Medical Tourism Blog
Standing to Urinate FTM: Phalloplasty in Korea as a Surgical Solution for Transgender Men
Table of contents
- Phalloplasty: A Detailed Medical Overview
- Best Clinics in Korea for Standing To Urinate Ftm
- The Process of Undergoing Phalloplasty in South Korea
- Costs of Phalloplasty: South Korea vs. Global Medical Tourism
- Patient Experiences and Functional Outcomes: Standing Urination After Phalloplasty
- Conclusion
- References
This guide is designed for patients and their advisors considering phalloplasty as a gender-affirming option, especially for those aiming to achieve standing urination. It explores the details of undergoing this surgery as a medical tourist in South Korea, including its benefits, complexities, and costs. For many transmasculine individuals, aligning their physical body with their gender identity is a profound goal—standing urination is a key part of this process and has both psychological and social significance as a major functional objective of gender-affirming genital surgery.
The term "standing to urinate FTM" describes the desire and ability for transmasculine (Female-to-Male) individuals to void while standing, reflecting a common feature of cisgender male anatomy. This ability is critical for many in their gender affirmation journey. Non-surgical aids such as the "STP" (Stand To Pee) device or "stand-to-pee device" are designed for this purpose and are widely used by transmasculine people before, and sometimes instead of, surgery. These funnel-shaped aids, sometimes shaped like a prosthetic penis, are useful in public or unsanitary bathrooms and can help foster bodily congruence and ease in gendered spaces. Learning to use stand-to-pee devices (especially STP packers) takes practice, and many recommend rehearsing at home before using them in public. The popularity and discussion around STPs shows that standing urination is not simply a post-surgical goal but a deeply embedded, immediate need for many, tightly linked to gender identity and societal comfort.
Phalloplasty: A Detailed Medical Overview
The primary aim of transmasculine bottom surgery, or masculinizing genital surgery, is to reconstruct female genitalia into male genitalia, allowing the body to better reflect the patient's gender identity. Specific functional goals include creating a natural-looking phallus with sensation and pleasure, achieving erections (with devices), and—importantly—enabling standing urination.
Phalloplasty involves creating several anatomical structures: the penile shaft, an internal shaft urethra, a perineal urethra to connect the new shaft to the native urethra, a scrotum (scrotoplasty), and often glansplasty (to form a circumcised-looking tip). Commonly, a vaginectomy (removal of the vagina) and burial of clitoral tissue are performed as part of the process.
Phalloplasty Techniques
- Free Flap Phalloplasty: In this method, a skin flap is fully detached (including its blood vessels and nerves) and transferred to the recipient site, allowing for nerve connections that may provide sensation:
- Radial Forearm Free Flap (RFF): Uses tissue from the forearm and is favored for good sensitivity and a natural look.
- Anterolateral Thigh (ALT) Flap: Uses tissue from the thigh, good for thinner patients.
- Musculocutaneous Latissimus Dorsi (MLD) Flap: Uses tissue from the back.
- Fibula Flap: Incorporates bone for structural support.
- Pedicled Flap Phalloplasty: The flap is partially attached at the donor site and repositioned. Sensation is more limited, except in Pedicled ALT Phalloplasty.
- Abdominal Flap Phalloplasty
- Groin Flap Phalloplasty
- Pedicled ALT Phalloplasty
- Tube-within-a-tube Phalloplasty: A flap is folded to form an outer shaft and an inner urethra, often with forearm tissue.
- Composite Phalloplasty: Uses tissue from two sites to create shaft and urethra separately.
- Shaft Phalloplasty: Only the outer shaft is created; urination remains through the native urethra, lowering risk and complexity.
- Metoidioplasty: Uses growth from testosterone-enlarged clitoral tissue to form a small phallus, sometimes including urethral lengthening for standing urination.
Phalloplasty usually requires multiple surgical stages, rarely completed in one session. This phased approach allows physical and emotional recovery, lowers complication risks, and lets patients adapt, reassess, and make choices between phases. The journey may take a year or more, demanding resilience and support.
