Metoidioplasty, also known as ‘meta’, is a type of bottom surgery for female-to-male gender reassignment for transgender men and non-binary gender. This surgery is the formation of a new penis from your genitals.
Before you go for a metoidioplasty, you will have to go through the procedure of hormone replacement therapy. This is to allow your clitoris to grow up to four or five centimeters, and then only you will be affirmed ready for metoidioplasty.
Even after a metoidioplasty, you will retain the sensation of your clitoris along with the erectile functions of your new penis.
Who is metoidioplasty for?
Metoidioplasty is a surgery for those who have taken an informed decision to undertake the change of the genitals. The requirements for anyone to have a metoidioplasty are:
- 18 years and over
- Should be fit mentally and physically
- Should have undergone testosterone therapy for not less than two years
Types of metoidioplasty surgery
- Simple Release: This approach is also called ‘simple meta,’ and in this procedure, your clitoris will be released from its surrounding tissues. It doesn’t alter your vagina or urethra
- Full Metoidioplasty: After releasing the clitoris the surgeon will take a tissue graft from the inside of your cheek. This is to connect your urethra to the neophallus. There are cases of removing the vagina (vaginectomy) to replace with scrotal implants.
- Ring Metoidioplasty: This procedure is similar to full metoidioplasty except for that ring metoidioplasty harvest the skin graft from your inner vaginal wall to connect the urethra to the neophallus. Here, you have the advantage of healing in one area rather than two as in full metoidioplasty – the vagina and your cheek.
- Centurion Metoidioplasty: In this procedure, there is no skin grafting from any parts of your body. The operation involves releasing the ligaments at the upper part of your labia and surrounds them to the new penis. With this approach, you will receive extra girth in your neophallus without scarring and with fewer complications.
- Vaginectomy: In this surgery, your vaginal lining will be removed (colpectomy), and the vaginal opening will be closed (colpocleisis) to create support to the pelvis. This procedure is reputed to be risky with high blood loss. Vaginectomy can be performed either as a standalone surgery or combined with metoidioplasty.
- Urethroplasty: This involves the lengthening of your urethra to allow effortless urination while standing, which means no more urinating in a sitting position.
- Scrotoplasty: Also known as oscheoplasty, this surgery will transform your external genitals into a penis and a scrotum. A testicular sac will be created with or without implanting testicular prosthesis.
Possible risks involved
- There will be risk of excessive bleeding during the surgery
- Possible infections in the pubic area
- Recovery time is slow
- You may not achieve your desired penis length
- It is possible to lose sensation on your clitoris or your new artificial penis
- Your pubic region might experience necrosis or death of tissues
- Possible narrowing and obstruction of the urethra
Recovery after surgery
Just like other surgeries, the recovery time for metoidioplasty will vary based on the procedure and individuals. It will be good to take about two weeks for recovery before resuming work. During the first two to four weeks, you will be required to avoid heavy exercises and strenuous task.
Right after surgery, you will experience swelling, discomfort and bruising. To minimize these, you will need medications and ample rest. Besides the standard discomfort post-surgery, there is a possibility of going through complications like urinary fistula. This means, there will be a hole in your urethra causing leakage of urine which can either heal itself or require surgery.
Metoidioplasty VS Phalloplasty
Both procedures constitute the ‘bottom surgeries” to create a new penis. A study has shown that 50% of transgender men who undergoes sex change surgery choose metoidioplasty and the other 50% choose phalloplasty.
Metoidioplasty involves enlarging the clitoris and separating it from the labia minora, cutting the suspensory ligament as well, all these to create a penis from your vagina. On the other hand, phalloplasty is the construction/reconstruction of the penis by harvesting flaps of skin from different parts of your body.
Comparatively, metoidioplasty is considered to be less costly with more accessible surgical techniques and fewer complications than phalloplasty. There is a possibility to have phalloplasty after metoidioplasty, but not the other way round.