Metoidioplasty: Meaning, Procedure, Benefits, and Risks

During surgery, the surgeon releases the enlarged clitoral tissue from the ligaments holding it close to the body. This allows the tissue to extend outward more visibly.

Depending on the chosen procedure, surgery may also:

• lengthen the urethra for possible standing urination;
• create a scrotum;
• insert testicular implants later;
• close or remove vaginal tissue;
• reduce fatty tissue around the new penis.

The results, functions, risks, and recovery differ according to the exact procedures performed.

It may be used as an uncountable term for the general procedure:

• Metoidioplasty is one form of gender-affirming genital surgery.
• The clinic provides consultations about metoidioplasty.

It may be countable when referring to particular operations:

• The surgeon performs several types of metoidioplasty.
• The patient underwent a staged metoidioplasty.

Common expressions include:

• undergo metoidioplasty;
• consider metoidioplasty;
• prepare for metoidioplasty;
• recover from metoidioplasty;
• perform urethral lengthening;
• create a scrotum;
• preserve sexual sensation;
• discuss surgical goals.

The released tissue becomes the shaft of the surgically created penis. Because the tissue retains its natural erectile structures and nerves, it can usually become firm without an implanted erectile device.

Johns Hopkins describes the resulting penis as commonly measuring approximately 4–6 centimeters, although size varies according to anatomy, hormone-related growth, surgical method, and healing.

The operation may be completed in one stage or divided into several procedures.

Simple Metoidioplasty

A simple metoidioplasty primarily releases and repositions the enlarged clitoral tissue.

It may not include:

• urethral lengthening;
• vaginal closure;
• scrotoplasty;
• testicular implants.

This version may involve fewer surgical steps and fewer urinary complications, but it usually does not enable standing urination through the tip of the new penis.

Full Metoidioplasty

A full metoidioplasty may combine several procedures, including:

• clitoral release;
• urethral lengthening;
• vaginal closure or vaginectomy;
• scrotoplasty;
• later testicular implants.

The exact combination depends on anatomy, health, surgical technique, and the person’s goals.

Ring Metoidioplasty

Ring metoidioplasty uses nearby genital tissues to help construct or lengthen the urethra and shape the penis.

Techniques vary, so the name does not guarantee one identical procedure at every surgical center.

The goal may be to make standing urination possible.

Tissue used for reconstruction may come from nearby genital tissue or from graft material taken from another part of the body. Success is not guaranteed, and some people may still have difficulty urinating while standing.

Urethral reconstruction is one of the more complication-prone parts of metoidioplasty.

Testicular implants may be placed inside the surgically created scrotum. They may be inserted during the original operation or after healing in a later procedure.

Implants provide shape and appearance but do not produce testosterone, sperm, or fertility.

Possible implant-related complications include infection, displacement, discomfort, erosion, or the need for replacement.

Other people retain the vaginal opening. This choice may depend on:

• personalpreference;
• sexual function;
• reproductive goals;
• urinary reconstruction;
• surgical technique;
• health considerations.

Keeping or closing the vagina does not determine a person’s gender. The decision should reflect the person’s own anatomical, functional, and transition goals.

Metoidioplasty

• uses hormone-enlarged clitoral tissue;
• generally creates a smaller penis;
• commonly preserves natural erectile ability;
• does not usually require a penile implant for firmness;
• may involve less extensive tissue transfer;
• may preserve strong erotic sensation.

Phalloplasty

• constructs a penis using tissue transferred from another body area;
• can create greater length and girth;
• usually involves a donor-site scar;
• may require an erectile implant for penetrative firmness;
• is often completed through several surgical stages;
• may involve more extensive reconstruction.

Neither option is universally better. The choice depends on priorities involving size, sensation, urination, penetration, scars, recovery, risk, and available surgical expertise.

The new penis may become naturally firm in response to arousal. Many people remain able to experience orgasm, although sensation and function can change during healing.

The ability to perform penetrative sex may be limited by the penis’s size and individual anatomy. Surgical results cannot guarantee a particular sexual function.

