Metoidioplasty: Difference between revisions

'''Metoidioplasty''' or '''metaoidioplasty''' (informally called a '''meta''') is a kind of surgery that some transgender and transsexual people seek.<ref>[https://archive.today/20121017065438/http://www3.interscience.wiley.com/journal/118853935/abstract Metoidioplasty: a variant of phalloplasty in female transsexuals] by S.V. Perovic and M.L. Djordjevic (BJU International, Volume 92 Issue 9, December 2003)</ref> It is sought by some transgender men, some trans-masculine people, some nonbinary people, and some intersex people. A meta surgery increases the exposed length of a person's phallus.<ref name="trans bodies 280">Laura Erickson-Schroth, ed. ''Trans Bodies, Trans Selves: A Resource for the Transgender Community.'' Oxford University Press, 2014. P. 280-281.</ref> For people who have certain kinds of phallus (called either a large clitoris or small penis), a meta surgery frees the phallus from the tissues that hold it close to the body,<ref name="trans bodies 280" /><ref name="hudson">Hudson. "FTM Genital Reconstruction Surgery (GRS)." ''Hudson's FTM Resource Guide.'' 2004. https://www.ftmguide.org/grs.html#meta</ref> and pulls it outward, making its external size larger, so that it can be easier to use for penetrative sex. A patient has a range of different options for other details of this surgery, or procedures that can be done at the same time as this surgery, which are described below.  

Metoidioplasty surgeries were developed in the 1970s.<ref name="hudson" />

In order to prepare for a meta, doctors prefer for the patient to first be on an appropriate [[hormone therapy]] ([[testosterone]]). When someone has been on [[testosterone]] [[hormone therapy]] for several years, this gradually enlarges the clitoris to a mean maximum size of 4.6 centimeters<ref>[https://doi.org/10.1007%2FBF01542220 Physical and hormonal evaluation of transsexual patients: A longitudinal study] by Meyer W, et al. (Archives of Sexual Behavior, Volume 15, Number 2, April 1986)</ref>. How much growth happens on hormones varies from one person to the next, and depends on their genes. Even without any kind of surgery or procedure, hormone therapy alone is enough to make a person's clitoris grow to be up to about the length of a thumb.<ref name="hudson" /> Without surgery, the clitoris is still tied down with skin, and partly buried in the body, so some people still find it difficult to use it to penetrate a sexual partner. Hormone therapy also doesn't make it easier for someone to pee standing up. Having the largest size of clitoris that a person is able to have through hormone therapy makes it easier to do a meta. The surgeon usually advises the patient to prepare for a meta by using clitoral [[pumping]] on a regular basis in order to make the phallus bigger. However, there is no research yet as to whether pumping helps do that, and pumping does have a risk of causing injury.<ref name="trans bodies 280" />  

In the metoidioplasty surgery itself, the surgeon cuts some tissues that had held the clitoris down. They cut a ligament that holds the clitoris under the pubic bone. They also separate the clitoris from skin connected to it, such as the labia minora.  

In addition to the metoidioplasty surgery itself, the patient has many options for other procedures that they may want to be done along with it. If the patient wants to be able to pee through their phallus after metoidioplasty, then they can ask to have their urethra extended through it, during the metoidioplasty surgery. If the patient prefers not to have their urethra extended, then the urethra stays where it was before, which is likely not on the phallus. The patient has the options to create a scrotum (a [[scrotoplasty]]) or not.<ref name="trans bodies 280" /> If the patient has a vagina (the orifice), then this also stays where it was. If the patient has already had their uterus taken out (a [[hysterectomy]]), then the patient has the option to close or get rid of the vagina (a [[vaginectomy]]) during the metoidioplasty, or to leave their vagina as it is.<ref name="trans bodies 280" /> The patient has the option to have a complete hysterectomy (taking away the uterus, cervix, and ovaries) at the same time as a meta, but only if they choose to do so.<ref name="trans bodies 280" />  

Recovering from a metoidioplasty surgery may take up to two weeks. During recovery, the patient may temporarily have a plastic catheter tube in their urethra that they need to pee through. Usually, this catheter will be taken out one or two days after surgery.<ref name="trans bodies 280" /> If the patient chose to have urethral lengthening, then the catheter may have to stay in for two to three weeks.<ref name="hudson" />

After a metoidioplasty surgery, most people have a phallus that has a flaccid length between 3 and 8 centimeters.<ref name="trans bodies 280" /> A phallus created by a meta usually has full sensation, an ability to become erect naturally, and an ability to orgasm.<ref name="trans bodies 280" />

If someone has had a metoidioplasty, then they will still be able to get a phalloplasty later, if they choose to do so.<ref name="trans bodies 280" />

Patients have many different options for what surgeries they want to include in their metaoidioplasty surgery, such as whether they also want a urethral lengthening, or not. The price range varies according to these options. A clitoral release without urethral lengthening can cost about USD$5,000. A metaoidioplasty that includes urethral lengthening can cost about USD$15,000.<ref name="trans bodies 280" />

Complications occur in up to 50% of surgeries, varying in severity between those requiring only minor supportive care to those requiring surgical correction. Complications include bacterial infections, ileus, wound dehiscence, tissue death, urinary fistula (pee coming out of an extra hole), narrowing of the urethra (urethral stricture), loss of sensation (uncommon), loss of ability to have an orgasm, scarring of varying degrees, and bleeding from the surgical site that may require surgery. <ref>http://www.gendersurgeryamsterdam.com/operation-female-male/metaidoioplasty/complications/</ref>

In a study of post-operative trans men, 28% of patients who had the urethra extended had temporary swelling resulting in dribbling and spraying of urine, and no medical intervention was needed. There was only a small chance of urethral strictures, and less than 10% had instance of a fistula requiring minor revision. The average neophallic length after was 5.7 centimeters (with a range 4–10 centimeters). All patients reported ability to achieve an erection and normal sensation. In patients who had scrotoplasty, some have reported rejection or complications related to the testicular prostheses.{{Citation needed}}