Metoidioplasty surgery is a gender-affirming surgery which is known as meta procedure. It includes lower genital tissues of clitoris and penis. This surgery is for those who were assigned female at birth or AFAB. It is a surgical process in which existing genital tissues like urethra get elongated to form a neophallus or new penis. Before performing metoidioplasty surgery treatment, it is followed by testosterone therapy one or two years ahead.

Types of Metoidioplasty

There are various types of metoidioplasty, which includes:

Simple Metoidioplasty: It is a simple meta procedure which includes release of clitorial from the surrounding tissue. It includes increasing the length of the penis up to 4.6 cm without altering vagina.
Full Metoidioplasty: It is a whole process which includes clitoris release by removing vagina and closing vaginal opening, and this is called vaginectomy. Then a tissue is grafted from inside the cheek, labia minora, and clitoris. It is done to extend urethra to form a new male reproductive, penis through urethroplasty. After this urethral opening is placed in the head of the neopenis, and this will help an individual to pass urine while standing.
Ring Metoidioplasty: It is quite the same as a full metoidioplasty with some differences. This includes cutting and attaching the ligaments to the clitoris with different techniques. In this surgery, urethroplasty is done by grafting skin from the vaginal wall not from the cheek. To form a long narrow hole of neopenis, the portion of labia majora is used by removing extra labia minora skin.
Centurion Metoidioplasty: This process involves releasing of the round ligaments that run along the side of the labia, which helps to provide girth to the penis. This procedure helps to erect the penis without the requirement of any device for penetrative sex. It results in a small and natural looking penis with full sensation.

Procedure of Metoidioplasty Surgery

This procedure is used to create a long penis by using the clitoris, and this enlargement includes hormone therapy.

Before Procedure

Patient’s medical history is required, which will also determine your allergies. Hormonal therapy should be started consistently for one year to identify gender.

Doctors will advise you to quit smoking, drinking alcohol and stop taking blood-thinning medicines. Before starting the procedure, you have to stop eating and drinking 12 hours before the surgery.

During Procedure

This process can require several procedures, and these are mentioned below:

A local anesthesia will be given to the patient, and its sedative effect will create numbness and puts you to sleep.
Once the clitoris gets enlarged with testosterone hormonal therapy, and continues with cutting ligaments that surround the clitoris.
After cutting, it releases clitoris, which will help to create a penis without penile implantation.
Firstly, surgeons will start with vaginectomy by removing mucous membrane lining of vagina and closing the vaginal opening.
After releasing clitoris, lengthening the urethra and constructing the neopenis by grafting local tissue.
Now, surgeons will connect the urethra so that an individual can pass urine while standing.
Sacroplasty is done to create a neo scrotum. The scrotum formed by using skin from the outer lips of the vulva.

After Procedure

Once the process of metoidioplasty is done, doctor will close the cut and cover them with bandages. The effect of anesthesia will reduce, and the patient will be awake. You will be observed for a certain period of time in the hospital like for 2 days. All these steps can be done in several steps, which may take 4 to 6 months after the first surgery.