Testosterone replacement therapy gradually enlarges the
clitoris to a mean maximum size of 4.6 cm (1.8 in)[4] (as the clitoris and the
penis are developmentally
homologous). In a metoidioplasty, the
urethral plate and
urethra 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 (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 reconstructed using labia minora and majora flaps.[5] The new neophallus ranges in size from 4–10 cm (1.6–3.9 in) (with an average of 5.7 cm (2.2 in)) and has the approximate girth of a human adult thumb.[6]
The term derives from meta- "change",
Ancient Greekαἰδοῖον, aidoion, 'genitals', and -plasty, denoting surgical construction or modification.[2]
Operation
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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 before its reattachment and elongation. Current studies show this method yielding penile lengths of 6–12 centimeters, with 7/10 patients being capable of obtaining erections capable of penetrative intercourse.[7]
Complications
Complications from metoidioplasty vary in severity. Minor complications may be resolved through minor supportive care, while more serious complications may require surgical correction. As with other surgical procedures, metoidioplasty has the possibility to cause infection, bleeding, blood clots, damage to surrounding tissues, pain, as well as negative reactions to anesthesia or other required medications.
If urethral lengthening is performed, urethral complications such as urinary
fistula may occur.[8] Patients who experience postvoid incontinence or dribbling following surgery report their symptoms as resolved within three months.[9]
Satisfaction rates among patients who undergo metoidioplasty are generally very high regarding both appearance and sexual satisfaction.[9][10]
Comparison with phalloplasty
Metoidioplasty is technically simpler than
phalloplasty, more affordable, and has fewer potential complications. However, phalloplasty patients are far more likely to be capable of
sexual penetration (mainly due to size constraints) after they recover from surgery.[11]
In a phalloplasty, a
plastic surgeon fabricates a neopenis by
autografting 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,
testicular prosthesis, and/or
penile implantation.
Metoidioplasty typically requires 2–3 hours to complete. Because the clitoris'
erectile tissue functions normally, a prosthesis is unnecessary for erection (although the clitoris might not become as rigid as a
penile erection). 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.[12]
History
The first metoidioplasty was reported in 1973 and the term was coined in a 1989 paper.[13][14]
^Meyer WJ, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA (April 1986). "Physical and hormonal evaluation of transsexual patients: a longitudinal study". Archives of Sexual Behavior. 15 (2): 121–38.
doi:
10.1007/BF01542220.
PMID3013122.
S2CID42786642.
^Perovic, S. and Djordjevic, M. (2003), Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU International, 92: 981-985. doi:10.1111/j.1464-410X.2003.04524.x
^Djordjevic ML, Stanojevic D, Bizic M, Kojovic V, Majstorovic M, Vujovic S, Milosevic A, Korac G, Perovic SV (May 2009). "Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience". The Journal of Sexual Medicine. 6 (5): 1306–13.
doi:
10.1111/j.1743-6109.2008.01065.x.
PMID19175859.
^Cohanzad S (February 2016). "Extensive Metoidioplasty as a Technique Capable of Creating a Compatible Analogue to a Natural Penis in Female Transsexuals". Aesthetic Plastic Surgery. 40 (1): 130–8.
doi:
10.1007/s00266-015-0607-4.
PMID26744289.
S2CID40551674.
^De Cuypere G, TSjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, et al. (December 2005). "Sexual and physical health after sex reassignment surgery". Archives of Sexual Behavior. 34 (6): 679–90.
doi:
10.1007/s10508-005-7926-5.
PMID16362252.
S2CID42916543.
^Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, van Moorselaar RJ, Mullender MG, et al. (November 2019). "The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series". The Journal of Sexual Medicine. 16 (11): 1849–1859.
doi:
10.1016/j.jsxm.2019.07.027.
PMID31542350.
S2CID202731384.