Metoidioplasty

What is a metoidioplasty?

Metoidioplasty is a gender confirming genital surgery which creates a penis using existing genital tissue. Sometimes metoidioplasty is shortened to “meta.” The natal erectile tissue (commonly called the clitoris) grows as a result of testosterone hormone therapy. Metoidioplasty involves rearranging the skin around the erectile tissue and releasing the ligaments holding it down, moving it to a more forward position on the body and helping make it more visually apparent. There are two types of metoidioplasty that our surgeons perform – one we refer to as a “simple meta” and the other we call “meta with PUL,” which stands for primary urethral lengthening. Read on to learn more about both procedures!

 

Simple metoidioplasty

This is also referred to as a simple meta, or a metoidioplasty without urethral lengthening. In this procedure, your surgeon will maximize the size of the penis  – or the clitoris that has been enlarged by testosterone – by dividing the ligaments and other tissues  that tether it to the body. There is a very low chance of losing any sensation in your penis or other tissue in your groin. Your urethra is also not lengthened or moved, so the place your urine exits from your body will not change.

 

A simple metoidioplasty only involves cutting the ligaments surrounding the natal erectile tissue. If you would like, the labia minora can also be removed. Some of the labia minora tissue may also be used to help give the shaft of the penis more girth. 

 

In addition to the simple meta, you can choose to have a scrotoplasty, hysterectomy, oophorectomy, mons resection, or testicular implants. You can choose some or none of these procedures. Read more about them in the “associated procedures” section on this page.

Metoidioplasty with primary urethral lengthening 

Here we will refer to this procedure as “meta with UL.” In this procedure, like a simple meta, your surgeon will maximize the size of the penis  – or the clitoris that has been enlarged by testosterone – by dividing the ligaments and other tissues  that tether it to the body. Then, they will take labia minora and other surrounding tissue to lengthen your urethra to approximately the tip of your penis, which will allow you to urinate from your penis and possibly stand to pee. There is a very low chance of losing any sensation in your penis or other tissue in your groin. 

 

Metoidioplasty Staging
Stage Length of hospital stay Procedure description
STAGE I No UL: Outpatient

With UL/vaginectomy: 2 days

Metoidioplasty +/- urethral lengthening, vaginectomy, scrotoplasty, hysterectomy/oophorectomy 
STAGE II Outpatient (Optional, may be recommended) Mons resection
STAGE III (3-4 months after stage I) Outpatient Insertion of scrotal tissue expanders
STAGE IV (3 months after stage III) Outpatient Removal of scrotal tissue expanders, insertion of testicular implants
STAGE V (3-4 months after stage IV) Outpatient Removal of scrotal tissue expanders, insertion of testicular implants

 

Associated Procedures

There are other procedures that can be done during a metoidioplasty as well, including: 

 

  • Urethral Lengthening: This involves using labial tissue to lengthen the urethra through the new penis, which will allow you to urinate through the tip of your penis. 
      • You must have a vaginectomy performed in order to have urethral lengthening done by Dr. Ley. 
  • Vaginectomy: This procedure removes and closes the vaginal canal through surgical excision (cutting out the tissue) or fulguration (burning). This is also known as colpocleisis.
      • You must have a hysterectomy (removal of the uterus and cervix) performed prior to or at the same time as undergoing a vaginectomy, though you can leave in one or both ovaries if you would like.
      • You can get a vaginectomy even if you are not getting urethral lengthening. 
  • Scrotoplasty/Testicular Implants: Labia majora tissue is used to create a scrotum; silicone testicular implants can be inserted as well after scrotal expansion through the use of tissue expanders. 
  • Tissue Expanders: These are placed in the scrotum prior to testicular implant placement and help make sure there is adequate room for the implants; tissue expanders stay in the scrotum for approximately 3-4 months. 
  • To help expand the scrotal skin, you will inject a small amount of saline into a port leading from the outside of your body into the expanders a few times a week.
  • Mons Resection: A mons resection removes fat/tissue over the pubic area; this can help to further elevate the penis, which can be performed after you heal fully from the initial procedure 
  • Hysterectomy: Removal of the uterus through laparoscopic or abdominal incisions.
  • Oophorectomy: Removal of the ovaries through laparoscopic or abdominal incisions. 


It is important to note that a vaginectomy is not optional if you are undergoing urethral lengthening with Dr. Ley. This is due to the high risk of complications that come along with urethral lengthening when done without a vaginectomy. However, if you do not want to have urethral lengthening performed during your surgery, you can still choose to get a vaginectomy, but you do not have to. Keeping your vaginal canal when having a metoidioplasty is sometimes referred to as vaginal preservation.