Metoidioplasty

Content warningThis article mentions genitals (with diagrams), reproductive organs, surgery (with photos of it in process). If you are not comfortable with reading about this kind of topic, we suggest you take a step back.

DisclaimerThe Nonbinary Wiki is written by volunteers who are not necessarily experts on medical topics. This wiki and its editors make no representations or warranties of any kind. This wiki and its editors shall not be liable for any physical, psychological, emotional, financial, or commercial damages, prosecutions, or proceedings instituted against any person or entity as a result of the use of information from this file, or any loss, injury, or damage caused thereby. You claim full responsibility for your own health decisions. This wiki will not be held responsible for your actions. Any information here does not constitute legal, financial, medical, business, or other advice. This wiki should not be used to recommend a path for diagnosing or treating any medical condition. For that, you must consult your physician.

Surgeries and procedures

Top surgery Enlarging (breast augmentation) Reducing or removing (mastectomy or breast reduction) Bottom surgery Changes to the gonads Removing testicles (orchiectomy) Removing ovaries (oophorectomy) Changes to the phallus Creating (phalloplasty) Removing (penectomy) Making a clitoris more like a penis (metoidioplasty) Changes to the vagina Creating (vaginoplasty) Removing (vaginectomy) Changes to the labia Changes to the uterus Removing (hysterectomy) Sterilizing (tubal ligation) Stopping periods (uterine ablation) Uterus transplant Combined changes Removing penis and testes (emasculation) Removing most or all genitals (genital nullification) Creating a vulva (Vulvoplasty) Creating a scrotum (scrotoplasty) Sterilization Other surgeries and procedures Adam's apple reduction Facial surgery

Metoidioplasty or metaoidioplasty (informally called a meta) is a kind of surgery that some transgender and transsexual people seek. 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. 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, 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.

History

Metoidioplasty surgeries were developed in the 1970s.

Process

Diagram of the vulva. As seen in an adult who was assigned female at birth, and who has not had hormone therapy or surgery.

Diagram of the inner anatomy of the clitoris. As seen in an adult who was assigned female at birth, and who has not had hormone therapy or surgery.

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. 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. 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.

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. 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. 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.

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. If the patient chose to have urethral lengthening, then the catheter may have to stay in for two to three weeks.

After a metoidioplasty surgery, most people have a phallus that has a flaccid length between 3 and 8 centimeters. A phallus created by a meta usually has full sensation, an ability to become erect naturally, and an ability to orgasm.

Compared with phalloplasty

Metoidioplasty and phalloplasty are two very different methods for creating a larger phallus. Metoidioplasty is technically simpler than phalloplasty, costs less, and has fewer potential complications. However, phalloplasty patients are more likely to be able to use their phallus to penetrate a sexual partner after they recover from surgery, because phalloplasty can usually create a larger penis.

In a phalloplasty, the surgeon creates a penis by grafting tissue from a donor site, such as from the patient's own back, arm, or leg, whereas a meta does not require any tissue grafts. A phalloplasty takes about 8–10 hours to complete (the first stage), and is generally followed by multiple (up to 3) additional surgical procedures including glansplasty, scrotoplasty, testicular prosthesis, and/or penile implant. A meta takes less time, and typically requires 2–3 hours to complete. Because the clitoris's erectile tissue still works normally in a meta, a meta does not need a prosthesis implanted for erection, although the phallus might not become as rigid as the erection of a cisgender man. In nearly all cases, meta patients can continue to have clitoral orgasms after surgery.^{[citation needed]}

If someone has had a metoidioplasty, then they will still be able to get a phalloplasty later, if they choose to do so.

Urethral hookup

Some patients choose to have an additional procedure in which their urethra will be extended through their phallus, called a "urethral hookup." This makes it so the person will be able to pee through their phallus, which makes it easier to pee while standing up. The surgeon can do a urethral hookup at the same time as a metaoidioplasty. There are two different methods for extending the urethra. One method takes a graft of skin from inside the patient's mouth. A newer method instead uses the inside of the labia and a flap from the vagina, which is called a "ring matoidioplasty."

Here is one version of how a metoidioplasty can go, for a patient who chose to have their urethra extended so they will be able to pee through their phallus, and who chose to have a scrotum created (scrotoplasty). In a metoidioplasty, the urethral plate and urethra are cut away from the clitoral corporeal bodies, then divided at the distal end, and the testosterone-enlarged clitoris straightened out and elongated. A longitudinal vascularized island flap is configured and harvested from the dorsal skin of the clitoris, reversed to the ventral side, tubularized and an anastomosis is formed with the native urethra. The new urethral meatus (the hole you pee through) is placed along the phallus to the distal end and the skin of the phallus and scrotum reconstructed using labia minora and majora flaps. The new phallus ranges in size from 4-10 centimeters (with an average of 5.7 centimeters), and has the approximate girth of a human adult thumb.

These are some photos of a meta surgery. Not every meta will look like this, because people vary in which other genital surgeries they want to have with it.

• 

  Meta, urethral extension, removal of vagina, and creation of scrotum surgeries in process.

• 

  Meta, urethral extension, and scrotoplasty, immediately post op. The stitches and catheter tube will be gone after healing.

Clitoral release

If a metoidioplasty is performed without extending the urethra and/or creating a scrotum, this is sometimes called a clitoral release or a clitoral free-up. A clitoral release by itself is less expensive than a "complete metoidioplasty" that includes these other procedures. By itself, a clitoral release has fewer health risks, because the urinary system remains unaltered without a urethral extension, and still affords some of the visual effects of a complete metoidioplasty, along with the ability to use the penis for sexual penetration. If the urethra is not changed from its original position, this does not allow for urination through the phallus, so this version of the procedure does not make it easier to pee standing up.^{[citation needed]}

Cost

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.

Complications

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. 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]}

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)

External links

• Metoidioplasty.net - The Metoidioplasty Surgery Guide
• FemaletoMale.org | Information about Metoidioplasty
• Hudson's FTM Resource Guide - FTM Genital Reconstruction Surgery (GRS) - Metoidioplasty

Further reading

• Trystan Theosophus Cotton, Hung Juries: Testimonies of Genital Surgery by Transsexual Men. Oakland, CA: Transgress Press, 2012.

See also

• Practical resources