Regarding lower surgeries, aka “genital surgeries,” aka “gender affirmation surgery,” aka “bottom surgeries”, trans people and gender non-binary people Assigned Female at Birth (AFAB) have different options. One of the most common lower surgeries on AFAB trans and gender non-binary persons is metoidioplasty.
Metoidioplasty or Meta describes surgical procedures to create a new penis, also known as neophallus, with the existing genital tissues. These surgical procedures can be performed on an individual with significant clitoral growth due to testosterone. Doctors recommend using testosterone therapy for one or two years before undergoing metoidioplasty.
According to the 2015 U.S. Transgender Survey, approximately 50% of trans men wanted or had undergone gender-affirming surgery. About half of those men were interested in phalloplasty – a surgical procedure to create a penis using tissues from other body parts. The remaining half were interested in metoidioplasty.
Related: Meet Dr. Jonathan Keith, a member of the World Professional Association for Transgender Health and the Rutgers Center for Transgender Health founder.
What Is The Meaning Of Metoidioplasty?
Metoidioplasty is the creation of a penis (phallus) from an enlarged clitoris due to the use of testosterone. The clitoris naturally increases in size after an individual begins to take testosterone. During metoidioplasty, the clitoral ligaments are disconnected so that the clitoris can lengthen and be in a position as the natal phallus.
The created penis or phallus is around 5-7 centimeters on average, meaning it may or not be able to penetrate a partner sexually. A plastic surgeon then shapes the head of the clitoris to resemble the glans peniAt.The labia can be reshaped into a scrotum with or without prostheses.
Metoidioplasty can be done with or without the procedures of lengthening the urethra. Urethra lengthening procedures extend the urethra along the new phallus to enable one to urinate from the phallus. However, some surgical risks accompany urethral lengthening, including urinary blockage, dribbling, or spraying during urination or fistula.
Metoidioplasty is considered a single-stage surgery. However, some individuals might require additional surgeries to attain their desired results.
Different Types Of Metoidioplasty
There are four common types of metoidioplasty procedures. They include:
Simple release
Also known as simple meta, the simple release frees the clitoris from the surrounding tissue without interfering with the urethra or the vagina. This procedure increases the length and exposure of the penis.
Full metoidioplasty
During this procedure, the clitoris is released, and grafted tissue from inside the cheek is used to link the urethra with the neophallus.
Ring metoidioplasty
This procedure is quite similar to full metoidioplasty. However, instead of grafting the skin from inside the cheek, the graft is done from inside the vaginal wall combined with the labia majora to connect the urethra and the neophallus.
Centurion metoidioplasty
Centurion metoidioplasty releases the round ligaments from the labia majora to surround the new penis, increasing the girth. Compared to other procedures, centurion does not require grafting of the skin from other parts, meaning there is less pain, less scarring, and fewer complications.
What is Phalloplasty?
A phalloplasty is a form of lower surgery for trans and nonbinary people who were assigned female at birth. This procedure is done to construct a neophallus or reconstruction of a penis. While this procedure creates a phallus in gender-confirming surgeries, it is also done to repair the penis in case of trauma, congenital defects, cancer, and other issues.
Multiple surgeries are completed during this procedure and may be accompanied by various complications, although they are minor and fixable. Most people, however, prefer metoidioplasty over phalloplasty.
Metoidioplasty vs. Phalloplasty
As with any surgical procedure, there are advantages and disadvantages to both metoidioplasty and phalloplasty. Trans people should make their interests and priorities known to their surgeons before the surgery. Most people who undergo metoidioplasty are happy with the results. However, depending on surgical goals, body composition, and structure, it might not be the best choice.
Possible Benefits of Metoidioplasty
The following are the advantages of metoidioplasty over phalloplasty:
- It has fewer complications and requires few procedures, even with urethroplasty
- Erotic sensitivity of the clitoris is maintained in the phallus
- It is more affordable
- Requires shorter healing time
- There is no need for a penile prosthesis since the new phallus has a natural erectile function
- It does not leave large scars that may be traumatizing to some people. The scars resulting from the most common phalloplasty procedures are large and are easily recognizable to anyone with a keen look. Although that might not be an issue for some people, it might be a significant drawback for some.
- There are slightly lower risks related to metoidioplasty compared to phalloplasty.
Possible Benefits of Phalloplasty
The following are the advantages of phalloplasty over metoidioplasty:
- Although erectile rods are essential for an erection, patients are more likely to be able to penetrate their partners sexually
- Some people think that with this surgery, they have more natural-looking genitalia
- The phalloplasty’s phallus is larger than those developed through metoidioplasty, although there is a lack of erogenous sensation.
Recovery From Metoidioplasty
As with any other surgery, the recovery period varies from one patient to another, depending on the procedures. However, you will likely be out of work for at least the first two weeks. It is also advisable that the patient avoid heavy lifting for the first two weeks after the surgery.
Generally, doctors are against traveling between ten days and three weeks after the procedure to avoid complications.
You must research the best surgeon who fits your requirements to have successful procedures. You should also research whether the facility you choose accepts health insurance if you do not want to use cash.
