Metoidioplasty
 | This article needs additional citations for verification. (April 2010) |
| Part of a series on |
| Transgender topics |
|---|
 LGBT portal Transgender portal |
Metoidioplasty, metaoidioplasty, or metaidoioplasty[1] (informally called a meto or meta) is a female-to-male sex reassignment surgery.[2]
Testosterone replacement therapy gradually enlarges the clitoris to a mean maximum size of 4.6 cm (1.6–2 in)[4] (as the clitoris and the penis 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, reversed to the ventral side, tubularized and an anastomosis is formed with the native urethra. The new 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.[5] The new neophallus ranges in size from 4–10 cm (with an average of 5.7 cm) and has the approximate girth of a human adult thumb.[6]
The term derives from meta- "change," Ancient Greek αἰδοῖον (aidoion) "genitals," and -plasty, denoting surgical construction or modification.[1]
Comparison with phalloplasty[edit]
Metoidioplasty is technically simpler than phalloplasty, costs less, and has fewer potential complications. However, phalloplasty patients are far more likely to be capable of sexual penetration (mainly due to size constraints) after they recover from surgery.[7]
In a phalloplasty, the surgeon fabricates a neopenis by grafting tissue from a donor site (such as from the patient's back, arm or leg). A phalloplasty takes about 8–10 hours to complete (the first stage), and is generally followed by multiple (up to 3) additional surgical procedures including glansplasty, scrotoplasty, testicular prosthesis, and/or penile implant.
Metoidioplasty typically requires 2–3 hours to complete. Because the clitoris' erectile tissue functions normally, a prosthesis is unnecessary for erection (although the clitoris might not become as rigid as a penile erection). In nearly all cases, metoidioplasty patients can continue to have clitoral orgasms after surgery.
Operation[edit]
- After patient prep, the skin surrounding the enlarged clitoris is incised on the underside and the lateral crura, which suspend the tissue in place, are cut, freeing the clitoral tissue from the pubic bone.
- If the urethra is to be extended, the process starts now using mucosal tissues from either the vaginal area or from inside the mouth/cheeks. An experimental option is a graft from the intestines. The labia minora can be used to protect the graft, as well as provide greater girth. A catheter is placed in the extension to facilitate healing for two to three weeks.
- The neopenis is then provided with skin by cutting the labia minora and wrapping around the tissue and secured with stitches. Scrotoplasty is usually done at the same time as metoidioplasty surgery. Vaginectomy, hysterectomy and/or oophorectomy can also be performed at this time if they have not been done already.
Alternative techniques[edit]
If a metoidioplasty is performed without extending the urethra and/or a scrotoplasty, this is sometimes called a clitoral release. This is less expensive than a complete metoidioplasty but does not allow for urination through the neopenis while standing. However this also offers surgery with less risk because the urinary system remains unaltered without a urethral extension, and still affords some of the visual effects of a complete metoidioplasty along with the ability to use the neopenis for sexual penetration. Vaginectomy is an option with this surgery.
Recent studies have introduced an operative technique known as Extensive Metoidioplasty. This method extensively detaches the clitoris, nearly completely detaching it from the pubic arch before its reattachment and elongation. Current studies show this method yielding penile lengths of 6-12 centimeters, with 7/10 patients being capable of obtaining erections capable of penetrative intercourse.[8]
Complications[edit]
Complications from Metoidioplasty vary in severity. Minor complications may be resolved through minor supportive care, while more serious complications may require surgical correction. As with other surgical procedures, metoidioplasty has the possibility to cause infection, bleeding, blood clots, damage to surrounding tissues, pain, as well as negative reactions to anesthesia or other required medications.
If urethral lengthening is performed, urethral complications such as urinary fistula may occur.[9] Patients who experience postvoid incontinence or dribbling following surgery report their symptoms as resolved within three months.[10]
Satisfaction rates among patients who undergo Metoidioplasty are generally very high regarding both appearance and sexual satisfaction.[11][12]
See also[edit]
Notes[edit]
- ^ a b Hage, J. Joris (1996). "Metaidoioplasty: an alternative phalloplasty technique in transsexuals". Plastic and Reconstructive Surgery. 97 (1): 161–167. Retrieved 26 February 2021.
- ^ Metoidioplasty: a variant of phalloplasty in female transsexuals by S.V. Perovic and M.L. Djordjevic (BJU International, Volume 92 Issue 9, December 2003)
- ^ a b Djordjevic, Miroslav L.; Stojanovic, Borko; Bizic, Marta (June 2019). "Metoidioplasty: techniques and outcomes". Translational Andrology and Urology. 8 (3): 248–253. doi:10.21037/tau.2019.06.12. PMC 6626308. PMID 31380231.
- ^ Physical and hormonal evaluation of transsexual patients: A longitudinal study by Meyer W, et al. (Archives of Sexual Behavior, Volume 15, Number 2, April 1986)
- ^ Perovic, S. and Djordjevic, M. (2003), Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU International, 92: 981-985. doi:10.1111/j.1464-410X.2003.04524.x
- ^ Metoidioplasty as a Single Stage Sex Reassignment Surgery in Female Transsexuals: Belgrade Experience Djordjevic, Miroslav L. et al., Journal of Sexual Medicine, Volume 6, Issue 5, 1306 - 1313
- ^ Frey, Jordan D. et al. “A Systematic Review of Metoidioplasty and Radial Forearm Flap Phalloplasty in Female-to-Male Transgender Genital Reconstruction: Is the ‘Ideal’ Neophallus an Achievable Goal?” Plastic and Reconstructive Surgery Global Open 4.12 (2016): e1131. PMC. Web. 5 July 2018.
- ^ Cohanzad, Shahryar. “Extensive Metoidioplasty as a Technique Capable of Creating a Compatible Analogue to a Natural Penis in Female Transsexuals.” Aesthetic plastic surgery vol. 40,1 (2016): 130-8. doi:10.1007/s00266-015-0607-4
- ^ https://www.metoidioplasty.net/risks-complications/
- ^ Vojkan Vukadinovic, Borko Stojanovic, Marko Majstorovic, Aleksandar Milosevic, "The Role of Clitoral Anatomy in Female to Male Sex Reassignment Surgery", The Scientific World Journal, vol. 2014, Article ID 437378, 7 pages, 2014. https://doi.org/10.1155/2014/437378
- ^ Vojkan Vukadinovic, Borko Stojanovic, Marko Majstorovic, Aleksandar Milosevic, "The Role of Clitoral Anatomy in Female to Male Sex Reassignment Surgery", The Scientific World Journal, vol. 2014, Article ID 437378, 7 pages, 2014. https://doi.org/10.1155/2014/437378
- ^ De Cuypere, G., TSjoen, G., Beerten, R. et al. Sexual and Physical Health After Sex Reassignment Surgery. Arch Sex Behav 34, 679–690 (2005). https://doi.org/10.1007/s10508-005-7926-5
- Metoidioplasty as a Single Stage Sex Reassignment Surgery in Female Transsexuals: Belgrade Experience by Miroslav L. Djordjevic, Dusan Stanojevic (Journal of Sexual Medicine, Volume 6 Issue 5, Oct 2008)
- Metaidoioplasty: An Alternative Phalloplasty Technique in Transsexuals by Hage, J. Joris (Journal of Plastic & Reconstructive Surgery, Volume 97 Issue 1, January 1996)
- Gender Reassigment by Dan Greenwald and Wayne Stadelmann (eMedicine Journal, Volume 2 Number 7, July 6, 2001)