Metoidioplasty
is a surgical procedure where the enlarged
clitoris is excised (cut out) from the labia
minora tissue and then dropped down via
cutting (release) of the suspensory ligament.
The result is a normal appearing, small penis
without needing the multi-staged surgical
procedures of phalloplasty.
During metoidioplasty, the
testosterone-affected clitoris is
released from its "hood". The result depends in
great part upon the size of the clitorial
tissue and its enlargement under the
influence of testosterone hormone
treatment.
Sometimes the urethra
(urine tube) is lengthened using vaginal
mucosal tissue, to exit at the tip of the
newly freed clitorial tissue. Additional
labial minora tissue is used to protect
the urethral extension as well as provide girth
to the small organ. This procedure is more
complex and involves additional risks such as
fistula formation (urinary leakage).
As the enlarged clitoris
is released from its hood, the undersurface of
the structure (known as the chordee), can
be freed of its dense fibrous tissue to allow
the entire structure to be free of surrounding
tissues and to allow for more exposure. This
technique can provide some additional length,
although it is somewhat limited.
Surgical care must be
taken to avoid injury to the natural internal
erectile tissues during removal of this fibrous
band. The labia minora tissue can be used
to provide additional girth and circumference to
the small phallus. At this time a surgical
procedure to fashion the tip of the clitoris to
appear as a male glans is also possible.
The result is a surgically
reconstructed small penis (micropenis or
neopenis). If everything goes as planned,
the micropenis can have an erection and orgasm,
although ejaculation of sperm is not possible.
This neophallus can be between 4–10 cm in
length in the flaccid (unaroused)
stage.
It is possible to
construct a scrotum including testicular
implants at this time or after healing has
occured. A scotoplasty
procedure can be carried out to result in
reasonable appearing male genitals.
Metoidioplasty is much
simpler than full-scale phalloplasty, and
usually with much less complications. Surgery is
considerably shorter (2-5 hours vs. 8-10 hours)
and is much cheaper.
Due to the effect
testosterone treatment has on the clitorial
tissue, an erectile prosthesis is usually not
needed to achieve erection.
If only the clitoris is
released from its hood, but no urethal
lengthening and no formation of a
scrotum is done, this is known as a
clitoral release.
(a) After
urethral plate tubularization, the native urethra
is lengthened.
(b) A longitudinal vascularized flap is created
from dorsal clitoral skin and a hole made at the
base.
(c) The flap is transposed ventrally by a
button-hole manoeuvre.
(d) The flap is anastomosed with the native urethra
(inset) and tubularization urethroplasty
performed.
(a) The new
urethra is brought to the top of the glans using
the glans-groove technique. The penile body is
reconstructed using the remaining clitoral skin and
labia minora flaps
(b) and the scrotum constructed using labia majora
flaps.
The results at 2
years after surgery;
a testicular prosthesis was implanted into the left
hemiscrotum.
Photographs from
Perovic, SV & Djordjevic, ML (2003) BJU
International, 92, 981-985.
Conclusion
Metoidioplasty
appears to be a reasonable alternative to
phalloplasty.
As said elsewhere, this
short section on genital reconstructive
surgeries should not be your only research into
these types of surgeries. You can find further
information on the internet and you are advised
to contact other men in a similar situation for
their opinions and experiences. Contact surgeons
in this field of surgery for their advice and
further information. Surgical techniques are
being developed and perfected on an ongoing
basis.
positives
- Urinating while
standing can be possible;
- natal tissue used;
- noninvasive;
- no surgical
scars;
- sensitivity
retained;
- surgery time is
relatively short;
- surgery cost is not as
high as other procedures;
- time off work is not
as demanding as other options;
- erectile prosthesis
not required;
- results depend on the
size of the clitorial tissue and its
enlargement under the influence of
testosterone hormone treatment;
- future genital surgery
can be carried out if required.
negatives
- small size of penis;
- result is usually not
large enough for vaginal
intercourse;
- urethral stenosis
(constriction or narrowing of urethra) and/or
fistula (a break or gap in the urethra) can
occur with urethral surgery ;
- outcome depends on the
enlargement of the clitorial tissue
under the influence of testosterone hormone
treatment.
Metoidioplasty
