Metoidioplasty, metaoidioplasty, or metaidoioplasty (informally called a meto or meta) is a female-to-male gender-affirming surgery. Testosterone replacement therapy gradually enlarges the

clitoris In amniotes, the clitoris ( or ; : clitorises or clitorides) is a female sex organ. In humans, it is the vulva's most erogenous zone, erogenous area and generally the primary anatomical source of female Human sexuality, sexual pleasure. Th ...

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

penis A penis (; : penises or penes) is a sex organ through which male and hermaphrodite animals expel semen during copulation (zoology), copulation, and through which male placental mammals and marsupials also Urination, urinate. The term ''pen ...

are developmentally homologous). In a metoidioplasty, the

urethral plate The development of the urinary system begins during prenatal development, and relates to the development of the urogenital system – both the organs of the urinary system and the sex organs of the reproductive system. The development continues as ...

and

urethra The urethra (: urethras or urethrae) is the tube that connects the urinary bladder to the urinary meatus, through which Placentalia, placental mammals Urination, urinate and Ejaculation, ejaculate. The external urethral sphincter is a striated ...

are completely dissected from the clitoral corporeal bodies, then divided at the distal (far) 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 (, : 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, or streams. Such a connection may be normal (su ...

(connection) is formed with the native urethra. The new urethral meatus is placed along the neophallus (newly formed penis) to the distal end and the skin of the neophallus and

scrotum In most terrestrial mammals, the scrotum (: scrotums or scrota; possibly from Latin ''scortum'', meaning "hide" or "skin") or scrotal sac is a part of the external male genitalia located at the base of the penis. It consists of a sac of skin ...

reconstructed using

labia minora The labia minora (Latin for 'smaller lips', : labium minus), also known as the inner labia, inner lips, or nymphae, are two flaps of skin that are part of the primate vulva, extending outwards from the inner Vagina#Vaginal opening and hymen, vagi ...

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 , '' meta'', meaning 'after' or 'beyond') is an adjective meaning 'more comprehensive' or 'transcending'. In modern nomenclature, the prefix 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 classical antiquity, ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Greek ...

, 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 The pubic arch, also referred to as the ischiopubic arch, is part of the pelvis. It is formed by the convergence of the inferior rami of the ischium and pubis on either side, below the pubic symphysis. The angle at which they converge is known a ...

before its reattachment and elongation. Current studies show this method yielding penile lengths of , with 7 out of 10 patients able to obtain erections that are capable of penetrative intercourse. Extended metoidioplasty is a more recent technique which attempts to refine extensive metoidioplasty. Both methods work on the same principal of releasing, thereby exposing, more of the clitoris. A study on 17 patients a range of 4–9cm increase in phallic length. Penetration was possible for 4, and 2 had significant length and growth during erection, but had not attempted sexual intercourse yet. Both methods are considered experimental, and are only offered by a few surgeons.

Complications

Complications from metoidioplasty vary in severity. Minor complications may be resolved through minor supportive care, while more serious complications may require surgical correction. Like other surgical procedures, each metoidioplasty procedure comes with the possibility of complications such as pain, infection, bleeding,

blood clots A thrombus ( thrombi) is a solid or semisolid aggregate from constituents of the blood (platelets, fibrin, red blood cells, white blood cells) within the circulatory system during life. A blood clot is the final product of the blood coagulati ...

, and damage to surrounding tissues. There is also a risk of adverse reactions to

anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...

or other medications that are required for the procedure or post-operative period. If urethral lengthening is performed, urethral complications such as urinary

fistula In anatomy, a fistula (: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") is an abnormal connection (i.e. tube) joining two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other h ...

may occur. Patients who experience postvoid

incontinence Incontinence or Incontinent may refer to: * Urinary incontinence, the most commonly occurring type of incontinence, the involuntary excretion of urine *Fecal incontinence Fecal incontinence (FI), or in some forms, encopresis, is a lack of con ...

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 (also called penoplasty) 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 B ...

, 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 sexual behavior in non-human animals. The term is most commonly used in statute la ...

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

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. Scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants ...

, testicular prosthesis, and/or

penile implant A penile implant is an Implant (Medicine), 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, inclu ...

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, vestibule, vagina and ...

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, a ...

). In nearly all cases, metoidioplasty patients can continue to have clitoral orgasms after surgery. Note also, that the two alternative techniques are not mutually exclusive and phalloplasty extension of a metioidiplasic base neophallus is possible.

History

The first metoidioplasty was reported in 1973 and the term was coined in a 1989 paper.

References

External links

{{wiktionary
Metoidioplasty.net - The Metoidioplasty Surgery Guide

FemaletoMale.org , Information about Metoidioplasty
Masculinizing surgery 1973 in health 1973 in science Plastic surgical procedures 1989 neologisms