Erectile Tissue Release

Erectile tissue release is a gender-affirming, lower body surgery that creates a penis by cutting ligaments around the erectile tissue (clitoris) to release it from the pubis and give the shaft more length (4 to 6 cm).

A scrotum can be created from the labia. Testicular implants can be inserted in the scrotum in a separate surgery, months later.  The goal is to create a phallus with sexual sensation that can get erections without the assistance of an implant and to leave the vagina intact. This surgery does not enable urination while standing and the goal is not to enable sexual penetration. 

Referral & Consult

Referral & consultation process


Complete surgical care planning

To get started, you will need one surgical recommendation, which is made after surgical care planning .This recommendation must be completed by a provider on Trans Care BC’s list of clinicians who are qualified to do surgical care planning for genital surgeries. Part of the surgical care planning process includes assessing whether you meet the WPATH criteria required for this surgery and whether you are ready for surgery. After you have completed your care planning and have received a surgical recommendation, your primary care provider will refer you to the Gender Surgery Program BC. Additional information or consultation with specialists may be required at the discretion of the surgeon. Contact Us for help finding a clinician qualified to do surgical care planning for genital surgery.

2Review referral options

Visit surgery referral for steps required in the referral options for erectile tissue release. 

3Speak to your surgeon

You may want to speak to your surgeon about:

  • The gender-affirming surgery goal you have after surgery (i.e. standing to pee, sexual penetration, passing in the change room)
  • The need to stop taking hormones (you are typically asked to stop taking hormone therapy medication three weeks before surgery)
  • The different surgical techniques available
  • The advantages and disadvantages of each technique
  • What your options are if you are not satisfied with the appearance of your surgical results
  • What your options are if you are having difficulty with sexual function
  • Whether they have before-and-after photographs of their own patients, including those of both successful and unsuccessful outcomes
  • The risks and possible complications of the various techniques
  • The surgeon's own complication rates for each procedure

The procedure

Surgical techniques vary from surgeon to surgeon.Before surgery, testosterone is taken to enlarge the erectile tissue (clitoris). Some people choose to wait 2-3 years to achieve maximum growth before proceeding with surgery. 

  1. The ligaments holding the erectile tissue (clitoris) in place under the pubic bone are cut. Some of the surrounding tissue is cut, releasing the erectile tissue (clitoris) and creating a phallus. 
  2. Fat may be removed from the pubis and skin may be pulled upward to bring your phallus forward. The external genitals (labia or outer labia) may be shaped into a scrotum. 
  3. The vagina may be removed or closed (if desired).
  4. Testicular implants may be put inside your scrotum at a later stage.

Preparing for surgery

Be sure to review the pre-operative information provided by the surgeon's office before surgery. For more information about preparing for this surgery and about your post-operative care, contact the surgical clinic directly.

While you wait for your referral to be processed, keep your personal information updated with all of your health care providers, including any change of name or contact information. This will ensure your health care professionals can reach you to schedule consultation and surgery appointments.

You may also want to visit the Preparing for Surgery page to help you create a plan for success after surgery


All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and infection. These complications can, in extreme cases, result in death. It's important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise and respond to them appropriately. They will also inform you about what you can do to minimize your risks. Some complications are particularly associated with clitoral release surgery. 

Below are a list of some possible complications of this surgery. Please note - this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

The risk of decreased sensation after clitoral release surgery is less than with phalloplasty but changes to sensation are still possible.

Some people may be dissatisfied with the size or shape of the erectile tissue (penis). You can check with your surgeon to see if surgical revision is possible.

When blood collects in the surgical site, causing pain, swelling and redness. Smaller hematomas can be drained, but larger ones require removal through surgery.

You can take steps to prevent severe scarring by following your surgeon's advice about getting rest, avoiding the sun and doing massage exercises. Severe scarring may require surgical revision.

When clear fluid accumulates in the surgical site, causing swelling. Seromas may resolve on their own or they may need to be aspirated (sucked out) once or more by the surgeon.

After surgery

Post-operative care

Details related to the time you will spend in hospital after surgery and your post-operative plan will depend on your surgical site. Ask your surgeon for details related to your recovery.

You will likely receive painkillers and antibiotics to prevent infection. Your surgeon will provide you with a list of medications to avoid around the time of your surgery.

During the healing process you can expect:

  • Some bleeding
  • Swelling of the genital region
  • Bruising in your genital region
  • Itching and occasional small, shooting electrical sensations as the nerve endings heal
  • Small scars on your genitals that will disappear over time


The number of check-ups needed varies from person to person. If possible, see your primary care provider about a week after you return from surgery and then every 2 to 4 weeks for the first few months. When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound healing problems. They will ask questions about pain, bleeding, urination, bowel movements, fever and how you are feeling physically and emotionally.

Recovery time

Recovery time varies from person to person, so always follow the advice of your surgeon. You'll be on bed rest for at least 24 hours following surgery and will need plenty of rest in the first week. Over the three weeks following surgery, you will gradually resume your usual activities. Some activities, such as driving, heavy lifting, exercise, sex and soaking in hot tubs, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities.

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