Metoidioplasty or Metaidoioplasty (phallic clitoral enlargement, stand to void)
The procedure confers the advantage of minimal surgery with preservation of natural sensation and erectile function. Donor site forearm scars avoided. Overweight patients may achieve greater length with pubic lipectomy which will recess the body surface line.
In this procedure the clitoral hood is lifted and the suspensory ligament of the clitoris is detached from the pubic bone, allowing the clitoris to extend out further. When the female tissues have been primed with testosterone, the clitoral head may resemble an adolescent glans penis, although the proportionality or size may be smaller.
The term “juvenile” sized phallus might be apt. If you have been on testosterone and experience clitoromegaly, self examination of your glans and clitoral body will give you a very good idea of what to anticipate post-operatively once surgical swelling subsides (6 to 8 weeks). Although visible engorgement may occur during arousal, the phallus is not suitable for penetration, nor is ejaculation possible.
For those patients who desire to void standing, the urethra is extended into the neo-penis. This may be accomplished simultaneously or performed secondarily using either a vaginal flap or buccal mucosal graft.
Please understand in that metoidioplasty involves a fair amount of tissue transfer, some degree of post-operative swelling is expected.
Complications may include but are not limited to less than anticipated length, torquing of the clitoris (usually amenable to release), loss of sensation, tissue necrosis, localized infection, persistent tenderness or hypersensitivity, transient or permanent narrowing of the vaginal opening which may render the vagina incapable of penile penetration, urethral narrowing, urethral obstruction, and urethral fistula (leakage of urine anywhere along the pathway of urethral extension). Between the first and second stages leading to urethral extension, voiding patterns and trajectory may vary.
Best results are achieved when the patient has previously had a laparoscopic assisted vaginal total hysterectomy with removal of tubes and ovaries, and this is followed by closure of the vagina (colpocleisis).
Fee $12,500. Please call for details.