Metoidioplasty, metaoidioplasty, or metaidoioplasty (informally called a meto or meta) is a female-to-male sex reassignment surgery.

Testosterone replacement therapy Androgen replacement therapy (ART), often referred to as testosterone replacement therapy (TRT) or hormone replacement therapy (HRT), is a form of hormone therapy in which androgens, often testosterone, are supplemented or replaced exogenously ...

gradually enlarges the

clitoris The clitoris ( or ) is a female sex organ present in mammals, ostriches and a limited number of other animals. In humans, the visible portion – the glans – is at the front junction of the labia minora (inner lips), above the ope ...

to a mean maximum size of (as the clitoris and the

penis A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...

are developmentally homologous). In a metoidioplasty, the urethral plate and

urethra The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...

are completely dissected from the clitoral corporeal bodies, then divided at the distal end, and the testosterone-enlarged clitoris straightened out and elongated. A longitudinal vascularized island flap is configured and harvested from the dorsal skin of the clitoris, reversed to the ventral side, tubularized and an

anastomosis An anastomosis (, plural anastomoses) is a connection or opening between two things (especially cavities or passages) that are normally diverging or branching, such as between blood vessels, leaf#Veins, leaf veins, or streams. Such a connection m ...

is formed with the native urethra. The new urethral meatus is placed along the neophallus to the distal end and the skin of the neophallus and scrotum reconstructed using labia minora and majora flaps. The new neophallus ranges in size from (with an average of ) and has the approximate girth of a human adult thumb. The term derives from ''

meta- Meta (from the Greek μετά, ''meta'', meaning "after" or "beyond") is a prefix meaning "more comprehensive" or "transcending". In modern nomenclature, ''meta''- can also serve as a prefix meaning self-referential, as a field of study or endea ...

'' "change",

Ancient Greek Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic peri ...

grc, αἰδοῖον, aidoion, genitals, label=none, and '' -plasty'', denoting surgical construction or modification.

Operation

Alternative techniques

Recent studies have introduced an operative technique known as extensive metoidioplasty. This method extensively detaches the clitoris, nearly completely detaching it from the pubic arch before its reattachment and elongation. Current studies show this method yielding penile lengths of 6–12 centimeters, with 7/10 patients being capable of obtaining erections capable of penetrative intercourse.

Complications

Complications from metoidioplasty vary in severity. Minor complications may be resolved through minor supportive care, while more serious complications may require surgical correction. As with other surgical procedures, metoidioplasty has the possibility to cause infection, bleeding, blood clots, damage to surrounding tissues, pain, as well as negative reactions to anesthesia or other required medications. If urethral lengthening is performed, urethral complications such as urinary

fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

may occur. Patients who experience postvoid incontinence or dribbling following surgery report their symptoms as resolved within three months. Satisfaction rates among patients who undergo metoidioplasty are generally very high regarding both appearance and sexual satisfaction.

Comparison with phalloplasty

Metoidioplasty is technically simpler than

phalloplasty Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement. History Russian surgeon Nikolaj Bogoraz performed the firs ...

, more affordable, and has fewer potential complications. However, phalloplasty patients are far more likely to be capable of

sexual penetration Sexual penetration is the insertion of a body part or other object into a body orifice, such as the mouth, vagina or anus, as part of human sexual activity or animal sexual behavior. The term is most commonly used in statute law in the context ...

(mainly due to size constraints) after they recover from surgery. In a phalloplasty, a

plastic surgeon Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes craniof ...

fabricates a neopenis by

autograft Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogene ...

ing tissue from a donor site (such as from the patient's back, arm or leg). A phalloplasty takes about 8–10 hours to complete (the first stage), and is generally followed by multiple (up to three) additional surgical procedures including glansplasty,

scrotoplasty Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. However, scientific research for male genital ...

testicular prosthesis A prosthetic testicle is an artificial replacement for a testicle lost through surgery or injury. Consisting of a plastic ovoid manufactured from silicone rubber, and either solid, or filled with a salt solution and implanted in the scrotum, a ...

, and/or

penile implant A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affi ...

ation. Metoidioplasty typically requires 2–3 hours to complete. Because the clitoris'

erectile tissue Erectile tissue is tissue in the body with numerous vascular spaces, or cavernous tissue, that may become engorged with blood. However, tissue that is devoid of or otherwise lacking erectile tissue (such as the labia minora, the vestibule/vagina an ...

functions normally, a prosthesis is unnecessary for erection (although the clitoris might not become as rigid as a

penile erection An erection (clinically: penile erection or penile tumescence) is a physiological phenomenon in which the penis becomes firm, engorged, and enlarged. Penile erection is the result of a complex interaction of psychological, neural, vascular, ...

). In nearly all cases, metoidioplasty patients can continue to have

clitoral orgasm Orgasm (from Greek , ; "excitement, swelling") or sexual climax is the sudden discharge of accumulated sexual excitement during the sexual response cycle, resulting in rhythmic, involuntary muscular contractions in the pelvic region charac ...

s after surgery. Note also, that the two alternative techniques are not mutually exclusive and phalloplasty extension of a metioidiplasic base neophallus is possible.

References

External links

Metoidioplasty.net - The Metoidioplasty Surgery Guide

FemaletoMale.org , Information about Metoidioplasty
Gender-affirming surgery (female-to-male)