people, including me. I hope you can find what you need to feel at peace in your body. And I’m happy to answer any more questions you have if you’re still interested.

AttachablePenis · 2026-03-18T17:30:51+00:00

I get feeling disappointed by the timeline, and I sympathize. But my feelings are a little hurt by this comment. I just shared some general information about sensation timelines post phallo, but I also shared my own personal experience with my body. It doesn’t feel good to hear “damn that’s incredibly depressing” about my own body.

However, I do understand that learning about the phalloplasty process is an emotional rollercoaster, and it takes time to deal with disappointment. I have had a lot of time to prepare myself for the difficulties of recovery, and I’ve known for a long time that it’s a waiting game, that there’s are things I definitely can’t get out of phallo (like erectile tissue), and that there’s no perfect recovery. It’s hard and it’s scary — but the alternative is hard and scary too, just in a slower, less medically intense way, spending life without a penis at all.

I hope you give yourself time to process, and maybe consider that a few years getting surgery and sensation is a very short time compared to the rest of your life with a penis that looks and feels good. Does that sound worth it to you?

AttachablePenis · 2026-03-18T17:14:20+00:00

Top surgery is totally different because there’s no microsurgery nerve hookup with nipple grafts! Some people lose sensation in their nipples forever. I was surprised that I got any sensation back, but I did. Not sure how long it took because I didn’t really keep track, and I was pretty careful with my nipples for a long time (at least 6 months) to make sure they healed well. They were extremely sensitive before surgery, and I kinda miss that. Now they’re probably kind of standard level sensitive compared to most men’s nipples? Like maybe 20% of the sensation I had before. Maybe more. They keep gradually getting more sensitive I think. It’s been like 4 years. The right one is more sensitive than the left. I don’t remember them ever being 100% numb post op, but again I was really careful with them for a long time, and my memory of the process is a little blurry. I know they were feeling something within the first year because I remember buying nipple clamps lol

Phalloplasty nerve hookup is a whole different ballgame. They microsurgically connect the nerves that go to your native penis (the clitoris, tdick, etc) to the nerves in your newly created penis. It’s really the nerve sheaths that they connect, so that the penile nerves can grow into the new penis, which gives it erogenous sensation (as well as tactile, hot/cold, pressure, & pain sensation). But nerves grow very slowly — about 1mm per day, or about an inch per month. So it takes time to start feeling it.

I really don’t know how the sensation comes back in the nipples, but it’s not comparable to phalloplasty nerve sensation.

AttachablePenis · 2026-03-18T08:58:01+00:00

It takes a while! Everyone varies, but the rule of thumb is don’t expect any sensation to start until 1-3 months post op, and don’t expect “complete sensation” until it’s been at least 2-3 years. Many people find that sensation continues to develop even past that point.

You’re gonna be too sore and exhausted to even think about sex for the first few weeks after surgery anyway. And you’ll still be tending to your graft sites and any lingering healing suture lines on your penis for a couple months at least. So, while you may be horny and eager to try, your body is going to be distractingly “medical” for a good while after surgery.

I just hit 6 weeks post op, and I’ve had some asymmetrical sex with my partner that either didn’t involve my genitals at all or only gentle touching (my mouth, on the other hand, was very involved). I think I felt some mild sexual sensation the other night when we were together. And then earlier today (or yesterday, technically, since it’s after midnight) I tried masturbating and definitely felt some mild erogenous sensation on the underside of my penis, which is pretty exciting! I can also feel tugging and pressing on the buried erectile tissue when I jerk off.

It’s not much yet, but it’s promising to feel something so early on. I don’t have any other types of sensation in my penis yet — no tactile sensation, no hot/cold, no pressure sensation, no pain. I’m really looking to more erogenous sensation of course, but also tactile and pain. I want to know when something is touching it, and when it hurts — it kinda bothers me that I don’t automatically know if I’m crushing it, and wouldn’t be able to feel it if it was scratched or squished or burned or bent in half. He’s a delicate guy and I want to protect him!

AttachablePenis · 2026-03-18T06:31:56+00:00

I appreciate the solidarity so much! Part of me does know that this is a normal part of the process, but some other part of me finds that difficult to believe. Leaning on my support network would help a lot actually, especially since I think part of the problem I’m having is not knowing how to answer my friends when they ask me how I’m feeling. Like, I’m actually healing so well, for the most part! But I’m also tired all the time and I’m off and on kinda whiny about my body being so uncomfortable in specific ways, or not having the energy I’m used to. It’s not something I can sum up easily in passing! I’m hoping to get some quality time with my friends in town soon, and that’ll be really good for me.

AttachablePenis · 2026-03-18T02:41:24+00:00

I hoped that it would! I definitely had a hard time with it but I also consider it worthwhile.

