Surgical Therapy: Metoidioplasty Technique and Results

Abstract

Despite a significant amount of time having passed since its inception, female to male sex reassignment surgery remains very challenging and demanding. There are two options for the creation of male-like genitalia in transgender patients – total phalloplasty and metoidioplasty. The former is the procedure that enables creation of a small penis from an enlarged clitoris, with completely preserved tactile and erogenous sensitivity and the goal of enabling voiding in a standing position. It is a procedure of choice for patients for whom penetrating sexual intercourse is not an issue and for whom the most important function is voiding in a standing position, as well as full preservation of sensitivity. The other advantage is avoidance of major surgery with unsightly scars. For some, this is only a temporary solution while “waiting” for better techniques in the future. It is a very complex procedure, largely dependent on clitoral size – it should be sufficiently long and the patient not too obese to provide good results. It is usually carried out simultaneously with removal of the female genitalia and scrotoplasty (and sometimes with bilateral mastectomy) as a single-stage procedure, which is an additional advantage.