Metoidioplasty

Metoidioplasty or metaoidioplasty (informally called a meto or meta) is a female-to-male sex reassignment surgery.

Testosterone replacement therapy gradually enlarges the clitoris to an average size of 4–5 cm (1.6–2 in) (as the clitoris and the penis are developmentally homologous). In a metoidioplasty, a surgeon separates the enlarged clitoris from the labia minora, and severs its suspensory ligament in order to lower it to the approximate position of the penis.

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 after they recover from surgery.

In a phalloplasty, the surgeon fabricates a neopenis by grafting tissue from a donor site (such as from the patient's arm or leg). A phalloplasty takes about 8–10 hours to complete, and may be followed by a second surgery to implant an erectile prosthesis.

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.

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.

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