Definition and Overview

Metoidioplasty is a type of gender reassignment surgery for individuals transitioning from female to male. Prior to this procedure, the patient undergoes testosterone replacement therapy that enlarges the clitoris. A metoidioplasty involves the separation of the enlarged clitoris from the labia minora, as well as the cutting of its suspensory ligament to create an artificial penis.

When compared to phalloplasty, which is another form of gender reassignment surgery that also involves the creation of an artificial penis, many experts believe that metoidioplasty is more cost-efficient, simpler in terms of surgical techniques, and has fewer risks and complications.

Metoidioplasty preserves the natural sensation in the clitoris, as well as the organ’s erectile function. Like a natural penis, the artificial organ formed from resecting the clitoris will also fill with blood when aroused. Unsightly scars, on the other hand, can be avoided because there is no need for large amounts of donor tissue. Overweight individuals can also achieve a longer penis, especially when metoidioplasty is combined with a pubic lipectomy.

Who Should Undergo and Expected Results

Metoidioplasty is for patients transitioning from female to male. After the procedure, the patient will have an artificial penis that has the capacity for erection. When the labia minora is used as flaps for the artificial penis, the patient can also achieve additional penile girth and tactile protection.

Additional requirements for a patient undergoing metoidioplasty include the following:

  • Good physical and mental health
  • At least 18 years of age
  • Undergoing testosterone replacement therapy for at least two years
  • Underwent at least one year of RLE, or real life experience

How is the Procedure Performed?

Prior to metoidioplasty, the patient is required to first undergo testosterone replacement therapy to encourage the growth of the clitoris to up to four to five centimetres. Once the optimal length is achieved, the patient will be considered ready for the gender reassignment surgery.

Following the administration of general anaesthesia and after the pubic area has been prepped for the procedure, the surgeon will begin by making an incision in the skin surrounding the newly enlarged clitoris, particularly on the underside of the organ and the lateral crura, which holds the clitoris up. Doing so will free the clitoral tissue from the pubic bone, where it is naturally attached to.

If the patient desires for a urethral extension, the surgeon will use the mucosal tissues from inside the mouth, cheeks, or the vaginal area to do so. Some surgeons may elect to use tissue grafted from the patient’s intestines. If a graft is performed, the surgeon will use the patient’s labia minora to protect the transplanted tissues. A catheter can be used to facilitate the healing of the area for around two to three weeks. The extension of the urethra will allow the patient to urinate while standing up.

Meanwhile, the surgeon can use the labia minora to provide skin for the enlarged and freed clitoris. It will be wrapped around the clitoral tissues before being closed and secured with small sutures.

If the patient elects for a scrotoplasty, then this procedure will have to be performed at the same time as metoidioplasty. Scrotoplasty is the creation of a scrotum and involves the dissection of the vulva or the labia majora to form a cavity to create the appearance of a scrotum. Silicone prosthetic testicles are then inserted into these cavities to mimic the appearance of a natural scrotum.

During the metoidioplasty, the patient can also have a vaginectomy surgical removal of the vagina), hysterectomy (surgical removal of the womb or uterus), and oophorectomy (surgical removal of the ovaries) to complete the gender reassignment process.

Metoidioplasty typically lasts between three and five hours, depending on the number of additional procedures desired by the patient or recommended by the doctor.

Possible Risks and Complications

Possible complications include the following:

  • Excessive bleeding during the operation
  • Infection of the pubic area
  • Slow healing
  • Twisting of the clitoral tissue
  • Failure to achieve the desired length
  • Loss of sensation in the clitoris or artificial penis
  • Necrosis of the tissues in the pubic region
  • Hypersensitivity or persistent tenderness or pain
  • Narrowing of the urethra
  • Obstruction of the urethra
  • Formation of fistulas in the urethra • Transient or permanent vaginal narrowing

    References:

  • Metoidioplasty as a Single Stage Sex Reassignment Surgery in Female Transsexuals: Belgrade Experience by Miroslav L. Djordjevic, Dusan Stanojevic (Journal of Sexual Medicine, Volume 6 Issue 5, Oct 2008)

  • Metaidoioplasty: An Alternative Phalloplasty Technique in Transsexuals by Hage, J. Joris (Journal of Plastic & Reconstructive Surgery, Volume 97 Issue 1, January 1996)

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