What is Metoidioplasty?
Choosing the right type of genital reassignment is a personal matter, which is based on the patient’s personal preference and sexual orientation. A flap based phalloplasty such as the ALT or radial flap, although pleasing in terms of size and appearance, may not be the first choice, due to complexity and higher complication rate. In these cases, a metoidioplasty can prove a much safer technique, offering the advantages of other types of phalloplasty, besides size. Also, patients who have undergone a metoidioplasty can chose later in the future to transition to a flap based phalloplasty.
Performance
Surgically seen, a metoidioplasty is a lengthening of the clitoris and the urethra, which is achieved using skin and mucosal flaps locally. During this procedure, a colpectomy (removal of the vulva) us performed and mucosal flaps from the vagina are harvested and flipped upwards to build the urethral wall. The labia majora are tacked in the midline, in order to create the scrotal pouch. The clitoris is freed from its deep attachments to gain length and combined with the new urethra up to the glans. The shaft of the neopenis is then covered with local skin flaps and a urethral catheter is inserted.
Procedure
Recovery after a metoidioplasty is quick and patients can return to daily activities after 10 days, after the catheter is usually removed. The penile length after a metoidioplasty is 5-8cm, however this can be improved in the future. The penis is fully sensual and shows partial erection. Urinating in a standing position is fully possible. Silicone scrotal implants can be inserted after 6 months.