Metoidioplasty

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Example of completed metoidioplasty including neourethra and scrotoplasty, two years post-operation Metoidioplasty 2 yr post-op.jpg
Example of completed metoidioplasty including neourethra and scrotoplasty, two years post-operation

Metoidioplasty, metaoidioplasty, or metaidoioplasty [2] (informally called a meto or meta) is a female-to-male gender-affirming surgery. [3]

Contents

Testosterone replacement therapy gradually enlarges the clitoris to a mean maximum size of 4.6 cm (1.8 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 (far) 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 (connection) is formed with the native urethra. The new urethral meatus is placed along the neophallus (newly formed penis) 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 (1.6–3.9 in) (with an average of 5.7 cm (2.2 in)) 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. [2]

Operation

Metoidioplasty procedure (via 'Belgrade technique'). A) Preoperative appearance (hormonally enlarged clitoris). B) Cutting of ligaments that suspend the clitoris to elongate it. C) Division of urethral plate with gap filled with vaginal mucosa graft D) Combining the vascularized labial tissue with the formed urethra to form final structure. Metoidioplasty - English.png
Metoidioplasty procedure (via 'Belgrade technique'). A) Preoperative appearance (hormonally enlarged clitoris). B) Cutting of ligaments that suspend the clitoris to elongate it. C) Division of urethral plate with gap filled with vaginal mucosa graft D) Combining the vascularized labial tissue with the formed urethra to form final structure.

Alternative techniques

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 to 12 centimeters (2.4 to 4.7 in), with 7 out of 10 patients able to obtain erections that are capable of penetrative intercourse. [7]

Extended metoidioplasty is a more recent technique which attempts to refine extensive metoidioplasty. Both methods work on the same principal of releasing, thereby exposing, more of the clitoris. A study on 17 patients a range of 4–9cm increase in phallic length. Penetration was possible for 4, and 2 had significant length and growth during erection, but had not attempted sexual intercourse yet. [8] Both methods are considered experimental, and are only offered by a few surgeons.

Complications

Complications from metoidioplasty vary in severity. Minor complications may be resolved through minor supportive care, while more serious complications may require surgical correction. Like other surgical procedures, each metoidioplasty procedure comes with the possibility of complications such as pain, infection, bleeding, blood clots, and damage to surrounding tissues. There is also a risk of adverse reactions to anesthesia or other medications that are required for the procedure or post-operative period.

If urethral lengthening is performed, urethral complications such as urinary fistula may occur. [8] Patients who experience postvoid incontinence or dribbling following surgery report their symptoms as resolved within three months. [9]

Satisfaction rates among patients who undergo metoidioplasty are generally very high regarding both appearance and sexual satisfaction. [9] [10]

Comparison with phalloplasty

Metoidioplasty is technically simpler than phalloplasty, more affordable, 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. [11]

In a phalloplasty, a plastic surgeon fabricates a neopenis by autografting 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 three) additional surgical procedures including glansplasty, scrotoplasty, testicular prosthesis, and/or penile implantation.

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.

Note also, that the two alternative techniques are not mutually exclusive and phalloplasty extension of a metioidiplasic base neophallus is possible. [12]

History

The first metoidioplasty was reported in 1973 and the term was coined in a 1989 paper. [13] [14]

See also

Related Research Articles

<span class="mw-page-title-main">Labia minora</span> Flaps of skin on either side of the vaginal opening in the vulva

The labia minora, also known as the inner labia, inner lips, or nymphae, are two flaps of skin that are part of the primate vulva, extending outwards from the inner vaginal and urethral openings to encompass the vestibule. At the glans clitoris, each labium splits, above forming the clitoral hood, and below the frenulum of the clitoris. At the bottom, the labia meet at the labial commissure. The labia minora vary widely in size, color and shape from individual to individual.

Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their identified gender. The phrase is most often associated with transgender health care and intersex medical interventions, though many such treatments are also pursued by cisgender and non-intersex persons. It is also known as sex reassignment surgery (SRS), gender confirmation surgery (GCS), and several other names.

