Metoidioplasty, sometimes referred to as a meto or meta or spelled "metaoidioplasty", is an alternative to phalloplasty

Phalloplasty

Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....

 for trans men

Trans man

A trans man, transman, trans guy, or FTM is a transgender or transsexual man: a person who was assigned female at birth, but who identifies as male....

. With the effects of testosterone

Testosterone

Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...

 treatment, the clitoris

Clitoris

The clitoris is a sexual organ that is present only in female mammals. In humans, the visible button-like portion is located near the anterior junction of the labia minora, above the opening of the urethra and vagina. Unlike the penis, which is homologous to the clitoris, the clitoris does not...

 enlarges, over time, to an average of 4–5 cm (due to the clitoris and penis being developmentally homologous organs).

In a metoidioplasty the enlarged clitoral tissue is released from its position and moved forward to more closely approximate the position of a penis. Oklahoma physician Dr. William David Foerester was one of the first U.S. surgeons to perform this technique on trans men.

Metoidioplasty is technically simpler than a phalloplasty

Phalloplasty

Phalloplasty refers to the construction of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement....

, and has fewer complications. The surgery itself is also considerably shorter (2–3 hours vs. 8–10 hours overall) and it is much less expensive. Unlike a phalloplasty, an erectile prosthesis is not needed to achieve erection, although the erection is usually less hard compared to the penis of a cisgender

Cisgender

Cisgender is an adjective used in the context of gender issues and counselling to refer to a class of gender identities formed by a match between an individual's gender identity and the behavior or role considered appropriate for one's sex.Kristen Schilt and Laurel Westbrook defined "cisgender"...

 man. Because metoidioplasty can not achieve penile dimensions comparable to a cisgender penis, the neopenis is usually not capable of penetrative sexual intercourse. Genital orgasm is almost always retained after surgery (unlike phalloplasty which carries significant risk of loss of erogenous sensation).

The operation

• After patient prep, the skin surrounding the enlarged clitoris is incised on the underside and the lateral crura, which suspend the tissue in place, are cut, freeing the clitoral tissue from the pubic bone.

• If the urethra is to be extended, the process starts now using mucosal tissues from either the vaginal area or from inside the mouth/cheeks. An experimental option is a graft from the intestines. The labia minora can be used to protect the graft, as well as provide greater girth. A catheter is placed in the extension to facilitate healing for two to three weeks.

• The neopenis is then provided with skin by cutting the labia minora and wrapping around the tissue and secured with stitches. A step usually done at the same time during metoidioplasty surgery, is scrotoplasty
  Scrotoplasty
  Scrotoplasty, also known as oscheoplasty, is reparative or plastic surgery of the scrotum.As part of the surgical options for trans men, scrotoplasty is one of several operations performed to transform/reform the external genitalia into a penis and a scrotum.In this procedure, the labia majora are...
  
  . Vaginectomy
  Vaginectomy
  Vaginectomy is a medical procedure to remove all or part of the vagina. It is usually used as a treatment for vaginal cancer. Vaginectomy is also used as part of some types of female-to-male sex reassignment surgery.-Cancer:...
  
  , hysterectomy‎ and/or oophorectomy
  Oophorectomy
  Oophorectomy is the surgical removal of an ovary or ovaries. The surgery is also called ovariectomy, but this term has been traditionally used in basic science research describing the surgical removal of ovaries in laboratory animals...
  
   can also be performed at this time if they have not been done already.

Complications and notes

In a study of post-operative men, 28% of patients who had the urethra extended had temporary swelling resulting in dribbling and spraying of urine, no medical intervention was needed. There was only a couple of percent chance of urethral strictures (narrowing of the urethra) and less than 10% had instance of a fistula (hole in the urethra) requiring minor revision. The average neophallic length after was 5.7 cm (with a range 4–10 cm). All patients reported ability to achieve an erection and normal sensation. In patients who had scrotoplasty, there was no reports of rejection or complications related to the testicular prostheses.

Alternate techniques

If a metoidioplasty is performed without extending the urethra and/or a scrotoplasty, this is sometimes called a clitoral release. This is less expensive than a complete metoidioplasty but does not allow for urination (through the new penis) while standing. However this also offers surgery with less risk because the urinary system remains unaltered without a urethral extension, and still affords some of the visual effects of a complete metoidioplasty along with the ability to have intercourse in a more traditional way. Vaginectomy is an option with this surgery.

See also

• Sexual reassignment surgery female-to-male
• List of transgender-related topics