Metoidioplasty (A complete guide)

In this blog article, we will discuss the ins and outs of the procedure known as metoidioplasty. 

What is metoidioplasty? 

Metoidioplasty is the careful formation of a penis using your current genital tissue.

It is a more specific technique than phalloplasty and is performed after the clitoris has been amplified using testosterone treatment.

It is possible to get a phalloplasty after a metoidioplasty, however, the reverse is not possible. 

The clinicians in the Center for Gender Surgery at Boston Children’s Hospital offer metoidioplasty as a gender confirmation technique to qualified patients over the age of 18 who have been living in their identified sex full-time for at least a year.

A talented group of specialists including urologists, plastic surgeons, and social workers, work together to give a full suite of choices for transgender adolescents and young adults. 

Gender confirmation medical procedures are a group of surgeries that some transgender or other individuals use to help confirm their gender identity.

Metoidioplasty is accessible to transgender men, or the individuals who recognize as transmasculine.

It includes the careful formation of a penis from your current genital tissue. 

Who is qualified for metoidioplasty? 

The medical procedure is never the first phase in a sex change.

It is something that occurs after you have investigated all the social and clinical options to transition to the gender with which you truly identify.

Individuals who decide to undergo metoidioplasty, for the most part, do so in combination with supplemental hormones and chest medical procedures, such as removal of the breasts.

To fit the bill for metoidioplasty at Boston Children’s Hospital, you should be at least 18 years of age and meet certain criteria. 

Kinds of metoidioplasty 

There are a few kinds of metoidioplasty, and specialists can perform them with a variety of procedures.

The particular strategy will rely upon the specialist’s experience. 

Any individual who is searching for a nitty-gritty breakdown of the method should talk to their specialist. 

A metoidioplasty can take 2–5 hours, contingent upon which technique is being used. 

The 2015 U.S. Transgender Survey found that, among respondents who recognized as sexual orientation nonbinary and who had been assigned female during childbirth, 4% had gotten a metoidioplasty, and 24% needed to have the procedure later on. 

A similar study found that, among respondents who identified as transgender men, 1% had experienced the medical procedure, and 25% planned to have it. 

Straightforward metoidioplasty 

A straightforward metoidioplasty is also called a clitoral discharge.

During this strategy, the specialist cuts off the tendons that connect the clitoris to the pubic bone. 

They at that point build the penile shaft from the clitoral skin and labia minora and Majora. 

Full metoidioplasty 

A full metoidioplasty includes a clitoral discharge, vaginectomy, and urethroplasty. 

In the initial part of the procedure, the specialist removes the vagina and closes the vaginal opening. This is a vaginectomy.

They then perform the clitoral discharge procedure. 

Utilizing tissue from the clitoris, they expand the urethra through the penis. This is an urethroplasty. 

They at that point position the urethral opening at the head of the neopenis, which permits the individual to urinate while standing.

Ring metoidioplasty 

A ring metoidioplasty is like a full metoidioplasty, but it includes an alternate procedure of slicing the tendons attached to the clitoris. 

Likewise, in a ring metoidioplasty, the specialist carries out the urethroplasty utilizing skin from the vaginal wall. 

They at that point utilize a segment of the labia minora to frame the shaft of the neopenis.

From that point forward, the specialist will either take off the excess labia minora skin or use it to cover the suture line at the base of the shaft. 

Before the operation 

Ø  Before a metoidioplasty, an individual must take hormone treatment to extend their clitoris. 

Ø  A metoidioplasty can at times be an outpatient procedure, which implies that the individual doesn’t need to remain in the clinic short-term. For this situation, it is essential to plan transportation home from the clinic. 

Ø  Likewise, an individual who has a basic metoidioplasty may undergo the procedure using a lighter form of anesthesia than an individual who has the full procedure. 

Technique

Ø  Obtaining the ideal result from this medical procedure can require more than one strategy. More procedures may occur following a metoidioplasty in follow-up visits. 

Ø  During a full metoidioplasty, the specialist performs the vaginectomy first. This includes removing the mucous film coating the vagina and closing the vaginal opening. 

Ø  They may take skin to join from the vaginal wall during this progression if they are performing a ring metoidioplasty. 

 The following stages incorporate discharging the clitoris, stretching the urethra, and developing the neopenis: 

Ø  The specialist will put a suprapubic catheter into the urethra, which will stay there for 5–7 days or until the urethra heals. 

Ø  If the individual is experiencing a scrotoplasty, the specialist will make a neo scrotum from the labia majora. They at that point embed gonad inserts into the scrotum and suture the entry points. 

Ø  If the specialist is utilizing tissue expanders to extend the labia before embedding bigger gonad embeds, the scrotoplasty will happen sometime in afterwards. 

Recovery

Ø  After a metoidioplasty, the clinical group will teach the individual the best way to check for infection. The individual ought to likewise utilize extraordinary caution when standing, sitting, or walking. 

Ø  Generally, the individual goes to a follow-up appointment with their specialist, during which the specialist checks for indications of infection and other complications. 

Ø  It is critical to rest and refrain from vigorous physical exercise, for at least a month and a half after a metoidioplasty. 

Full recovery can take a year to a year and a half. 

What are the results of a metoidioplasty? 

