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From Susan's Place Transgender Wiki

Metoidioplasty, sometimes referred to as a meto or meta, is an alternative to phalloplasty for trans men ^[1]. With the effects of testosterone treatment, the clitoris enlarges, over time, to an average of 4-5 cm.^[2] (due to the clitoris and penis being developmentally homologous organs)

Metoidioplasty is technically simpler than a phalloplasty, and has fewer complications. Surgery itself is also considerably shorter (1-2 hours vs. 8-10 hours) and it is much less expensive. Unlike a phalloplasty, an erectile prosthesis is not needed to achieve erection, although the erection is usually less hard than in a cisgender penis. Due to and average size after metoidioplasty, the neopenis is usually not capable of penetrative sexual intercourse.

[edit] The operation

After patient prep, the skin surrounding the enlarged clitoris is incised (figure 1) on the underside and the lateral crura which suspends the tissue in place is cut, freeing the clitoral tissue from the pubic bone. (figure 2) If the urethra is to be extended, the process starts now, otherwise the neopenis is skinned by cutting the labia minora and wrapping around the tissue and secured with stitches. (figure 3)

Illustration of starting incisions

Illustration of freeing of clitorial tissue

Illustration of skinning of the neopenis

Illustration of scrotum fabrication

A step usually done at the same time during metoidioplasty surgery, is scrotoplasty. In this procedure, the labia majora (see vulva) are dissected to form hollow cavities, and united to into an approximation of a scrotum, (figure 4) where prosthetic testicles (usually made of silicone) can be inserted. Vaginectomy, Hysterectomy‎ and/or Oophorectomy (surgical removal of the overies) can also performed at this time if they have not been done so already.

[edit] Complications and notes

In a study of post-op men, 28% of patients who had the urethra extended had temporary swelling resulting in dribbling and spraying of urine, no medical intervention was needed. There was only a couple percent chance of urethral strictures, (narrowing of the urethra) and less then 10% had instance of a fistula, (hole in the urethra) requiring minor revision. The average neophallic length after was 5.7 cm. (with a range 4–10 cm) All patients reported ability to achieve an erection and normal sensation. In patients who had scrotoplasty, there was no reports of rejection or complications related to the testicular prostheses.

[edit] Alternate techniques

If a metoidioplasty is performed without extending the urethral and/or a scrotoplasty, this is sometimes called a clitoral release. This is less expensive than a complete metoidioplasty but does not allow for urination (through the new penis) while standing. However this also offers surgery with less risk because the urinary system remains unaltered without a urethral extension and still affords some of the visual effects of a complete metoidioplasty. Vaginectomy is an option with this surgery.

[edit] See also

• Gender reassignment surgery (female-to-male)

[edit] Notes

• 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)
• Gender Reassigment by Dan Greenwald and Wayne Stadelmann (eMedicine Journal, Volume 2 Number 7, July 6 2001)

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