Which Is Better Metoidioplasty Or Phalloplasty?
Metoidioplasty: When it comes to lower section, transgender and nonbinary people who were appointed female at birth (AFAB) have a few different options. One of the most common lower incisions that is routinely performed on AFAB trans and nonbinary people is called metoidioplasty.
Metoidioplasty, also known as meta, is a phrase used to represent surgical procedures that manage with your existing genital tissue to form what is called a neophallus, or new penis. It can be performed on everyone with significant clitoral growth from the use of testosterone. Most physicians recommend being on testosterone medicine for one to two years before having metoidioplasty.
Testosterone replacement medicine regularly enlarges the clitoris to a mean superlative size of 4.6 cm (1.6–2 in) (as the clitoris and the member are developmentally homologous). In a metoidioplasty, the urethral plate and urethra are completely dissected from the clitoral corporeal bodies, then divided at the distal end, and the testosterone-enlarged clitoris straightened out and elongated.
A longitudinal vascularized island flap is configured and harvested from the dorsal skin of the clitoris, overturned to the ventral side, tubularized and an anastomosis is organized with the native urethra. The different urethral meatus is placed along the neophallus to the distal end and the skin of the neophallus and scrotum reconstructed using labia minora and majora flaps. The new neophallus reaches in size from 4-10 cm (with an average of 5.7 cm) and has the approximate girth of a personal adult thumb.
There are several types of gender affirming sections that are available to transgender men who want to withstand genital surgery, frequently also known as “bottom surgery.” The 2015 U.S. Transgender Survey found that generally 50 percent of men required or had undergone such surgery. Approximately half of those men were interested in a phalloplasty, the surgical creation of a penis using tissue from elsewhere on the body. The other half were interested in a metoidioplasty.
Also known as simple meta, this transaction consists only of the clitoral release — that is, a procedure to free the clitoris from surrounding tissue — and doesn’t alter the urethra or vagina. Straightforward release increases the length and disclosure of your penis.
Surgeons who function full metoidioplasty release the clitoris and then use a tissue graft from the inside of your lip to link the urethra with the neophallus. If desired, they may also perform vaginectomy (removal of the vagina) and introduce scrotal implants.
This procedure is very similar to full metoidioplasty. However, instead of picking up a skin graft from the innard of the mouth, the surgeon uses a graft from the inside of the vaginal wall combined with the labia majora in order to connect the urethra and the neophallus.
The advantage to this procedure is that you’ll particularly have to heal at one site as prevented to two. You also won’t experience complications that may emerge from surgery in the mouth such as pain while chewing and decreased manufacture of saliva.
Metoidioplasty is the production of a phallus (penis) from the hormonally-enlarged clitoris. The clitoris naturally enlarges when a man begins to take testosterone. A margin of a year on testosterone is a precondition for all transmasculine genital surgeries.
During a metoidioplasty, the clitoral ligaments are detached, which allows the clitoris to augment and drop within a position more comparable to a natal phallus. On average, the created phallus is between 5 and 7 cm long, which may or not be sufficient to penetrate a companion sexually. (Hinging on on the man, this is not always a concern.)
A plastic surgeon then sculpts the head of the clitoris to more strictly resemble the glans penis. At the same time, the labia can be reshaped into a scrotum, with or without testicular prostheses.
Metoidioplasty can be done either with or without urethral lengthening procedures. Urethral lengthening extends the urethra along the new phallus. Then, men are able to pee from their phallus. Being competent to stand to pee is a major reason that men appoint to undergo genital surgery. However, urethral lengthening does increase the risk of surgical complications. These complications are usually minor and can include squirting or spraying during urination. They may also incorporate urinary blockages or fistula.
