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