<span class="mw-page-title-main">Epispadias</span> Medical condition

Epispadias is a birth defect in which the urethra fails to fully develop, resulting in urine leaving the body from an abnormal site. In males, this may be an opening on the upper aspect of the penis, and in females when the urethra develops too far anteriorly. It occurs in around 1 in 120,000 male and 1 in 500,000 female births.

Phalloplasty is the construction or reconstruction of a penis or the artificial modification of the penis by surgery. The term is also occasionally used to refer to penis enlargement.

Gender-affirming surgery for female-to-male transgender people includes a variety of surgical procedures that alter anatomical traits to provide physical traits more comfortable to the trans man's male identity and functioning.

Gender-affirming surgery for male-to-female transgender women or transfeminine non-binary people describes a variety of surgical procedures that alter the body to provide physical traits more comfortable and affirming to an individual's gender identity and overall functioning.

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It may correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

Genital reconstructive surgery may refer to:

<span class="mw-page-title-main">Intersex medical interventions</span> Performed to modify atypical or ambiguous genitalia

Intersex medical interventions (IMI), sometimes known as intersex genital mutilations (IGM), are surgical, hormonal and other medical interventions performed to modify atypical or ambiguous genitalia and other sex characteristics, primarily for the purposes of making a person's appearance more typical and to reduce the likelihood of future problems. The history of intersex surgery has been characterized by controversy due to reports that surgery can compromise sexual function and sensation, and create lifelong health issues. The medical interventions can be for a variety of reasons, due to the enormous variety of the disorders of sex development. Some disorders, such as salt-wasting disorder, can be life-threatening if left untreated.

<span class="mw-page-title-main">Clitoromegaly</span> Unusually large clitoris

Clitoromegaly is an abnormal enlargement of the clitoris that is mostly congenital; it is otherwise acquired through deliberately induced clitoral enlargement e.g. body modification by use of anabolic steroids, including testosterone. It can happen as part of a gender transition. It is not the same as normal enlargement of the clitoris seen during sexual arousal.

<span class="mw-page-title-main">Scrotoplasty</span> Type of surgery to create or repair the scrotum

Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. Scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants began in 1940 made from materials outside of what is used today. Today, testicular implants are created from saline or gel filled silicone rubber. There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.

<span class="mw-page-title-main">Labiaplasty</span> Plastic surgery procedure for altering the labia minora

Labiaplasty is a plastic surgery procedure for creating or altering the labia minora and the labia majora, the folds of skin of the human vulva. It is a type of vulvoplasty. There are two main categories of women seeking cosmetic genital surgery: those with conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their vulvas because they believe they do not fall within a normal range.

<span class="mw-page-title-main">Vaginectomy</span> Surgical removal of the vagina

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Clitoral enlargement methods are forms of body modification that have the potential to increase the size of the clitoris and enhance sexual pleasure. Clitoral enlargement can be accomplished through a variety of means, each potentially having certain side effects and risks.

<span class="mw-page-title-main">Penile implant</span> Medical device

A penile implant is an implanted device intended for the treatment of erectile dysfunction, Peyronie's disease, ischemic priapism, deformity and any traumatic injury of the penis, and for phalloplasty or metoidioplasty, including in gender-affirming surgery. Men also opt for penile implants for aesthetic purposes. Men's satisfaction and sexual function is influenced by discomfort over genital size which leads to seek surgical and non-surgical solutions for penis alteration. Although there are many distinct types of implants, most fall into one of two categories: malleable and inflatable transplants.

<span class="mw-page-title-main">Transsexual</span> People experiencing a gender identity inconsistent with their assigned sex

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<span class="mw-page-title-main">Clitoral hood reduction</span> Cosmetic surgical procedure

Clitoral hood reduction, also termed clitoral hoodectomy, clitoral unhooding, clitoridotomy, or (partial) hoodectomy, is a plastic surgery procedure for reducing the size and the area of the clitoral hood in order to further expose the glans of the clitoris.

<span class="mw-page-title-main">Miroslav Djordjevic</span> Serbian genital surgeon

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Rajveer Purohit is an Indian-born American physician, Director of Reconstructive Urology at the Icahn School of Medicine at Mount Sinai Hospital in New York City, and associate professor in its Department of Urology.

