For transmasculine people, bottom surgery can be an important and affirming step in their transition. As gender-affirming care becomes more available, it’s important to understand the procedures involved, the expected outcomes, and, of course, the risks. It’s also important to understand how treatments like testosterone transfer via sperm can effect offspring.
A question many people have when considering this type of surgery is: Can you die from FTM bottom surgery?
It’s a valid question. While it’s very rare, any surgery carries risks, and that includes the risk of death. However, it’s important to put that risk into perspective and understand what factors contribute to it.
In this article, we’ll explore the different types of bottom surgery available to transmasculine people, potential complications that can arise, and what steps you can take to minimize your risk.
Types of FTM Bottom Surgery: An Overview
FTM bottom surgery encompasses a range of procedures aimed at creating male genitalia. Here’s a breakdown of some common options:
Phalloplasty
Phalloplasty is the surgical creation of a penis. This often involves using skin grafts taken from other parts of the body to construct the new phallus.
Key features of phalloplasty:
- It can involve multiple surgical stages to achieve the desired outcome.
- The goal is to create a functional penis with sensation and, potentially, erectile capabilities through the use of implants.
Metoidioplasty
Metoidioplasty involves releasing the clitoris, which has typically been enlarged through testosterone therapy or, in some cases, DHT gel, to create a smaller penis.
Key features of metoidioplasty:
- The resulting penis is typically around 4-6 cm long.
- Sexual sensation may be preserved.
- Some patients are able to urinate while standing after this procedure.
Other Procedures
In addition to phalloplasty and metoidioplasty, other procedures often performed as part of FTM bottom surgery include:
- Scrotoplasty (creation of a scrotum)
- Urethral lengthening
- Vaginectomy (removal of the vagina)
General Surgical Risks Associated with Bottom Surgery
As with any surgery, bottom surgery carries a risk of complications. It’s important to discuss these risks thoroughly with your surgeon before proceeding.
Anesthesia Risks
Anesthesia is a necessary part of most bottom surgeries, but it’s not without risk. Potential complications include:
- Allergic reactions to the anesthesia medication
- Breathing difficulties during or after the procedure
- Cardiovascular issues
Blood Clots (Deep Vein Thrombosis – DVT) and Pulmonary Embolism (PE)
Blood clots are a serious concern with any surgery that involves a long period of immobility. Clots can form in the legs (DVT) and, if they travel to the lungs (PE), they can be life-threatening. Surgeons take precautions to minimize this risk, including:
- Sequential Compression Devices (SCDs) to promote blood flow in the legs
- Blood thinners like aspirin
- Encouraging early ambulation (walking) after surgery
Infection
Infection is always a risk after surgery, whether at the surgical site or from catheters. Post-operative antibiotics and diligent wound care are crucial. Watch for symptoms like fever, redness, swelling, or unusual drainage.
Bleeding and Hematoma
Excessive bleeding can occur during or after surgery. Hematomas (collections of blood under the skin) may form and require drainage.
Specific Risks and Complications of Phalloplasty
While rare, phalloplasty, like any major surgery, carries potential risks. It’s important to be aware of these before making a decision.
Blood Flow Issues and Graft Failure
One of the most significant concerns is compromised blood supply to the newly created penis. Surgeons meticulously monitor blood flow after the operation to ensure the graft survives.
Unfortunately, sometimes the blood supply isn’t sufficient, leading to partial or complete graft failure. This means the tissue doesn’t survive, and further surgery is required to correct the problem.
Urological Complications
The urinary system is delicate, and complications can arise. These include:
- Urethral stricture (narrowing of the urethra, making it difficult to urinate)
- Fistula formation (an abnormal connection between the urethra and the skin, leading to urine leakage)
- Urinary incontinence (difficulty controlling urination)
Careful catheter management is crucial after surgery to minimize these risks.
Wound Healing Problems
Delayed wound healing is another potential complication. Skin grafts may not take properly, leading to further issues. Poor wound healing also increases the risk of infection.
Sensory Issues
Nerve damage is a risk with any surgery, and phalloplasty is no exception. This can lead to loss of sensation in the penis or chronic pain. Surgeons use microsurgery techniques and carefully reconnect nerves to minimize these issues, but it’s not always possible to restore full sensation.
