With testosterone, the clitoris grows. A metoidioplasty removes tissue around the clitoris. This exposes more of it and helps it to hang in a more male position. That’s why a metoidoplasty is sometimes also called a “clitoral release” or a “free-up”. That’s it — that’s the core of a metoidioplasty.
In addition, the urethra can also be routed through the neopenis. At the same time the vagina can also be removed, and a scrotum made from the labia. A metoidioplasty does not remove the cervix, uterus, or ovaries. That would be a different surgery. However some surgeons will perform a hysterectomy at the same time as a metoidioplasty.
All in all, a metoidioplasty preserves the tissues that are already there. It shuffles them around into a masculine shape. Not everybody will have everything done, and there are many options.
Why would I want a metoidioplasty?
Everyone has their own reasons. Here are some that I have heard:
- Ability to “pass” in male spaces, such as bathrooms and locker rooms. With genital surgery, the fear of having a towel around the waist slip at an awkward moment is gone.
- Relieving gender dysphoria. What’s not to like about that?
- Ability to pee standing up. Only with a urethral lengthening procedure, which carries its own risks.
- Keeping erections and erogenous sensation. Some men are also able to have penetrative sex after a metoidioplasty.
- Cheaper, easier to find a surgeon, and fewer surgeries than a phalloplasty with good results.
What is involved in metoidioplasty? What are my options?
Different surgeons will include different specific stages to a metoidioplasty. But the core of a metoidioplasty is clitoral release. The clitoris is freed from its surrounding tissues so it can hang the way a penis hangs.
Others steps are often included, including…
- Vaginectomy: Removal of the vagina. May be required for some forms of urethral lengthening. Usually combined with a scrotoplasty, which fuses the labia together to make a scrotum. At the same time testicular implants can also be placed.
- Urethral lengthening: The urethra is routed through the neopenis and lengthened using other tissue. This allows peeing through the penis and while standing.
- Hysterectomy, oophorectomy: Removal of the uterus, fallopian tubes, and ovaries.
I’ve heard there are different techniques. What are they?
The biggest difference centers around urethral lengthening. Since the urethra is only so long, other tissue is used to lengthen it. That tissue can come from the vagina or inner labia, or it can come from the inside of your cheek (“buccal”).
Surgeons often have their own individual techniques and strategies in addition.
Can you tell me more about the surgery? Does it require full anesthesia? How long would I be in the hospital? What kind of recovery time am I looking at?
It depends on which specific procedures you have done.
For a simple metoidioplasty only without urethral lengthening, vaginectomy/scrotoplasty, or hysterectomy, some surgeons will perform it under “twilight” anesthesia. This is also called conscious sedation. You’ll be relaxed and won’t feel pain but will likely stay awake. This level of sedation is also used by some dentists, so it’s not unique to this procedure. If you’re also having more intense procedures, like urethral lengthening, then you’ll be under general anesthesia.
The surgery itself lasts anywhere from 2-5 hours depending on what procedures you’re having. You’ll likely spend one night in recovery in the hospital. Full recovery time also varies. One surgeon advises bed rest for 24 hours, plus either 7-14 days off work with no heavy lifting for 2-4 weeks. Again — this depends on the intensity of your surgery.
What are the possible risks of metoidioplasty?
The usual risks with surgery apply here: adverse drug reactions, bleeding, infection and the like. Permanent loss/reduction in sensation may occur, as with all surgeries. And pain can persist for a long time.
The penis itself can end up twisted (torqued), which is repairable by surgery. The length may also be less than was hoped.
Urethral lengthening caries its own risks, including urethral narrowing or blockage, and urethral fistula. Urethral fistula is when a hole forms between the urethra and somewhere it shouldn’t be — so urine may spray from the underside of the penis, for example. Narrowing, blockage, and fistula can be repaired surgically. The stream of urine may also spray or be not what you expect.
What about scars?
The beauty of metoidioplasty is that it doesn’t leave very visible scars.
How will metoidioplasty affect my long-term health?
The metoidioplasty itself (the clitoral extension) doesn’t generally have long-term health implications unless there were complications. The same applies to the urethral lengthening.
Vaginectomy removes your risk for vaginal cancer. If you also had a hysterectomy/oophorectomy, you no longer are at risk for those cancers. However in order to maintain bone health it’s important to stay on sex hormones (testosterone) life-long.
Can I have penetrative sex with my partners after a metoidioplasty?
It depends, but the answer is definitely not “no”. Different people have different results, and different surgeons have different results too. Some surgeons report 4-6cm (1.6-2.4″) long penises, others boast 6-12cm (2.4-4.7″).
If being able to penetrate a partner is the most important thing for you, then you might want to consider a phalloplasty.
I am not a surgeon, nor an expert on surgeries! Check out some of these other resources and surgeon websites for more information:
- Hudson’s FTM guide for more basic information
- Dr Crane’s website For one surgeon’s description of the procedure, recovery, and risks.
- Belgrade reconstructive center (NSFW – has graphic surgical images) For another surgeon’s descriptions
- Metoidioplasty.net (NSFW) Has more basic information including anatomical diagrams.
- Study demonstrating 6-12cm lengths
- Hung Jury — a must-read book of essays by trans guys and their surgeries.