Common Staging Approaches
- "1-Stage" Approach (Tube-within-a-tube): Phallus and urethra are created together, with additional surgeries later for prosthetics.
- Phallus-First Approach: Shaft and urethra first, then connect to native urethra and perform vaginectomy in a second stage.
- Metoidioplasty-First Approach: Metoidioplasty and initial urethral extension first, then connect to phallic urethra subsequently.
Sample staging can involve up to four stages, often beginning with hysterectomy, followed by different combinations and sequences of phalloplasty, urethral work, scrotoplasty, glansplasty, and prosthetic insertion.
Preoperative Preparation
- Medical Evaluation: Comprehensive testing (e.g., brain MRI, bone density, labs, hormones, X-rays, EKG) to ensure readiness.
- Psychological Evaluation: Requires two letters from separate therapists to confirm gender dysphoria and understanding of risks.
- Medication Management: Adjustments may be needed; typically, patients stop aspirin and certain supplements before surgery.
- Lifestyle Changes: Smoking cessation is strongly advised.
- Hormone Therapy: Testosterone therapy is recommended for masculine features and requires regular medical monitoring. Achieving maximal effect can take one to five years.
The demanding pre- and post-operative requirements emphasize that phalloplasty is not a quick process but a multi-year, medically cautious journey.
Best Clinics in Korea for Standing To Urinate Ftm
Listed below are the best clinics in Korea for standing to urinate ftm:
| Clinic Name | Key Features | Special Techniques |
|---|---|---|
| Kangdong Sacred Heart Hospital LGBTQ Plus Center | Dedicated to comprehensive LGBTQ+ healthcare; emphasis on respect, diversity, and patient-centered care; addresses physical, psychological, and social health; multidisciplinary team; inclusive and affirming environment | Gender-affirming hormone therapy, top surgery, hysterectomy, gender confirmation surgery (phalloplasty, metoidioplasty), functional neourethra creation for standing urination |
| Kangdong Sacred Heart Hospital | Comprehensive, patient-focused care; advanced facility; multidisciplinary approach; latest technology; privacy and dignity prioritized | Gender-affirming care for transgender men; STP (standing to urinate) procedures; complex reconstructive urological surgeries |
| PS Beauty Clinic | Premier cosmetic and beauty clinic; experienced team; personalized approach; modern aesthetic solutions; holistic care; accessible location | Advanced cosmetic and reconstructive procedures for transgender individuals; STP surgery for FTM; state-of-the-art techniques; comprehensive consultations and follow-up care |
Kangdong Sacred Heart Hospital LGBTQ Plus Center
Kangdong Sacred Heart Hospital LGBTQ Plus Center, located in Cheonho, is dedicated to providing comprehensive medical care tailored to the unique needs of the LGBTQ+ community in Korea. With a strong emphasis on respect, diversity, and patient-centered care, the center offers a full spectrum of services that address the physical, psychological, and social aspects of gender-affirming healthcare. The clinic aims to foster a healthier society by ensuring that all individuals, regardless of gender identity or sexual orientation, receive personalized and affirming medical support.
Among its wide-ranging services, the center offers specialized programs that are particularly relevant for transmasculine individuals, including those seeking assistance with standing to urinate (STP). Their multidisciplinary team provides access to mental health psychiatry, gender-affirming hormone therapy, top surgery, hysterectomy, and gender confirmation surgeries such as phalloplasty and metoidioplasty, which can incorporate the creation of a functional neourethra for standing urination. This inclusive approach ensures that trans men and non-binary individuals can pursue their transition goals in a supportive and medically advanced environment.
