This article addresses metoidioplasty, a surgery that is part of the gender affirmation process of woman to man (FTM) or to non-binary (FTX).
Metoidioplasty is an alternative to phalloplasty, the latter being a surgery to obtain natural-looking male genitals. Metoidioplasty rather seeks to masculinize the biological genitalia. There are several surgical techniques.
Metoidioplasty is to create a phallus by lengthening the clitoris which will have previously increased in size because of a masculinizing hormonal treatment. This surgery allows the genitals to have a masculine appearance. To lengthen the clitoris, your surgeon will relax the clitoral ligaments (ventral or dorsal depending on each individual’s anatomy) completely. Even if the erogenous zones are preserved, this intervention rarely allows penetrative sex. It is the intensity of the clitoral enlargement (hypertrophy) and the presence or not of a specific implant that could allow penetration. In addition, metoidioplasty will allow the patient to urinate while standing only if a neo-urethra construction was requested.
It should be pointed out that the patient has several options. The construction of a neo-urethra can be added to a metoidioplasty, which would allow the patient to urinate standing by lengthening the urethra surgically. The patient can also request a vaginectomy, which means that the surgeon will close the vaginal cavity. For this last surgery, a hysterectomy with removal of the cervix must be performed first. For even more realism, we can then proceed to the scrotoplasty, which is the creation of a scrotum by using the skin of the labia majora. The scrotoplasty can either be bifid, when the implants are inserted into the labia majora, or be done in two stages by creating a single scrotum followed by the insertion of the implants during a second surgery. Finally, it is possible to request a resection of the mons Venus. The mons Venus is located above the pubis and sometimes has excess skin and fat which prevents the neo-penis from being revealed to its maximum. The surgeon can therefore remove a section of the fatty tissue to prevent a large part of the neophallus from being buried beneath an excess of soft tissue.
At GrS Montreal, renowned surgeons ensure that each intervention suits the patient’s wishes and make sure that they are informed and guided through the different surgical options. They will also take into account your lifestyle as well as your health history which could greatly change the parameters of the surgical procedure.
Metoidioplasty does not require a stay at the convalescent homeMaison de Convalescence Asclépiade, except in the case where one chooses to couple it with a vaginectomy and a scrotoplasty. Four to eight weeks of rest at home after the procedure should be planned depending on the surgical options chosen by the patient.
Metoidioplasty remains an interesting alternative for patients who do not want phalloplasty, which is a more complex and longer procedure. It is important to discuss with your surgeon all the options available to you based on the expected esthetic and functional results.