NHS should pay for women wanting a penis to undergo surgery ABROAD, campaigners say

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Taxpayers should pay for trans men wanting a penis to get one abroad because of lengthy NHS queues, campaigners have controversially said.

Biological females transitioning to become men can ask for a penis — sometimes called bottom surgery — so they can better match their gender identity.

But waiting lists for the complex op, called a phalloplasty, which is also offered to men who lose their genitalia in serious accidents, can be up to four years.

Some patients decide to fundraise to fly abroad where they can pay up to £21,000 for the procedure and skip the NHS backlog, which currently sits at an all-time high in the wake of Covid. 

This diagram shows one method surgeons use to create a new penis, it involves harvesting skin and blood vessels from another of the body such as the forearm, and attaching it to the groin. After a recovery period the medics then connect it to the bladder allowing the patient to urinate from the penis and also form a new scrotum. The final stage is to add an implant that allows the patient to activate an erection. The surgery can be offered to both trans patients as part of gender surgery as well as biological males whose genitalia has been damaged

This diagram shows one method surgeons use to create a new penis, it involves harvesting skin and blood vessels from another of the body such as the forearm, and attaching it to the groin. After a recovery period the medics then connect it to the bladder allowing the patient to urinate from the penis and also form a new scrotum. The final stage is to add an implant that allows the patient to activate an erection. The surgery can be offered to both trans patients as part of gender surgery as well as biological males whose genitalia has been damaged

What is phalloplasty? 

Phalloplasty is a three-stage operation that creates an artificial penis from material harvested from other parts of the body. 

One type, Radial Artery Phalloplasty (RAP), uses skin from the forearm to form the new penis.

It is generally used for patients who want to urinate whilst standing, and for whom aesthetics and sensation are the most important factors to the patient.

Another called Pubic Phalloplasty and uses a flap of flesh from the lower belly or crotch region to form the organ. This is generally recommended when phallus size and penetrative sex are more important to the patient. 

In RAP phalloplasty blood supply will need to be connected to feed the new penis, whereas for the pubic procedure the blood supply can be rerouted. 

The creation of the phallus is considered stage one of the procedure.

Stage two involves fashioning a neo-urethra to allow urine to flow through the new penis, creating a scrotum out of labia skin and sculpting the glans of the new penis.

The third and final stage is the insertion of prosthetic testicles and an inflatable device inside the penile shaft that can produce an erection.

This erection is inflated by a pump usually hidden inside one half of the scrotum that a patient squeezes to activate and is connected to a fluid reservoir inserted near the groin. 

Whilst most commonly known as a surgery for trans men phalloplasty is also offered to biological males in some circumstances.

This can be to replace a penis that was lost or severely damaged in a serious accident or conflict.

It can also be performed in some cases where a birth defect effected the usual development of a boy’s sex organs. 

Transactual, an advocacy group for trans people living in Britain, estimates there are around 2,000 trans men currently in line for the op.

It claimed it is unacceptable that their gender-affirming surgery is being left to the generosity of strangers and have called for the NHS to step in and ‘offer funding for those seeking phalloplasty overseas’ so waiting times are reduced.  

This would mean trans men no longer have to ‘put their life on hold’ on NHS waiting lists, said Chay Brown of Transactual.

There would be precedence for such a move, with the health service already paying millions each year for patients to go abroad to skip queues in the UK under a little-known EU-era funding route, MailOnline revealed this week. 

Sending all trans men on the waiting list abroad may cost approximately £40million, campaigners roughly estimate. 

Currently only one hospital in the UK takes on NHS phalloplasty patients, the private New Victoria Hospital.

Mr Brown claimed that estimates for a four-year wait for a phalloplasty on the NHS are ‘optimistic’ because it includes two other services — one in Chelsea and another yet to be confirmed — being brought online to juggle the backlog.  

He added that this was merely like ‘sticking a plaster over an open wound’.

Mr Brown said: ‘It’s costing people’s mental health and they need NHS help with that for already stretched services.

