Metoidioplasty

Who can undergo metoidioplasty?

While for some trans men metoidioplasty or metaoidioplasty is essential, for others it is not. Before undergoing metoidioplasty, 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.

Preparations – Hormone treatment for a metoidioplasty

In order to achieve a micropenis through the metaidoioplasty 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.

Admission

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

Metoidioplasty surgery

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 metoidioplasty 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 prostheses 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.

Admission to the ward after metoidioplasty

During metoidioplasty 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 seven days following the metoidioplasty, it is essential to follow a residue-free diet.

Going home after metoidioplasty

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.

Possible complications

The IM Gender team will explain to the patient how to avoid possible metoidioplasty 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.

The results

Once you have recovered from metoidioplasty, you will have a functional micropenis of about 3–6 cm in length with an aesthetic similar to that of a natural penis. This organ will have erogenous sensation. However, the results of the metoidioplasty will not allow penetrative sexual intercourse.

Post-operative visits

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 the metoidioplasty.