Find more about this clinic here: Kangdong Sacred Heart Hospital LGBTQ Plus Center Website
Kangdong Sacred Heart Hospital
Kangdong Sacred Heart Hospital in Cheonho is recognized as a leading provider of specialized medical procedures in Korea, offering care that is both comprehensive and patient-focused. In a state-of-the-art facility, the hospital brings together highly qualified professionals and a multidisciplinary approach to meet the diverse needs of its patients, ranging from general, orthopedic, and neurological surgery to advanced procedures in cardiology, oncology, urology, gastroenterology, and nephrology. Each department is equipped with the latest technology, ensuring safety, precision, and optimal outcomes for every patient.
Among its many specialized services, Kangdong Sacred Heart Hospital extends expertise to gender-affirming care for transgender men, including procedures that facilitate standing to urinate (STP). The hospital’s urologists, experienced in complex reconstructive surgeries, work within a supportive environment that prioritizes privacy, dignity, and personalized consultation. With a commitment to embracing new medical advancements and inclusive healthcare practices, Kangdong Sacred Heart Hospital stands as a trusted destination for FTM individuals seeking sensitive, high-quality medical care in Korea.
Find more about this clinic here: Kangdong Sacred Heart Hospital Website
PS Beauty Clinic
PS Beauty Clinic, conveniently located in Gyodae, is a premier destination for advanced cosmetic and beauty treatments dedicated to helping patients enhance their natural features and boost self-confidence. With a reputation for excellence and a comprehensive range of services, PS Beauty Clinic is recognized for its experienced medical team, personalized care, and modern approach to both facial and body aesthetics. Standing at the forefront of gender-affirming procedures, it has become a leading choice for individuals seeking solutions for standing to urinate (STP) for FTM patients in Korea.
Why PS Beauty Clinic is the Best Choice for Standing To Urinate FTM:
- Extensive experience in advanced cosmetic and reconstructive procedures, including those specific to the transgender community.
- Multilingual, compassionate staff who prioritize patient privacy, dignity, and individual needs.
- State-of-the-art technology and refined surgical techniques that ensure optimal functional and cosmetic outcomes.
- Comprehensive consultations and follow-up care designed for successful adaptation to standing urination solutions.
- Convenient location in Gyodae, easily accessible for both local and international clients.
- A holistic approach to care that integrates both physical transformation and psychological well-being, ensuring patients feel supported at every step.
Find more about this clinic here: PS Beauty Clinic Website
The Process of Undergoing Phalloplasty in South Korea
South Korea is recognized internationally for its skill in cosmetic and reconstructive surgery, with surgeons in Seoul excelling in microsurgical and customized procedures. Patients can benefit from advanced technology, personalized surgical planning (including 3D modeling), and globally acknowledged expertise.
Steps for Medical Tourists
- Initial Consultations and Evaluations: Involve specialists across disciplines, mandatory psychological confirmation, and comprehensive health checks before hormone therapy or surgery.
- Hormone Therapy: Male hormones (testosterone) are provided to induce masculinizing changes, with ongoing checkups to monitor for side effects.
- Clinic Selection: Notable clinics include Shinsang Plastic Surgery Clinic, Chiu Plastic Surgery, VIP Plastic Surgery Clinic, Asan Medical Center, Ruby Plastic Surgery Clinic, Kyung Hee University Hospital, and Grand Plastic Surgery Seoul. Decisions are informed by ratings, response rates, and treatment packages, often with 3D planning.
- Legal & Social Barriers: South Korea requires strict legal conditions for change of legal gender (court approval, nonmarital status, age, lack of minor children, sometimes parental consent). There is no comprehensive anti-discrimination law, though interpretations protect some rights. This creates a gap between medical excellence and legal/social support, potentially impacting the overall experience.
- Post-operative Care & Recovery: After microsurgical phalloplasty (RFF or ALT), hospital stays range from 5–7 nights, with more time needed if complications arise. Recovery involves PCA for pain, close monitoring, continued use of catheters, and gradual progression in mobility and activity. Intensive follow-ups and restrictions (including abstaining from sex for 3–4 months) are part of the recovery timeline.