Clitoroplasty is a type of plastic surgery involving the clitoris. It encompasses several procedures, including clitoral reduction, clitoral reconstruction, and the creation of a neoclitoris in male-to-female gender-affirming surgery. These surgeries aim to retain or restore sensation and function in the clitoris, often employing nerve-sparing techniques.

References

  1. ↑ Bordas N, Stojanovic B, Bizic M, Szanto A, Djordjevic ML (2021-10-13). "Metoidioplasty: Surgical Options and Outcomes in 813 Cases". Frontiers in Endocrinology. 12: 760284. doi: 10.3389/fendo.2021.760284 . PMC   8548780 . PMID   34721306.
  2. 1 2 Hage JJ (January 1996). "Metaidoioplasty: an alternative phalloplasty technique in transsexuals". Plastic and Reconstructive Surgery. 97 (1): 161–167. doi:10.1097/00006534-199601000-00026. PMID   8532774. S2CID   38412526.
  3. ↑ Perovic SV, Djordjevic ML (December 2003). "Metoidioplasty: a variant of phalloplasty in female transsexuals". BJU International. 92 (9): 981–5. doi:10.1111/j.1464-410x.2003.04524.x. PMID   14632860. S2CID   11836091.
  4. ↑ Meyer WJ, Webb A, Stuart CA, Finkelstein JW, Lawrence B, Walker PA (April 1986). "Physical and hormonal evaluation of transsexual patients: a longitudinal study". Archives of Sexual Behavior. 15 (2): 121–38. doi:10.1007/BF01542220. PMID   3013122. S2CID   42786642.
  5. ↑ 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
  6. ↑ Djordjevic ML, Stanojevic D, Bizic M, Kojovic V, Majstorovic M, Vujovic S, Milosevic A, Korac G, Perovic SV (May 2009). "Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience". The Journal of Sexual Medicine. 6 (5): 1306–13. doi:10.1111/j.1743-6109.2008.01065.x. PMID   19175859.
  7. ↑ Cohanzad S (February 2016). "Extensive Metoidioplasty as a Technique Capable of Creating a Compatible Analogue to a Natural Penis in Female Transsexuals". Aesthetic Plastic Surgery. 40 (1): 130–8. doi:10.1007/s00266-015-0607-4. PMID   26744289. S2CID   40551674.
  8. 1 2 "Metoidioplasty Risks and Complications: Is Metoidioplasty Really Worth It?". Trans Media Network.
  9. 1 2 Vukadinovic V, Stojanovic B, Majstorovic M, Milosevic A (2014). "The role of clitoral anatomy in female to male sex reassignment surgery". TheScientificWorldJournal. 2014: 437378. doi: 10.1155/2014/437378 . PMC   4005052 . PMID   24982953.
  10. ↑ De Cuypere G, TSjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, et al. (December 2005). "Sexual and physical health after sex reassignment surgery". Archives of Sexual Behavior. 34 (6): 679–90. doi:10.1007/s10508-005-7926-5. PMID   16362252. S2CID   42916543.
  11. ↑ Frey JD, Poudrier G, Chiodo MV, Hazen A (December 2016). "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): e1131. doi:10.1097/GOX.0000000000001131. PMC   5222645 . PMID   28293500.
  12. ↑ Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, van Moorselaar RJ, Mullender MG, et al. (November 2019). "The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series". The Journal of Sexual Medicine. 16 (11): 1849–1859. doi:10.1016/j.jsxm.2019.07.027. PMID   31542350. S2CID   202731384.
  13. ↑ Bordas, Noemi; Stojanovic, Borko; Bizic, Marta; Szanto, Arpad; Djordjevic, Miroslav L. (2021). "Metoidioplasty: Surgical Options and Outcomes in 813 Cases". Frontiers in Endocrinology. 12: 760284. doi: 10.3389/fendo.2021.760284 . PMC   8548780 . PMID   34721306.
  14. ↑ Hage, Joris J. (1996). "Metaidoioplasty: An Alternative Phalloplasty Technique in Transsexuals". Plastic and Reconstructive Surgery. 97 (1): 161–167. doi:10.1097/00006534-199601000-00026. PMID   8532774. S2CID   38412526.

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