Phalloplasty represents the latest step in female-to-male transitioning and still remains a great challenge for transgender surgeons. Since we have two options in this transitioning—metoidioplasty and amount phalloplasty—the transgender surgeon has to fully inform the individual about all aspects such as surgical steps, outcomes, advantages and detriments, possible complications, and prospects. Total phalloplasty with the creation of a neophallus of a similar volume to that in genetic males, is a sophisticated and multi-staged transaction. Many different tissues (i.e., turbulences) can be used, and the ideal procedure is still not established. In contrast to the above complexities suggested in total phalloplasty, metoidioplasty presents a simple and one-stage procedure for the creation of a neophallus from a hormonally extended clitoris. This technique is very promising for human beings who desire gender-affirmation surgery without having to undergo the difficult and multistage creation of a male-sized neophallus. Also, this technique prevents maiming to the extragenital region, requiring the final results more acceptable for transgender individuals. Our goal is to objectively present the techniques for metoidioplasty and to define their value based on postoperative results.
Gender-affirming surgery presents the latest development in genital transition for individuals with gender dysphoria. The World Professional Association for Transgender Health (WPATH) proposed guidelines for the treatment of transgender people. The most recent Version 8 of WPATH standards of care offers more flexible options for this treatment and defines all criteria for male-to-female and female-to-male transgenders (1,2). According to these standards, individuals are required to provide two letters of recommendation from board certified mental health providers, who should confirm gender identity and recommend further hormonal therapy according to the real-life test and “adjusting the body to the mind”. Preoperative consultation with transgender surgeons with a description of desired outcomes and possible complications should be done to prevent postoperative disappointment.
Metoidioplasty And phalloplasty
Metoidioplasty is the surgical creation of a penis using your existing genital tissue. It is a less-extensive procedure than phalloplasty and is performed after the clitoris has been enlarged through the use of testosterone therapy. It is possible to undergo phalloplasty after a metoidioplasty, but the reverse is not true.
The clinicians in the Center for Gender Surgery at Boston Children’s Hospital offer metoidioplasty as a gender affirmation procedure to eligible patients age 18 and over who have been living in their identified gender full time for at least 12 months. Our skilled team includes specialists in plastic surgery, urology, gender management and social work, who work together to provide a full suite of options for transgender teens and young adults.
Gender affirmation surgeries are a group of surgical procedures that some transgender and gender diverse people use to help affirm their gender identity. Metoidioplasty is a type of “bottom surgery” (surgery on the genitals) available to transgender men, or those who identify as transmasculine. It involves the surgical creation of a penis from your existing genital tissue.
Who is eligible for metoidioplasty?
Surgery is never the first step in a gender transition. It is something that happens after you have already explored social and medical transition options. People who choose to undergo metoidioplasty usually do so after taking other steps in the gender affirmation process, such as taking supplemental hormones and undergoing chest surgery. To qualify for metoidioplasty at Boston Children’s Hospital, you must be at least 18 years old and meet certain criteria.
What happens during metoidioplasty?
Although they have different functions, the clitoris and penis are both derived from the same tissue. Metoidioplasty takes advantage of this fact by creating a penis from the clitoris after it has been enlarged through the use of testosterone therapy. Often, a scrotoplasty (surgical creation of a scrotum from the labia majora) is performed at the same time.
Metoidioplasty may also include surgical construction of a glans and lengthening of the urethra. The first option improves the resemblance to a cisgender male’s penis. The second makes it possible for you to urinate while standing up. It is possible to have a phalloplasty after a metoidioplasty but the reverse is not true.
What happens after metoidioplasty?
Metoidioplasty can take between 2 and 5 hours and you may need to stay in the hospital for a day or two. Because the healing process can take time, you shouldn’t engage in strenuous physical activity or heavy lifting in the first 6 weeks after metoidioplasty.
If you undergo urethral lengthening as part of metoidioplasty, you will also likely need to urinate through a catheter for 3 to 4 weeks after surgery. Your clinical team will give you detailed instructions on how to care for the catheter, and how to check for signs of infection at the surgical site, such as redness and swelling. You will likely be able to walk around and engage in light activity within a week after surgery, and healed enough to go back to all activities at around 6 weeks. This surgery has a very long healing process that can take 12 to 18 months.