Specific Risks and Complications of Metoidioplasty
As with any surgery, it’s important to be aware of the specific risks and potential complications associated with each type of procedure. Metoidioplasty, while generally considered less complex than phalloplasty, still carries its own set of considerations.
- Limited Size and Functionality: The penis created through metoidioplasty is typically smaller than what can be achieved with phalloplasty. This can mean that penetrative sex may not be possible for some individuals.
- Urological Complications: Similar to phalloplasty, there are risks of urethral stricture (narrowing of the urethra) and fistula (an abnormal connection between the urethra and another body part).
- Sensory Changes: There’s a possibility of altered sensation in the penis after metoidioplasty. This could involve changes in sensitivity or the type of sensation experienced.
- Need for Additional Procedures: Some individuals may require additional procedures to achieve their desired aesthetic or functional goals. These additional procedures may come with their own sets of risks.
Minimizing Risks and Ensuring Patient Safety
While the risk of death from FTM bottom surgery is low, it’s crucial to take steps to minimize risks and prioritize patient safety. Here’s how:
Choosing an Experienced Surgical Team
Selecting a surgeon with extensive experience in FTM bottom surgery is essential. Look into their credentials, years in practice, and carefully read patient reviews.
Pre-operative Assessment and Optimization
A thorough medical evaluation is necessary to identify and manage any pre-existing conditions. If you smoke, you’ll need to quit. If you’re overweight, your medical team may advise you to lose weight prior to surgery. A psychological evaluation ensures you’re mentally and emotionally prepared for the procedure.
Following Post-operative Instructions
Adhering to medication schedules is vital, as is proper wound care. You’ll also have activity restrictions to allow for proper healing, and you’ll need to attend all follow-up appointments so your medical team can monitor your progress.
Recognizing and Reporting Complications Early
Be vigilant for signs of infection, bleeding, or other problems. If you notice anything unusual, contact your surgical team immediately.
Frequently Asked Questions
Do you get hard after bottom surgery?
It depends on the specific procedure. If a phalloplasty is performed, the resulting phallus typically does not achieve a natural erection without the aid of a penile implant. However, some procedures may incorporate erectile devices. A metoidioplasty, which uses existing tissue, may allow for some rigidity, but it varies.
Is bottom surgery worth it in FTM transitions?
The decision of whether or not bottom surgery is “worth it” is deeply personal. Many transgender men report increased self-esteem, body confidence, and overall quality of life after undergoing gender-affirming bottom surgery. However, it’s crucial to carefully consider the risks, recovery process, and potential outcomes before making a decision.
Do people regret bottom surgery?
While the majority of individuals who undergo gender-affirming bottom surgery are satisfied with the results, regret is possible. Factors that may contribute to regret include unrealistic expectations, complications, inadequate psychological preparation, and lack of social support. Thorough pre-surgical counseling and realistic expectations are essential.
Can you still feel pleasure after bottom surgery?
Yes, the goal of bottom surgery is to preserve or create the capacity for sexual pleasure. Surgeons take great care to preserve nerve endings and create erogenous zones in the newly constructed genitalia. The type and intensity of pleasure experienced can vary depending on the specific procedure performed.
How safe is FTM bottom surgery?
Like any surgical procedure, FTM bottom surgery carries inherent risks, including infection, bleeding, wound healing complications, and anesthesia-related complications. However, when performed by experienced surgeons in reputable facilities, bottom surgery is generally considered safe. It’s important to discuss potential risks and complications with your surgeon during the consultation process.
Closing Thoughts
The risk of death from FTM bottom surgery is low, but it’s not zero. It’s essential to keep this in mind as you consider your options.
Making an informed decision is key. Talk in depth with your surgeon about the risks and benefits of each procedure you’re considering. Make sure you understand what’s involved and what to expect.
Your own vigilance and commitment to post-operative care also play a vital role. Following your surgeon’s instructions carefully can help minimize risks and improve your chances of a successful outcome. Taking care of yourself after surgery is just as important as choosing the right surgeon and procedure.