Overview
Metoidioplasty is the surgical creation of a penis using your existing genital tissue. It is a less-extensive procedure than phalloplasty and is performed after the clitoris has been enlarged through the use of testosterone therapy. It is possible to undergo phalloplasty after a metoidioplasty, but the reverse is not true.
Gender affirmation surgeries in Iran are a group of surgical procedures that some transgender and gender diverse people use to help affirm their gender identity. Metoidioplasty in Iran is a type of “bottom surgery” (surgery on the genitals) available to transgender men, or those who identify as transmasculine. It involves the surgical creation of a penis from your existing genital tissue.
Here in Iran we offer metoidioplasty as a gender affirmation procedure to eligible patients age 18 and over. Our skilled team includes specialists in plastic surgery, urology, gender management and social work, who work together to provide a full suite of options for transgender teens and young adults.
What is metoidioplasty?
When it comes to lower surgery, transgender and nonbinary people who were assigned female at birth (AFAB) have a few different options. One of the most common lower surgeries that is routinely performed on AFAB Trans and nonbinary people is called metoidioplasty.
Metoidioplasty, also known as Meta, is a term used to describe surgical procedures that work with your existing genital tissue to form what is called a neophallus, or new penis. It can be performed on anyone with significant clitoral growth from the use of testosterone. Most doctors recommend being on testosterone therapy for one to two years before having metoidioplasty.
Different types of metoidioplasty
There are four basic types of metoidioplasty procedures:
. Simple release
Also known as simple Meta, this procedure consists only of the clitoral release — that is, a procedure to free the clitoris from surrounding tissue — and doesn’t alter the urethra or vagina. Simple release increases the length and exposure of your penis.
. Full metoidioplasty
Surgeons who perform full metoidioplasty release the clitoris and then use a tissue graft from the inside of your cheek to link the urethra with the neophallus. If desired, they may also perform vaginectomy (removal of the vagina) and insert scrotal implants.
. Ring metoidioplasty
This procedure is very similar to full metoidioplasty. However, instead of taking a skin graft from the inside of the mouth, the surgeon uses a graft from the inside of the vaginal wall combined with the labia majora in order to connect the urethra and the neophallus.
The advantage to this procedure is that you’ll only have to heal at one site as opposed to two. You also won’t experience complications that may arise from surgery in the mouth such as pain while eating and decreased production of saliva.
. Centurion metoidioplasty
The Centurion procedure releases the round ligaments that run up the labia from the labia majora, and then uses them to surround the new penis, creating extra girth. Unlike other procedures, Centurion doesn’t require that a skin graft be taken from the mouth or from the vaginal wall, meaning there is less pain, less scarring, and fewer complications.
What is the difference between metoidioplasty and phalloplasty?
Phalloplasty is the other most common form of lower surgery for AFAB Trans and nonbinary people. While the metoidioplasty works with existing tissue, phalloplasty takes a large skin graft from your arm, leg, or torso and uses it to create a penis.
Metoidioplasty and phalloplasty each have their own unique benefits and disadvantages.
Advantages and disadvantages of metoidioplasty
Here are some of the pros and cons of metoidioplasty:
Pros
. Fully functioning penis that can become erect on its own
. Minimal visible scarring
. Fewer surgical procedures than phalloplasty
. Can also have a phalloplasty later if you choose
. Shorter recovery time
. Significantly less expensive than phalloplasty.
Cons
. New penis relatively small in both length and girth, measuring anywhere from 3 to 8 cm in length.
. May not be capable of penetration during sex.
. Requires use of hormone replacement therapy and substantial clitoral growth
. May not be able to urinate while standing
Who is eligible for metoidioplasty?
Surgery is never the first step in a gender transition. It is something that happens after you have already explored social and medical transition options. People who choose to undergo metoidioplasty usually do so after taking other steps in the gender affirmation process, such as taking supplemental hormones and undergoing chest surgery. To qualify for metoidioplasty at Iran’s Hospital, you must be at least 18 years old and meet certain criteria.
During metoidioplasty
What happens during metoidioplasty?
Although they have different functions, the clitoris and penis are both derived from the same tissue. Metoidioplasty takes advantage of this fact by creating a penis from the clitoris after it has been enlarged through the use of testosterone therapy. Often, a scrotoplasty (surgical creation of a scrotum from the labia majora) is performed at the same time.
Metoidioplasty may also include surgical construction of a glans and lengthening of the urethra. The first option improves the resemblance to a cisgender male’s penis. The second makes it possible for you to urinate while standing up. It is possible to have a phalloplasty after a metoidioplasty but the reverse is not true.
How does the procedure work?
The initial metoidioplasty surgery can take anywhere from 2 to 5 hours depending on the surgeon and on which procedures you choose to have as part of your metoidioplasty.
If you’re seeking out simple Meta only, you’ll likely be placed under a conscious sedation, meaning that you’ll be awake but mostly unaware during the surgery. If you’re having a urethral lengthening, hysterectomy, or vaginectomy performed as well, you’ll be placed under general anesthesia.
If you choose to have scrotoplasty, the doctor may insert what are known as tissue expanders into the labia during the first procedure in order to prepare the tissue to accept the larger testicle implants during a follow-up procedure. Most surgeons wait three to six months to perform the second surgery.
Most doctors perform metoidioplasty as an outpatient surgery, meaning you’ll be able to leave the hospital on the same day that you have the procedure. Some doctors may request that you stay overnight following your surgery.
Complications
. Apart from the standard issues that may arise from having surgery, there are a few potential complications you may experience with metoidioplasty. One is called a urinary fistula, a hole in the urethra that can cause leakage of urine. This can be repaired surgically and in some instances may heal itself without intervention.
. The other potential complication if you’ve chosen scrotoplasty is that your body may reject the silicone implants, which may result in needing to have another surgery.
After metoidioplasty
Recovery
Metoidioplasty can take between 2 and 5 hours and you may need to stay in the hospital for a day or two. Because the healing process can take time, you shouldn’t engage in strenuous physical activity or heavy lifting in the first 6 weeks after metoidioplasty.
If you undergo urethral lengthening as part of metoidioplasty, you will also likely need to urinate through a catheter for 3 to 4 weeks after surgery. Your clinical team will give you detailed instructions on how to care for the catheter, and how to check for signs of infection at the surgical site, such as redness and swelling. You will likely be able to walk around and engage in light activity within a week after surgery, and healed enough to go back to all activities at around 6 weeks. This surgery has a very long healing process that can take 12 to 18 months.
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