Costs of Phalloplasty: South Korea vs. Global Medical Tourism
In South Korea, phalloplasty costs range from $21,200 to $67,900 USD. The multi-stage Kim FTM Phalloplasty, for example, is about $23,000 USD (Stage One: $10,000, Stage Two: $6,500, Stage Three: $6,500). By comparison, general plastic surgery in Korea can be as low as $3,000–$25,000 USD. Costs typically cover surgery, anesthesia, hospital stays, and care, with some packages including accommodation and transport. Prices depend on the technique, hospital, location (Seoul costs about 20% more), and surgeon expertise—most clinics provide actual prices upon request.
Compared to Western countries, patients can save 40–65% by choosing Korea:
| Country | Estimated Cost Range (USD) | Estimated Cost Range (EUR) | Notes |
|---|---|---|---|
| South Korea | $21,200 – $67,900 | N/A | Example multi-stage ~$23,000 |
| USA | $20,000 – $150,000 | €20,000 – €40,000 | Average ~$29,500 |
| Thailand | $2,560 – $25,000 | €10,000 – €15,000 | Average ~$8,890 |
| Turkey | $3,556 – $16,500 | €6,000 – €9,000 | Average ~$8,000; often includes hotel, transfers |
| Germany | N/A | €15,000 – €25,000 | Known for high-quality results |
| UK | From $8,000 | €12,000 – €20,000 | Similar to other Western countries |
| Singapore | $50,000 – $60,000 | N/A | |
| Mexico | From $8,950 | N/A |
Other expenses include hospital and surgical facility fees, anesthesiology, medications, post-surgical garments, and necessary preoperative tests. Additional costs can accrue for hysterectomy/oophorectomy, travel, accommodations, recovery therapies, and revision surgeries. While South Korea is an innovation leader with competitive pricing, wide variances in phalloplasty pricing and regular "price upon request" policies mean patients must conduct careful research regarding what is included in each package and be prepared for unexpected costs due to possible complications.
Patient Experiences and Functional Outcomes: Standing Urination After Phalloplasty
Standing urination after phalloplasty relies on constructing a functional urethra that reaches the tip of the new phallus. This process blends native urethral tissue with newly constructed tissue—often needing tissue from the vaginal wall and labia minora—and usually requires a vaginectomy for optimal results due to urethral complication risks. Urethral and perineal connections are not completed until 6–9 months post-initial surgery. Catheters are used throughout recovery, and a retrograde urethrogram (X-ray) confirms the new urethra's openness before final catheter removal.
Some opt for "shaft phalloplasty" (creating only the outer shaft without urethral extension) to avoid higher complication rates. Historically, most transmasculine patients seek standing urination, with studies showing 87%–100% success with metoidioplasty and a 79% rate after phalloplasty in transgender male patients.
Complications and Patient Satisfaction
Urethral lengthening remains the most challenging part, carrying risks like:
- Urethrocutaneous Fistula: Leaking urine from the skin (15%–70% of cases).
- Urethral Strictures/Stenosis: Narrowing/blockage, requiring further treatment.
- Hair Growth in Urethra: Can cause infections and blockages.
- Urethral Diverticulae: Pouch formation that can cause discomfort and infection.
Other common issues include post-void dribbling or spraying, less-than-perfect cosmetic results (with additional corrections increasing risk), infection, scarring, lack of sensation, tissue death (less than 1% full failure), nerve damage, decreased sexual satisfaction, and more.
Despite risks, many report high satisfaction, with studies showing 6 out of 7 satisfied with urination ability and aesthetics. For most, the psychological benefit of standing urination outweighs the risks and potential need for revisions, making it vital for counseling to address both surgical details and personal goals.
Conclusion
Phalloplasty provides transmasculine individuals with the opportunity for standing urination—a significant step in gender affirmation—through a complex, multi-stage process. South Korea offers advanced expertise and cost advantages, but requires careful planning and realistic expectations regarding function, appearance, and the high possibility of complications. Engaging with experienced multidisciplinary teams and understanding the long-term nature of recovery are essential for a satisfactory outcome.
References
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