Metoidioplasty - Types, Procedure, and Complications

Introduction

Gender affirmation surgeries are a group of surgeries that gender-diverse individuals use to proclaim their gender. Individuals assigned as female at birth have very few options when it comes to bottom surgery. Bottom surgery is a surgery performed on the genitals. Metoidioplasty is a type of bottom surgery that is available to transgender people or transmasculine individuals.

What Is Metoidioplasty?

Metoidioplasty is the surgical procedure to create a penis with the help of the existing genital tissues. It is a type of gender affirmation surgery. Gender affirmation surgeries are surgeries that help transgenders affirm their gender identity. It is less expensive than phalloplasty. It is carried out after the clitoris is enlarged with the help of testosterone therapy. One should be on hormone therapy for a year. Testosterone increases the size of the clitoris.

What Are the Types of Metoidioplasty?

The following are the various types of metoidioplasty:

• Simple Release Metoidioplasty: Simple-release metoidioplasty is also referred to as simple meta. In this procedure, the clitoris is only released. It does not change the vagina or urethra. This procedure increases the length of the penis.

• Full Metoidioplasty: In full metoidioplasty, the clitoris is released, and a tissue graft is used from the cheek to link the urethra with the newly formed penis. If needed, a vaginectomy or vagina removal can also be performed.

• Ring Metoidioplasty: Ring metoidioplasty is the same as full metoidioplasty, but instead of taking a skin graft from the cheek, a graft from the vaginal wall is used that is combined with the labia majora to connect the urethra and the newly created penis. This procedure can heal in one place rather than two places. Discomforts arising due to mouth surgery can also be avoided.

• Centurion Metoidioplasty: This procedure releases the ligaments that extend from the labia majora, thus surrounding the newly created penis, giving extra thickness. Centurion procedure does not need a skin graft from any body part.

How Is Metoidioplasty Performed?

Before the Procedure:

• Before the procedure, the doctor evaluates the overall health and medical history.

• The doctor explains the risks, benefits, and care to be taken after surgery.

• The doctor explains the impact of the procedure on one's life.

• The individual is evaluated for mental health to ensure that one understands the procedure.

• One is advised to take hormonal therapy for a year before surgery.

• One should quit smoking and lose weight, reducing complications post-surgery.

During the Procedure:

• The surgery can take up to two to five hours.

• The surgery is usually carried out under general anesthesia.

• During the metoidioplasty procedure, the surgeon uses tissue from the clitoris to create a micropenis.

• The clitoris is released by cutting the ligaments connecting it to the pubic bone.

• A plastic tube or catheter is inserted into the bladder through the newly created penis to keep the urethra open.

• A cheek or vaginal graft tissue is used to make the urethra longer.

• The genital tissue increases the length and thickness of the newly created penis.

• A neophallus or newly created penis is less than seven centimeters long.

• Other surgical changes can be carried out during this procedure, for example, if one wants to add a testicular prosthesis or have a scrotoplasty.

• In scrotoplasty, the surgeon inserts a tissue expander into the labia during the first procedure to prepare the tissue to accept the large testicle implants. A surgeon waits around three to six months before performing the second surgery.

• One may be able to leave the hospital on the same day of the procedure.

After the Procedure:

• The recovery after surgery varies from person to person. However, a minimum of two weeks is required for recovery.

• One should refrain from lifting any heavy object for the first two to four weeks post-surgery. Travel should also be curbed between ten days to three weeks post-surgery.

• If one has undergone urethral lengthening during metoidioplasty, they have to urinate with the help of a catheter for three to four weeks post-surgery. Proper instructions are given by healthcare professionals on how to care for the catheter to prevent infection and check for signs and symptoms of surgical site infections like redness and swelling.

• Healing takes place around two weeks after surgery. One can resume normal daily life activities after six weeks. Complete recovery may take around a year and a half.

Who Is a Potential Candidate for Metoidioplasty?

Potential candidates for metoidioplasty are those seeking genital reconstruction to align their physical appearance with their gender identity. It is important for individuals to consult healthcare providers and get detailed information about metoidioplasty.

What Are the Advantages of Metoidioplasty?

The following are the advantages of metoidioplasty:

• The following are the procedures for having metoidioplasty:

• Esthetically acceptable genitalia.

• A functional penis that can get an erection on its own.

• Easy urination.

• The sensation is preserved.

• Lesser surgical procedures than phalloplasty.

• Lesser time of recovery.

What Are the Drawbacks of Metoidioplasty?

Metoidioplasty drawbacks include limited neophallus size, urethral issues like urethral stricture(Narrowing of the urethra or urethral stricture), urethral fistula(It is an abnormal connection between the urethra and other organs), potential aesthetic dissatisfaction, less rigid erectile function, scrotal implant challenges, and the possibility of needing additional revision surgeries. Psychological adjustment and varying individual experiences are also important considerations.

What Is the Outlook of Metoidioplasty?

The outlook of metoidioplasty is usually good. People who undergo metoidioplasty can retain sexual sensations, and many can even achieve an erection and smooth penetration during sexual intercourse. Metoidioplasty is relatively cheaper, has fewer complications, and has good results. It is a better option than other gender affirmation surgeries.

Conclusion

Metoidioplasty is a gender-affirming surgery intended to help transgender people with acceptable genitalia. The main goal of the surgery is to create male genitalia that would help one while passing urine, satisfactory sexual function, and proper genitalia. The surgery creates a penis by straightening and lengthening the clitoris that has been hormonally enlarged.

To achieve acceptable results, other procedures like urethral lengthening and scrotoplasty can be carried out along with metoidioplasty. The disadvantage of metoidioplasty is that the penis length is insufficient for penetrative sex. Some types of metoidioplasty are challenging and require an experienced surgeon to operate. Nevertheless, the procedure of this gender-affirming surgery has a favorable prognosis and is an affordable surgery for those looking for gender affirmation.