Metoidioplasty

You will be admitted to the hospital on the same day as the metaoidioplasty operation. During the hours prior to the surgery, the necessary monitoring will be carried out.

In order to achieve a micropenis through the metoidioplasty technique, it is necessary to have previously undergone androgen therapy to considerably increase clitoris size. Your endocrinologist will advise you on how and when to undergo this treatment.

Metoidioplasty is a technique that uses the clitoris, previously hypertrophied through hormone treatment, to achieve a micropenis. The result is a small but sensitive, erogenous and erectile penis.

This technique is always performed under general anaesthesia and surgery usually lasts between 5 and 6 hours in the operating theatre. To construct a urethra from the base of the clitoris to the tip, the surgeon will use a flap from the anterior wall of the vagina (with an approximate length of 5 to 7.5 centimetres and a width of 2 to 3 centimetres) and a flap with the skin of the labium minora. With all this, the surgeon achieves a tubular shape to achieve the lengthening of the urethra.

During the same operation, the labia majora are mobilised dorsally and joined at the midline to form a new scrotum. Once the scrotal pouch has been created, silicone testicular implants are inserted. The implantation of the testicular prosthesis can be performed during the same surgical procedure or can be postponed to a second procedure at the discretion of the surgical team performing the operation.

Who can undergo metoidioplasty?

While for some trans men metoidioplasty is essential, for others it is not. Before undergoing this surgery, it is essential that your medical team assesses your health and the suitability of the procedure. It is important to discuss all possible options with your surgeon.

Difference between metoidioplasty and phalloplasty

The main difference between metoidioplasty and phalloplasty lies in the size and complexity of the procedures. Metoidioplasty creates a smaller, functional micropenis using the clitoris, which typically grows with testosterone treatment, while phalloplasty reconstructs a larger, cis-like penis using tissue from other parts of the body. Phalloplasty also allows for penetrative intercourse through the use of a prosthesis, while metoidioplasty may not. The decision depends on the patient’s goals and needs​.

Risks of metoidioplasty surgery

The IM GENDER team will explain to the patient how to avoid possible complications and, should they arise, how to proceed. Among the complications that could occur are:

• Infection
• You may experience an episode of bleeding during or after the procedure.
• Extrusion of the testicular prosthesis.
• Urethro-cutaneous fistula – communication of the urethra with the scrotal skin.
• Urethral stricture – decrease in the urethra’s diameter.
• Vesico-vaginal fistula – communication between the bladder and the vagina.

If you experience discomfort or simply have any doubts, you should consult the patient care team or your referring surgeon. In addition, a 24-hour phone number is available to answer any questions you may have.

Will I have to be hospitalised after this surgery?

During surgery, two drains are placed in the perineal area, which are usually removed after 24 hours. On the second post-operative day, the patient is allowed to move around. After metoidioplasty, hospitalisation usually lasts between 5 and 7 days, depending on the patient’s progress. At all times, the IM GENDER team’s aim will be to offer you and your companions a comfortable stay for a speedy recovery. During the first week of the postoperative period, it is essential to follow a residue-free diet.

Will I have postoperative visits in the postoperative period?

During the post-operative period, always follow the IM GENDER medical team’s instructions to ensure a speedy recovery. Once you are discharged from hospital, the patient care team will schedule the follow-up medical visits and check-ups until you are officially discharged from hospital, normally one year after sex reassignment surgery.

When can I go home after my treatment?

Although you will be able to go home in about 5–7 days after the metoidioplasty, you will need to continue to wear the bladder catheter for at least 21 days.

What should I do if I experience pain or discomfort during the postoperative period?

If you experience pain or discomfort during the postoperative period, it’s important to follow your surgeon’s pain management plan. This may include taking prescribed medications, applying ice or heat to the surgical site, and resting as needed.

What is the recovery process like?

The recovery process after metoidioplasty surgery can vary depending on the individual and the extent of the procedure. Patients may experience pain and discomfort, swelling, and limited mobility during the initial recovery period. It is important to follow your surgeon’s postoperative care instructions carefully to promote healing and minimize the risk of complications.

What are the results after metodioplasty recovery?

After metoidioplasty recovery, you will have a functional micropenis that is typically 3-6 cm in length, with an aesthetic appearance similar to that of a natural penis. This organ will retain erogenous sensation. However, it is important to note that metoidioplasty after recovery may not allow for penetrative sexual intercourse.

When will I be able to have sexual activity after metoidioplasty surgery?

The timing of when you can resume sexual activity following metaoidioplasty surgery will depend on the individual and the extent of the procedure. It’s important to discuss your specific goals and expectations with your surgeon to determine when it is safe to resume sexual activity.