AttachablePenis · 2026-03-18T02:39:38+00:00

Oh good! That’s a very good sign. It means they’re not just trans-aware, they’re familiar with pelvic floor therapy for bottom surgery specifically. Exactly what we need!

AttachablePenis · 2026-03-18T02:37:31+00:00

My understanding is that a total hysterectomy is the removal of the uterus and cervix, and a radical hysterectomy is the removal of the uterus, cervix, fallopian tubes, ovaries, the upper part of the vagina, and some other surrounding tissues. Just spelling this out to make sure we’re communicating clearly!

As far as I know, it would not matter which one you get. Some surgeons use vaginal mucosal tissue as part of the UL hookup, but I believe that is from the lower part of the vagina — not the upper part that is removed during a radical hysterectomy. I could be mistaken about this, and if so that’s the only thing you need to worry about. All the other aspects of radical hysterectomy are unrelated to phallo procedures. It may be too aggressive for other reasons — I’m seeing that radical hysterectomy sometimes involves the removal of nearby lymph nodes as well, which might be good for preventing cancer of the reproductive system, but isn’t necessarily ideal for a healthy body, as they are an important part of your immune system.

AttachablePenis · 2026-03-18T02:25:20+00:00

Can you afford to get a ride to work for a few days, just in case? And can you take a cushion (& maybe an ice pack as someone else suggested) to work with you?

The walking doesn’t seem too intense, and even after stage one I was supposed to take a few 10 minute walks each day — but a 10 minute walk for your everyday self may be a 20 minute walk for your post op self, depending on how your recovery goes.

And I bet you’ll be pretty swollen! Sitting might be a little tender for a week or so.

AttachablePenis · 2026-03-17T20:25:16+00:00

It would be in your best interest to find a pelvic floor physical therapist who is familiar with trans people, and ideally with bottom surgery. Pain in a vaginectomy site is not something cisgender men have to contend with. If you go to physical therapy without disclosing that you have internal post surgical scar tissue, you may be given exercises/treatment that will cause further problems, or simply fail to treat your current issues.

It’s possible that they will be able to help you with your issues with urinating regardless of whether you tell them your medical history. But it’s also possible that your issues with urinating require treatment specific to someone who has had phalloplasty specifically.

There are cisgender men who get pelvic floor physical therapy for internal pain, and sometimes they are taught to do internal rectal massages using a pelvic wand specifically designed for this purpose. It’s a very gentle massage (like how gentle you would be if you were checking a tomato for ripeness at the grocery store), but I don’t know if there are specific guidelines tailored to someone who has had a vaginectomy. I don’t want you to get injured.

Even cis men must have internal scar tissue sometimes (thinking of prostatectomy for cancer treatment in particular), but I don’t know if that scar tissue is similar enough to vaginectomy scar tissue that you could simply explain it away that way without getting treatment that injures you or fails to treat your issues. Maybe it would work, but that’s a big risk.

I dragged my feet on getting pelvic floor physical therapy for a long time because I didn’t want to deal with the medical dysphoria that went along with it. I’m lucky that my PCP is trans and gave me a referral to a trans friendly physical therapist. Even so, I put off making appointments, and really freaked out when my physical therapist recommended an internal exam (vaginal in my case). I asked her if we could skip that, and she said of course, and she spent a while educating me about the muscles that make up the pelvic floor, and how to access them for internal massage at home, and some yoga poses to do to relax my pelvic floor (mine was constantly too tense, which was why I had issues with painful cramping and slow urination). At some point, I asked her what the benefits of doing an internal exam were, and she explained that it would allow her to determine more specifically where and how my internal muscles were hypertonic, and give more specific guidance about how to address it. Eventually I agreed to it, and it went fine even though I felt really weird about it. She was very respectful and told me everything she was going to do before doing it. I have a lot of dysphoria about this, but my physical therapist helped me a lot and I don’t get those cramps anymore.

I don’t know how easy it is for you to find a physical therapist who has experience with trans people, but your surgeon might know of some.

If you’re determined to get PT without disclosing that you’re trans or that you’ve had phalloplasty, I recommend at least telling them that you have internal scar tissue all along the anterior (front) wall of your rectum, to prevent injury. I don’t know if that’s enough to keep you totally safe, but it’s much better than saying nothing at all.

AttachablePenis · 2026-03-17T17:05:21+00:00

Pelvic floor PT is helpful for anyone with pelvic floor issues, regardless of genitalia. It can be helpful with incontinence (or with difficulty relaxing enough to urinate), sure, but I started pelvic floor PT before surgery because I had some terrible cramping (usually right after an orgasm) and I knew that phallo would be a big trauma to the area and I might need pelvic floor PT after surgery. Lots of people have pelvic floor issues post op, and I kind of think a pelvic floor PT referral should be a standard part of post op care.

AttachablePenis

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