Ø  All things considered, a metoidioplasty results in penis that is 4–10 centimeters (cm) long. 

Ø  The length may not be optimal for penetrative sex. If this is a worry, an individual may choose to get a phalloplasty after a metoidioplasty. 

Ø  Following a metoidioplasty, an individual will be able to experience sexual pleasure, and their new penis will be capable of erection. 

Risks of metoidioplasty

Like any medical procedure, metoidioplasty involves risks, including: 

Ø  infection

Ø  bleeding

Ø  pain

Ø  swelling

Ø  allergic responses to anesthesia  

Problems specific to metoidioplasty include: 

Ø  infection or tissue misfortune at the base of the penis 

Ø  infection of the tissue along the shaft 

Ø  urinary catheter issues, for example, blockage or leakage 

Ø  bladder diseases 

Ø  urethral injury, which happens when scar tissue hinders the flow of urine 

Ø  urethral fistula, an opening in the urethra that can cause urine leakage 

Ø  rejection of testicular inserts 

As per studies detailed in 2019 in the journal Translational Andrology and Urology, urethral fistulas happen following 7–15% of metoidioplasty surgeries and urethral injury happens after 2–3% of procedures. 

Smoking increases the risks of complications from this surgery by 40%.

Individuals might be ineligible for metoidioplasty if they smoke, vape, or utilize other nicotine items. 

Optional additional procedures 

A specialist can perform the following procedures during a metoidioplasty: 

Ø  Vaginectomy: This is the removal and closure of the vaginal canal. 

Ø  Urethroplasty: This is the augmentation of the urethra through the neopenis. The objective is to enable the individual to urinate while standing. 

Ø  Scrotoplasty with testicular inserts: This is the formation of a scrotum utilizing the labia majora. The specialist at that point embeds the inserts. 

Ø  Hysterectomy: An all-out hysterectomy includes removing the uterus and cervix. A fractional hysterectomy includes removing the uterus however leaving the cervix intact. 

Ø  Bilateral salpingo-oophorectomy: Also known as a BSO, this includes removing the fallopian tubes and the ovaries

How much does a metoidioplasty cost?

The monetary expense can introduce an obstacle for individuals who wish to have gender confirmation procedures. 

The expense of a metoidioplasty can rely upon a few elements, including: 

Ø  the precise kind of method 

Ø  any extra procedures 

Ø  health insurance 

Ø  surgeon charges 

Ø  hospital office costs 

Ø  medication 

An insurance company may consider a metoidioplasty as a medically necessary procedure. 

Some open and private insurance plans currently offer coverage for expenses of care specific to transgender individuals. 

Metoidioplasty versus Phalloplasty

There are positives and negatives to both metoidioplasty and phalloplasty procedures.

In this manner, it’s important for men to talk about their inclinations and needs with their specialist during the early interview stage.

Most men who decide to go through with a metoidioplasty are very content with the result of their medical procedure.

Be that as it may, it is not always the best decision for everyone.

A few focal points of metoidioplasty vs phalloplasty include: 

Ø  Shorter recuperating time 

Ø  More moderate medical procedure 

Ø  Lower complication  rates, even with urethroplasty 

Ø  No noticeable scars that might cause distress

Ø  The phallus made by metoidioplasty has the normal erectile capacity, and there is no requirement for a penile prosthesis. 

Ø  Erotic capabilities of the clitoris is maintained in the phallus. 

A few focal points of phalloplasty over metoidioplasty include: 

Ø  Patients will have the ability to engage in penetrative intercourse if they so choose.

Ø  The phallus is altogether bigger than the one made through metoidioplasty. 

Ø  Some men feel that this medical procedure results in more “regular” looking genitalia. 

In this blog article, we discussed many different things about the metoidioplasty, one of the medical procedures that transgender people may undergo to confirm their preferred gender.

We outlined the risks and benefits of this procedure, as well as the differences between a metoidioplasty and a phalloplasty. 

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Frequently asked questions (FAQs) about metoidioplasty:

Can you still pee with Metoidioplasty?

Metoidioplasty is possible either with or without urethral protracting systems.

Urethral protracting broadens the urethra along with the new phallus.

At that point, men are capable of urinating from their phallus.

Still having the ability to urinate is a significant reason that men decide to go through with the genital medical procedure. 

Would you be able to have phalloplasty after Metoidioplasty? 

A phalloplasty and is performed after the clitoris has been augmented using testosterone treatment.

It is possible to undergo phalloplasty after a metoidioplasty, however, the opposite isn’t true.

What do the results of a metoidioplasty look like?

Metoidioplasty is the production of a phallus (penis) from the hormonally-augmented clitoris.

A plastic surgeon at that point shapes the head of the clitoris to look like a penis.

Simultaneously, the labia can be reshaped into a scrotum, with or without testicular prosthesis.

Want to learn more about metoidioplasty? Try this recommended reading!

Gender Confirmation Surgery: Principles and Techniques for an Emerging Field 

This book by Loren S. Schechter discusses the complexities and challenges that people with gender dysphoria might go through during their transition period.

It includes information about surgical and non-surgical options and educational opportunities. 

References

1.     https://www.verywellmind.com

2.     https://www.medicalnewstoday.com/

3.     https://www.healthline.com

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