‘They might find its cheaper to send people overseas.

‘Just because it’s not physical pain doesn’t mean it’s not pain. When people are struggling with dysphoria they can struggle to even leave the house.’

Phalloplasty is a three-stage operation that creates an artificial penis from material harvested from other parts of the body. 

One type, Radial Artery Phalloplasty (RAP), uses skin from the forearm to form the new penis.

It is generally used for patients who want to urinate whilst standing, and for whom aesthetics and sensation are the most important factors.

Another called Pubic Phalloplasty and uses a flap of flesh from the lower belly or crotch region to form the organ. This is generally recommended when phallus size and penetrative sex are more important to the patient. 

In RAP phalloplasty blood supply will need to be connected to feed the new penis, whereas for the pubic procedure the blood supply can be rerouted. 

The NHS has sent over 5,000 Britons overseas for treatment since 2019 figures obtained by MailOnline show

The NHS has sent over 5,000 Britons overseas for treatment since 2019 figures obtained by MailOnline show

While costs have declined in recent years, the total bill is still £4million (figures are based on an average exchange rate for 2022)

While costs have declined in recent years, the total bill is still £4million (figures are based on an average exchange rate for 2022)

The creation of the phallus is considered stage one of the procedure.

Stage two involves fashioning a neo-urethra to allow urine to flow through the new penis, creating a scrotum out of labia skin and sculpting the glans of the new penis.

The third and final stage is the insertion of prosthetic testicles and an inflatable device inside the penile shaft that can produce an erection.

This erection is inflated by a pump usually hidden inside one half of the scrotum that a patient squeezes to activate and is connected to a fluid reservoir inserted near the groin. 

Phalloplasty is also offered to biological males in some circumstances.

This can be to replace a penis that was lost or severely damaged in a serious accident or conflict.

It can also be performed in some cases where a birth defect effected the usual development of a boy’s sex organs. 

Mr Brown told MailOnline the NHS couldn’t simply increase the number of surgeons offering the procedure due to the complexity of phalloplasty. 

‘It’s a complicated operation, it involves shifting nerves, blood vessels, things with the urethra,’ he said.

‘So obviously the surgeons need to be well-trained.

‘This situation is something that should of been seen coming years ago, the planning has not been there.

Transactual’s demand comes at time of record NHS waiting lists for elective care. 

Latest official figures show 7.1m people in England were in the queue for routine ops such as hip and knee operations by the end of September.

Of these, 400,000-plus have been waiting for over a year, often in significant pain. 

Official figures show 7.1million people in England were in the queue for routine hospital treatment, such as hip and knee operations, by the end of September ¿ the equivalent of one in eight people (red line). The figure includes more than 400,000 people who have been waiting, often in pain, for over one year (yellow bars)

Official figures show 7.1million people in England were in the queue for routine hospital treatment, such as hip and knee operations, by the end of September — the equivalent of one in eight people (red line). The figure includes more than 400,000 people who have been waiting, often in pain, for over one year (yellow bars)

Mr Brown said that trans men understood that at time where millions of Britons were waiting for care, their demand for faster treatment might seem outrageous. 

But he added they also deserved timely access to the health care, and in NHS terms the amount of spending was a relatively small portion of the health service’s £153billion budget. 

‘We’re not saying people who need a hip replacement shouldn’t be sent overseas either, they deserve quick treatment as well,’ he said.

‘Everybody should have timely access to the healthcare that they need, and goes for whether it’s a phalloplasty or a hip replacement.’

Mr Brown, who was born a woman, has personal experience about the challenges of getting a phalloplasty in the UK.

He managed to get stage one of the procedure back in 2019 but was told it could be 2023 or even 2024 before he could get stage two.

‘It was unthinkable, I was really starting to struggle and that’s when I started looking at what was available,’ he said.

Mr Brown eventually opted to go to Serbia with his father paying the £15,000 fee. He acknowledged this is something he was incredibly lucky to receive and an option not available to many trans men or their families.  

NHS England was contacted for comment. 

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