Metoidioplasty is one of the most common surgeries performed on trans or non-binary people who are given the gender female at birth to change into a male.
This procedure is used to create ‘neophallus’ or simply ‘a new penis’ using existing genital tissue after the clitoris has been enlarged using testosterone therapy. The doctor recommends using it for at least one or two years before going under surgery.
- 1 What are Different Types of Metoidioplasty?
- 2 What is the Difference Between Metoidioplasty and Phalloplasty?
- 3 Pros and Cons of Metoidioplasty
- 4 How Does the Procedure Work?
- 5 Results and Recovery from Metoidioplasty
- 6 Optional Additional Procedures
- 7 How Do You Find the Right Surgeon?
- 8 Conclusion
What are Different Types of Metoidioplasty?
There are mainly 4 types of metoidioplasty which include.
1. Simple Release
This technique is also known as simple meta and involves freeing of clitoris from the surrounding tissue, thus, causing clitoral release. In this case, urethra and vagina are not altered.
The remaining clitoral skin (attached to labia minora and labia majora) is used for covering the clitoral body. This gives a bulky appearance to the clitoris. It is used to increase the length of your penis.
This technique does not allow you to urinate while standing up.
2. Full Metoidioplasty
Full metoidioplasty involves the release of clitoris, lengthening of urethra and insertion of testicular implants. Vaginectomy can also be involved if you desire before inserting implants.
This type of metoidioplasty is more straightforward.
Surgeons performing this surgery use skin tissue graft from the cheek to use it for attaching neophallus to the urethra.
3. Ring Metoidioplasty
This technique involves the creation of a new urethra and the tissue is not used from inside of the cheek but labial tissue is used from inside of the vaginal wall and labia majora. This tissue is used to connect urethra to neophallus.
This type of metoidioplasty is beneficial as it lessens the complications resulting from the surgery like pain during eating and decreased saliva production. Also you can urinate while standing up and healing has to occur only at one site, instead of two.
4. Centurion Metoidioplasty
This technique is used to provide extra girth to the penis by using round ligaments that run on the sides of labia, extending from labia majora and then bring them together to surround the neophallus. This leaves a hollow area for scrotal implants and scrotum is fused to form a single sac.
This technique causes fewer complications like pain and scars because the skin is not taken from any other separate tissue like cheek or labia.
What is the Difference Between Metoidioplasty and Phalloplasty?
Metoidioplasty is used to create a new penis using a skin graft in a hormonally enlarged clitoris. Phalloplasty is used to create neophallus or reconstruction of a penis and also used in cases of repair of a penis from trauma, injury, cancer or other issues. It requires multiple surgeries to be completed and has numerous complications.
While metoidioplasty works with a skin graft from mouth or existing tissue, phalloplasty requires a bigger skin graft from leg, arm or torso to create a penis.
Both the procedures have their own advantages and disadvantages and either one must be chosen after careful consideration.
Pros and Cons of Metoidioplasty
Following are the pros and cons of this procedure.
1. It ranges from $2000 to $20000, which is significantly lower than that of phalloplasty, hence, cost effective.
2. It takes less time to heal
3. Scar visibility is not much
4. You can have phalloplasty after metoidioplasty but vice versa is not possible
5. There are fewer surgical procedures involved
6. Result of this surgery is a fully functional penis with erectile property
7. Complication rates are lower
1. With exception of Ring metoidioplasty, a person is unable to urinate while standing up
2. Hormonal therapy is required for requires enlargement of clitoris
3. Penis is small in size in both length and girth (measures usually between 3 to 8 cm)
4. May not be able to penetrate during the intercourse
How Does the Procedure Work?
Although clitoris and penis have different functions to perform, they both are derived form same to tissue which makes it possible to create a penis after significant enlargement of clitoris. Glans construction, urethral lengthening and scrotoplasty are also involved in it.
It takes about 2.5 to 5 hours for the surgery to be completed. Time taken depends upon the technique used and surgeon which performs. You
In simple release type of metoidioplasty, you are awake but in a state of unawareness throughout the surgery. During other procedures like urethral lengthening or vaginectomy, general anaesthesia is given.
The process of reshaping labia to scrotum is called scrotoplasty. Doctor inserts tissue expanders in the labia three to six months before the second surgery so that enough space is created in the tissue for scrotal implants to be accommodated.
A plastic surgeon can reshape the head of the clitoris to make it look more like a glans penis.
Results and Recovery from Metoidioplasty
Although time of recovery varies from person to person, in general, you may be asked to leave the hospital the same day or stay for a day or two.
For at least 15 days, you are not allowed to work as you do normally. It is also recommended to avoid any strenuous activity or weightlifting during the recovery time for at least next 2 to 4 weeks. You should also avoid travelling for the next few weeks during the recovery period.
You may also experience certain complications during the first few weeks including pain. Urethral lengthening can lead to a urinary fistula or leakage from urethra due to a hole. Cathedral has to be used to urinate for 3 to 4 weeks after surgery. Instructions are given for proper care and to check for any infection.
Sometimes the body rejects silicone implants and another surgery for it.
You are likely to be able to perform light activities within the first week but to totally heal, it takes from 12 to 18 months.
Optional Additional Procedures
There are several optional procedures that can be considered and included in metoidioplasty-
1. Clitoral Release
This is used to increase the length and exposure of neophallus by freeing it from the tough connective tissue and ligament that attaches clitoris to pubic bone.
As the name suggests, it is closing the vaginal opening or in simple words, removal of the vagina.
This procedure is to allow you to urinate while standing up. It results in the placement of the urethra through the neophallus.
4. Scrotoplasty or Testicular Implants
Scrotoplasty involves the insertion of silicone implants into the labia. Sometimes two scrotal sacs are fused to form one.
5. Mons Resection
This procedure involves taking out a part of the skin and fatty tissue from mons pubis.
It is used to increase the visibility of the penis and it becomes more accessible because the skin is pulled upward bringing the penis and testicles forward.
These procedures are your personal choice. After careful consideration, you can go for all of them , some of them or none of them. Ultimately, these procedures are meant to reflect your real personality.
How Do You Find the Right Surgeon?
Doctors related to this field follow the World Professional Association for Transgender Health standards. Under this, eligibility criteria for undergoing the procedure requires you to have-
1. Required age or above
2. Two letters for medical specialists recommending you for surgery
3. At Least 12 months of hormonal therapy
4. Presence of persistent gender dysphoria
5. 12 months of living according to your gender identity
6. No mental or physical health issues
Finding out the best suited doctor to carry out the procedure you want is very important.
You should look for somebody
1. Who can carry out all the procedures that you need
2. Who provides health insurance
3. Who has the least number of cases of complications or other problems
You can go by recommendation of somebody who has already undergone the procedure and based on reviews, make a decision.
Like every surgery, metoidioplasty has its own pros and cons.
Studies and surveys have shown that 100% of people who have undergone this method donot lose their erogenous sensation but only half the percentage is able to penetrate during intercourse. 89% of the people who have undergone this surgery are able to urinate while standing up. There is still evaluation going on for more accurate results.
This lower surgery option is available at an affordable price with not much complications. There are a variety of methods that can be included to perform along with for better visibility. It is a good option for somebody looking for gender affirmation. Though, you must take into thought every possible option and choose the best one for you.
Ultimately the purpose is for you to feel yourself.