People should discuss desired sexual outcomes directly with an experienced surgeon.

• hysterectomy;
• removal of the ovaries;
• removal of the fallopian tubes;
• vaginal closure.

Some of these procedures can permanently affect fertility and the ability to carry a pregnancy.

Before surgery, a person may wish to discuss:

• egg freezing;
• embryo preservation;
• future pregnancy possibilities;
• genetic parenthood;
• contraception;
• the effects of stopping testosterone.

Fertility preservation is optional, but relevant information should be available before irreversible procedures.

• consultation with an experienced surgical team;
• review of transition and functional goals;
• physical and medical assessment;
• discussion of fertility;
• review of medications and hormone treatment;
• stopping nicotine as instructed;
• arranging recovery support;
• understanding urinary and sexual outcomes;
• planning time away from work or school.

Requirements vary among healthcare systems and surgical programs. A person should follow the instructions of the treating team rather than assuming that one clinic’s requirements apply everywhere.

During early recovery, a person may experience:

• swelling;
• bruising;
• pain;
• numbness;
• temporary changes in sensation;
• difficulty moving comfortably;
• drainage from incisions;
• restrictions on exercise and sexual activity.

A urinary catheter may remain in place while the reconstructed urethra heals. Follow-up appointments are important for checking wounds, urination, healing, and possible complications.

Final appearance and function may take months to become clear.

• bleeding;
• infection;
• scarring;
• delayed wound healing;
• pain or altered sensation;
• tissue loss;
• dissatisfaction with size or appearance;
• implant complications;
• urinary problems;
• need for revision surgery.

When urethral lengthening is performed, important risks include:

• urethral fistula, an unintended opening that allows urine to leak;
• urethral stricture, narrowing caused by scar tissue;
• urinary tract infection;
• difficulty emptying the bladder;
• spraying or dribbling during urination.

Johns Hopkins identifies urethral scarring, fistulas, infection, and recurrent urinary infections among potential complications.

Fever, worsening redness, severe pain, heavy bleeding, inability to urinate, foul-smelling discharge, or unusual swelling requires prompt medical attention.

• reduced genital or physical dysphoria;
• preserved erotic sensation;
• natural erectile ability;
• greater comfort with nudity or intimacy;
• possible standing urination;
• a genital appearance that feels more affirming;
• reduced need for a large donor site;
• increased gender euphoria.

No outcome can be guaranteed, and satisfaction depends partly on whether expectations match what the procedure can realistically provide.

Metoidioplasty always enables standing urination.
No. Urethral lengthening may make it possible, but complications or functional limitations can occur.

The surgery removes sexual sensation.
Not usually, because the original erectile and nerve-containing tissue is retained, though sensation can change.

Every procedure includes vaginal closure.
No. Surgical combinations vary according to individual goals.

Testicular implants produce testosterone.
No. They provide appearance and shape but do not function as biological testicles.

Metoidioplasty is required for transgender men.
No. Genital surgery is entirely optional.

1. Metoidioplasty uses testosterone-enlarged clitoral tissue to create a penis.
2. He discussed metoidioplasty and phalloplasty with his surgical team.
3. Does metoidioplasty always include urethral lengthening?
4. Their metoidioplasty plan included scrotoplasty but not vaginal closure.
5. Metoidioplasty may preserve natural erectile ability and erotic sensation.
6. The surgeon explained urinary complications before the metoidioplasty.
7. Recovery from metoidioplasty depends on the combination of procedures performed.
8. Understanding metoidioplasty helps readers compare gender-affirming genital surgery options accurately.

The procedure may reduce physical dysphoria or increase gender euphoria, but it is not required for someone to be a man, masculine, transgender, or nonbinary. Some people choose different surgery, retain their original anatomy, or do not medically transition.

Understanding metoidioplasty helps readers discuss genital construction, sexual sensation, urination, recovery, and surgical choice without treating one anatomical outcome as necessary for gender validity.