Metoidioplasty is a gender-affirming surgical procedure designed to create a penis using existing clitoral tissue. It’s an alternative to phalloplasty for transgender men and nonbinary people seeking genital masculinization.
There are several different types of metoidioplasty techniques. Some involve simply releasing the clitoris to allow for additional growth. Some involve creating a urethra so you can stand to pee. Some include closing the vagina.
The best option depends on your anatomy and your goals. The surgeon will work with you to figure out which of the different types of metoidioplasty is right for you.
Metoidioplasty Techniques: An Overview
There are several different approaches to metoidioplasty, each with its own advantages and disadvantages. The choice of technique depends on the individual’s goals and anatomy.
Metoidioplasty without Urethral Lengthening
This procedure involves freeing the clitoris from its surrounding tissues, allowing it to enlarge and project outwards. The goal is to create a small phallus.
Results typically yield a phallus around 1.5-2 inches in length, although some individuals explore options like hyaluronic acid girth enhancement. However, aesthetic and functional outcomes can vary depending on individual factors. The main limitation is that it doesn’t allow for standing urination or penetrative sex.
Metoidioplasty with Urethral Lengthening
This technique extends the urethra to the tip of the newly created phallus (neourethra), enabling standing urination.
Urethral lengthening can potentially add up to 50% more length. However, it can also limit the ability to penetrate during sexual activity. It might also impact urination in public restrooms due to the need for a seated position in some cases.
Specific Techniques: Simple Release, Ring Meta, Belgrade
Within these broader categories, there are specific variations in surgical technique:
- Simple Release (Simple Meta): A basic procedure focused on releasing the ligaments around the clitoris.
- Ring Metoidioplasty: A more complex technique involving additional tissue rearrangement.
- Belgrade Metoidioplasty: Another advanced technique with its own distinct approach and characteristics.
Surgical Considerations and Complementary Procedures
Metoidioplasty is often just one part of a more comprehensive gender-affirming surgical plan. Several other procedures can be performed alongside or after metoidioplasty to achieve the desired aesthetic and functional results.
Scrotoplasty and Testicular Implants
Scrotoplasty involves creating a scrotum. This is typically done using tissue from the labia majora. The surgeon carefully shapes and sutures the labial tissue to form a pouch-like structure that resembles a scrotum. Sometimes, a bifid scrotum is created, meaning the scrotum is divided into two distinct halves.
To further enhance the masculine appearance, testicular implants can be placed within the newly created scrotum. These are typically silicone implants that come in various sizes and shapes to mimic the look and feel of testicles.
Urethroplasty/Urethral Lengthening
Urethroplasty is a surgical procedure to lengthen the urethra, allowing for standing urination. This involves creating a “neourethra” – a new urethral channel – that extends from the base of the phallus to the tip. Urethroplasty is a complex procedure and may require multiple stages.
After urethroplasty, a catheter is typically placed in the neourethra for 2-3 weeks to support healing and prevent complications such as strictures (narrowing of the urethra).
Vaginectomy
Vaginectomy is the surgical removal of the vagina. This procedure is often performed in conjunction with metoidioplasty to achieve complete masculinization of the genitals.
Mons Resection
Mons resection involves removing excess tissue from the mons pubis area (the area above the genitals). This procedure helps to create a more masculine contour in the lower abdomen and genital region.
Factors Influencing Outcomes and Requirements
Outcomes for metoidioplasty can vary, and certain factors play a significant role in achieving the desired results.
Pre-operative Requirements
Before undergoing metoidioplasty, there are typically a few requirements to consider:
- Hormone therapy: Typically, a patient must undergo hormone therapy (testosterone) to enlarge the clitoris prior to the procedure. For example, in the Hage technique, patients received testosterone therapy for a minimum of 1.75 years before surgery.
- Psychological evaluation: Preoperative psychological counseling and support letters are often essential. The WPATH (World Professional Association for Transgender Health) Standards of Care, for example, require pre-op psychological counseling and letters of support.
Patient Factors
Certain patient characteristics can also influence the outcome of metoidioplasty:
- Maintaining a healthy weight
- Having intact genital skin
- Clitoral hypertrophy (enlargement)
Surgeon Experience
Choosing an experienced surgeon is key to successful results. As with any surgery, a surgeon’s experience and skill level play a crucial role in achieving the desired outcome and minimizing potential complications. Look for a surgeon with specific expertise in gender-affirming surgeries and, ideally, metoidioplasty.
Risks, Complications, and Post-operative Care
Like any surgery, and procedures such as HA girth enhancement, metoidioplasty comes with potential risks and complications. It’s essential to discuss these thoroughly with your surgeon so you have realistic expectations and can make an informed decision.
Potential Risks and Complications
Some potential risks associated with metoidioplasty include:
- Fistulas (abnormal connections between organs or vessels) and strictures (narrowing of a passage in the body).
- Implant migration or extrusion (if an implant is used).
- The possibility of a smaller-than-desired or non-bulging neophallus (newly formed penis).
- Chordee (a curvature of the penis).
Post-operative Care
The recovery period after metoidioplasty can vary, but generally involves a convalescence period of around 4 to 6 weeks at home. Your surgeon will provide detailed postoperative care instructions to ensure proper healing and minimize complications.
Dihydrotestosterone (DHT) topical gel is sometimes prescribed post-operatively.
Revision Surgeries
It’s important to be aware that revision surgeries may be necessary in later stages to address complications or achieve desired aesthetic outcomes. Discuss the possibility of revisions with your surgeon during the initial consultation.
Frequently Asked Questions
What is ring metoidioplasty?
Ring metoidioplasty refers to a type of metoidioplasty where the surgeon releases the phallus from the surrounding tissue but leaves it attached to the perineum. A skin graft from another area, like the groin, is then used to create a ring of skin around the base of the phallus, effectively lengthening the shaft. It’s a less common variation.
What is a neophallus?
A neophallus refers to the newly created penis constructed during phalloplasty, a more complex gender-affirming surgery. It’s not related to metoidioplasty, which utilizes the existing, hormonally enlarged clitoris.
What does healed metoidioplasty look like?
A healed metoidioplasty typically looks like a small, but more prominent, penis. The appearance varies depending on the specific surgical techniques used, the individual’s anatomy, and the degree of growth achieved through testosterone therapy. Scarring will be present, but usually fades over time.
Can a metoidioplasty get erect?
Yes, one of the significant advantages of metoidioplasty is that the phallus retains its natural erectile function. Because the procedure utilizes the existing clitoris, which is erectile tissue, the individual can experience sensation and erections.
Can you get phallo after metoidioplasty?
Yes, it is possible to undergo phalloplasty after having metoidioplasty. This is sometimes referred to as a staged approach. However, it’s crucial to discuss this option thoroughly with a surgeon experienced in both procedures to understand the potential risks and benefits, as previous surgery can impact future options.
Wrapping Up
Metoidioplasty offers a range of surgical options for transmasculine people seeking gender affirmation. Each type of “meto” — from simple release to more complex procedures involving grafts — has unique benefits and limitations.
The best choice depends on individual needs and desired outcomes.
It’s vital to research the different techniques and surgeons thoroughly and to develop realistic expectations about what surgery can achieve. Open communication with potential surgeons is essential, so that they understand your needs and expectations and you understand the potential outcomes.
Ultimately, metoidioplasty can be a powerful step in the gender affirmation process, helping transmasculine individuals align their physical bodies with their gender identities and easing gender dysphoria.