Alexander Björn Gunnarsson is the first trans man to undergo radial forearm phalloplasty in Iceland. The surgery was performed last week by Doctor Hannes Sigurjónsson, a plastic surgeon that has specialized in gender reassignment surgery.
“I‘m told that the surgery went exactly by the book and that I‘m recovering by the book too, there have been no complications. There‘s no bandage covering the penis so I can see it. It looks all right, it‘s not very swollen but there are stitches in it and obviously all the “seams” are still healing. I have to be careful not to let it get weighed down so not to stretch the stitching, so need to keep it lying in an upward position while healing,“ says Alexander, who was more than happy to answer questions about his brand new crown jewels.
There‘s always a slight possibility that the blood flow to the new body part isn‘t sufficient so that the body part withers, or that blood doesn‘t circulate back from it, causing it to swell up, so Alexander is still kept under close guard at the hospital. But he says that so far everything looks good. “I’m young and healthy, a non-smoker so even though such a long surgery is always difficult, and it took me a while to recover after the anaesthesia, there wasn’t much risk involved.”
Phalloplasty is what the actual construction of a penis is called. This type of phalloplasty, called radial forearm phalloplasty, is quite a big operation and took about eight hours. “I‘m not exactly sure in which order this was done but during the surgery, the surgical team removed quite a big piece of skin from my forearm, almost an entire sleeve, and thick enough to be able to take veins and nerves with it. That piece was then rolled up and shaped like a penis and attached to my crotch, connecting the veins and the nerves. There are two main nerves that need attaching to, a skin nerve so that I‘ll have skin sensation in my penis, and then a nerve in my clitoris, so that I‘ll have the possibility of later developing an erotic sensation in it too. Then they also remove a thin layer of skin from my thigh to cover the area on the forearm. So that‘s healing now too and I‘ve got a lot of bandage there.“
“I‘m told that the surgery went exactly by the book and that I‘m recovering by the book too, there have been no complications.“
Alexander will need to undergo a few more minor operations to finalize what he wants to have done. “I‘m probably going to have two more surgeries. One where my outer labia will be made into a “pouch” and another where silicon testicles will be implanted. There‘s also a possibility of having a surgery to close up my vagina but there‘s no one in Iceland who can perform that so we‘re still looking at how to solve that.”
Alexander has the option of having the urethra extended through the new penis to be able to pee with it but says there‘s an increased risk of something going wrong with it, then leading to considerable problems with urinating and repeated interventions to solve those. So he chose to skip that bit. “I just pee as before, from beneath the penis. It doesn‘t matter to me at all to continue peeing sitting down.”
Have you always been determined to have a phalloplasty? “No not really. It‘s only about a year ago that I decided on it. I had the top surgery then and started to feel better about my body and myself and began wondering whether I should have something more done.
“I want to stress that even though I‘m very open and candid about my genitals, it doesn‘t give people permission to ask all trans people about their private parts.”
I had known that these sort of surgeries hadn‘t been particularly reliable so I never wanted to pursue them but there‘s been a lot of progress in the past few years so in April last year I decided I didn‘t need to wait for further developments in that area, that the phalloplasty surgery had reached a good enough level for me.”
Whad did your family and girlfriend think when you decided to have this done? “They‘re nothing but supportive and accept everything I choose to do. Of course my mum always gets a bit anxious when I need to have an operation but she‘s there for me all the way. And I‘m sure it‘s not fun for my girlfriend to have me stuck in hospital all this time but she‘s fine about it.”
Will you be able to have intercourse when the penis has healed? „No, not unless I have a special erection device implanted, but right now the penis is completely limp. I didn‘t have this surgery for that anyway, I only had it done to look more male and feel better about the way I look.”
Alexander hopes to be discharged from hospital in a few days. He‘ll see a physiotherapist to advise him on how to look after his arm while the skin there heals, and he‘ll have to be careful not to let his penis hang downwards until it‘s fully healed. “But I expect I‘ll be able to go to the pool and stuff in about three months! “
You‘ve been very open about this and blogged about your experience, why do you do that? “It‘s a combination of wanting to educate others about this procedure and how it works, and hopefully help and encourage other trans boys at the same time. I read lots of foreign blogs written by guys who have had phalloplasty so I want to inform those in Iceland about this possibility.
However, I want to stress that even though I‘m very open and candid about my genitals, it doesn‘t give people permission to ask all trans people about their private parts. I‘ve expressed myself about this unprompted and therefore expect people to ask me question, and that‘s all right. But apart from that, people should not ask others personal questions that they wouldn‘t want to be asked themselves.”
Good outlook for phalloplasty patients
Doctor Hannes Sigurjónsson, who performed the radial forearm phalloplasty, says that the outlook is good for future phalloplasty patients in Iceland.
“Last year we performed ALT phalloplasty for the first time here, that’s when we use skin tissue from the thigh to create the penis, but up until then it was common to use skin tissue from the groin.
But the technology has evolved a lot in the past few years and it’s getting more common to use skin tissue from other parts of the body.
The advantage of using thigh skin tissue is that it’s very thick and is more able to have an erection device implanted.
The good thing about using skin tissue from the forearm however is that it’s easy to shape it and simpler to extend the urethra through it, as well as connecting skin nerves to give the patient skin sensation in the penis but nerves take a long time to heal and recover, up to two years.”
“We’ve been testing a new erection device from Switzerland, which is especially designed for phalloplasty. That means Iceland is one of the first countries in the world to use this new device.”
Hannes says it’s a common misunderstanding that the ability to orgasm is lost after a phalloplasty. “Very often, we connect a nerve to the clitoris but otherwise we don’t interfere with it. Therefore, the sensation there remains as well as the ability to orgasm through the clit.”
The so-called “trans team” at LSH will continue offering these types of phalloplasty to patients and Hannes says there are around 3-4 people on a waiting list. These surgeries are fully subsidized by the state as they are part of the treatment offered to trans people.
And the outlook is good for future phalloplasty patients in Iceland. “We’ve been testing a new erection device from Switzerland, which is especially designed for phalloplasty. That means Iceland is one of the first countries in the world to use this new device. In the past, we’ve been using devices that were designed for incompetent men but they don’t really fit well with phalloplasty cases. We have good contact with the gender reassignment team in Gent in Belgium too; last time we spoke to them they had used six of these new erection devices and were really happy with the results, both the doctors and the patients.”
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