Hello all,

I am planning to start looking into phalloplasty options for patients who have had a vaginoplasty with penectomy. I am particularly focused on phalloplasty methods that allow for innervation via microsurgery.

This is a small cohort but those in it suffer significantly due to lack of known surgical options, lack of community support, and internal emotional issues such as guilt. As such, providing a satisfactory surgical intervention to this group is essential to permanently resolving their prolonged dysphoric emotional state.

I will drop information in this thread as I find it, in an informal way. In the future I will assemble the information in a more formal way. I invite you, dear reader, to leave any journal articles or personal knowledge here as well.

If you are a surgeon or investigator in this area, I welcome your input and assistance. If you wish to publish a paper based on this investigation, please do not hesitate to contact me.

A reddit user who got penis and testicle preserving vaginoplasty!

I know a lot of people have been curious about this or wanting it, so this is a good opportunity to get greater visibility on this option.

Why does the clinical trial for this still languish?

This has been a trial in progress since 2018, so human trials have been backlogged for 5 years now.

As someone who used to have a penis and wants one again, I have very high standards.

This is bad because meeting them is going to be a pain in my ass.

Here's some information about next generation penis technology that I've been keeping my eyes on the past few years.

Please feel free to add your own information and I'd love to hear about what ideas you think might help things.

Pedicled Gracilis muscle based erectile control

This appears to give voluntary erectile control after a period of learning. Additionally it provides enough rigidity to do some kind of sex, presumably penis-in-vagina since the study participants didn't elaborate. Everyone has these muscles so there isn't much limit to where it could go.

https://academic.oup.com/jsm/advance-article/doi/10.1093/jsxmed/qdac022/6986025

Complete Human Penile Scaffold for Composite Tissue Engineering: Organ Decellularization and Characterization

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6841966/

Dr. Yu Tan under Dr. Coon seems to have expanded significantly on the work that previously had been led by Dr. Atala, et al. Dr. Tan went above and beyond, starting some preliminary work on reseeding.

The Atala lab worked on a rabbit model back in 2009, which we can see here: https://www.pnas.org/doi/10.1073/pnas.0909367106

The jump from rabbit to human is large and I hope to see a continuation of this line of research either from Dr. Tan or Dr. Coon's lab.

FAQ ==========

Welcome to the FAQ.

I know you're all impatient as all hell to learn about doing something, so I put surgery first.

Surgery Related ----------

General Applicability

• Do I need to be on hormones to get surgery?

  • If hormone replacement therapy doesn't apply to your body/gender identity mix, then no. There are explicit carve outs in the new transgender care guidelines that make the HRT requirement not applicable to people who don't need HRT.

• How much does surgery cost?

  • This is HIGHLY variable. Many US insurance companies will cover surgery and so far all surgeons accept insurance. Cash price may exceed 100k USD.

• Does it feel as good as a natal penis/vagina after surgery?

  • No one has yet answered this because people with penises don't tend to get more penises, and people with vaginas don't tend to get more vaginas. Most people who get any form of bottom surgery end up sensate and orgasmic. Truthfully there isn't much point to comparing against natal genitalia as you can't obtain any more than what you're born with.

• Where can I get surgery in my town?

  • You probably can't. As of now, providers are scattered around the country. Be prepared to travel.

For people with a natal penis

• Can I get a vagina without removing my penis?

  • Yes, you can. This is called Penis Sparing Vaginoplasty and multiple surgeons provide this.

• Can I keep my testicles?

  • Yes. You can keep them where they are, as-is. Moving them internally has not yet been approved by any surgeon known to the wiki author. Surgeons typically cite the inability to check for cancer.

• Can I have labia? Will it look like natal labia?

  • Yes, you can have labia. Surgery has improved over time and labia are now possible, but may require two stages. Any labia can look natal because nature makes all kinds of labia, see the Great Wall of Labia project to see why pretty much any labia, or even no labia, is possible by birth.

For people with a natal vagina

• Can I get a penis without removing my vagina?

  • Yes, you can. You can get meta, phallo, or both. Be sure to be explicit with your surgeon about NOT wanting vaginectomy. Urethral lengthening is more difficult in phalloplasty without vaginectomy because the vaginal tissue is usually used to lengthen the urethra. This means lengthening almost always requires additional surgery. DON'T LET THAT STOP YOU! Just keep future repairs in mind when you are scheduling and planning.Citation

• Can I get testicles without removing my vagina?

  • Yes, there are options for testicular implants without vaginectomy.

• Can I keep my clit/t-dick?

  • Yes. Phallo can be done with or without burial. Opting not to bury your t-dick does technically mean you'll have two penises.

• Can I keep my vulva?

  • Yes. The only surgeries that would impact this are scrotoplasty and metoidioplasty if you want the vulva foreskin-ized. Some creative salmacians have combined their scrotum and vulva.

For people with (a) natal genital(ia) that isn't explicitly a penis/vagina

• Can I get surgery too?
  • Yes, probably. It is best to contact one of the known surgeons and discuss your specific situation with them. They can create a care plan that meets your needs. You can also ask on the discord and we can try to help guide you to a surgeon.

For people who already got a bottom surgery that removed and replaced a genital

• What can I do?
  • I'm not sure yet. The FAQ author is also in this category and is always looking for solutions.

Identity ----------

• Do I belong here if I'm cis and just want a penis/vagina added?

  • Yes. Your gender isn't important to salmacian identity. Just the number of genitals.

• Am I still salmacian if I haven't/can't/won't have the surgery

  • Of course. Circumstances may vary, but your identity is your own. The only requirement is that you prefer to have a mixed set of genitalia.

• Am I trans?

  • If you're trans, then yes. If you're not trans, then no.

• I'm not trans?

  • That's not really a question Q&A strawman, but that's totally fine. Many cis people are salmacian.

• Does cis and trans even mean anything if you just leave it up to self identity?

  • It's a useful shorthand for most communities. Unfortunately, salmacians in general don't do very well to being told to pick one. In our spaces, your self identification is probably the most useful role of these terms.

• Am I salmacian if I want no genitals?

  • No. That is called nullification.

• Am I salmacian if I want new/novel/xeno genitals?

  • Depends. Do you want more than one? We have decided to be as accepting as reasonably possible, so if your setup involves 2 or more genitals then we think so.

Other Groups ----------

• Isn't this perisexist (anti-intersex)?

  • We do not believe so. Some salmacians are intersex. Some intersex people are salmacian. We are separate groups with overlapping membership. The mods also believe that solidarity and mutual aid with the intersex community is extremely important to ensure both of our communities are safe in a world that holds perisexist and isosexist (anti-trans/salmacian/gnc) views.

• Does getting surgery make me intersex?

  • No. Intersex people are often misrepresented as having full sets of both genitalia. Genitalia is not the end-all-be-all of the intersex experience. Intersex people have a medical condition that can impact genitalia, hormones, childhood development and much more. A perisex (not intersex) person getting a genital surgery does not become intersex.

• Futa/futanari is a slur against trans women?

  • That's not actually a question, strawman-question-asker, but we do get that a lot. We DO NOT approve of the label being used on someone without their consent. Large portions of our community identify as transfem, MtF, as trans women, etc. and some use the term futanari as their identity. Futanari roughly means "someone of two kinds" and is not specific to feminine people. Masculine people can be futanari as well!