Association Transgenre Wallonie
Page E28 - Metaidoioplasty
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Metaidoplasty refers to a surgical operation that is part of sex reassignment surgeries. This operation is an alternative to phalloplasty. But it does not have the same advantages.

The virilizing hormonal treatment gradually causes the enlargement of the clitoris to reach a dimension between 4 and 5 centimeters. This is due to the fact that the clitoris and the penis initially have a similar development.

Metaidoplasty surgery involves separating the clitoris from the labia minora and bringing it back to a position similar to that of the penis by cutting the suspensory ligament that holds it.

Note that this will not allow penetrative sex because, although the tissues of the clitoris are erectile, the latter will never have an erection as rigid as the penile erection.

In most cases, this operation does not take away the possibility of obtaining a clitoral orgasm.

However, it helps to give a more masculine appearance to the genitals.

The different stages of the operation.

This operation involves three steps :

First, the skin of the clitoris is incised on its inner side. The side branches that hold the tissue in place are cut off; which frees the clitoral tissue from the puben bone.

In the second step, the surgeon prepares the urethra if it needs to be stretched. This will be done with mucous tissue from the vaginal area or inside the mouth and cheeks. A transplant of a piece of intestine is another possibility. The labia minora can be used to protect the graft while providing greater circumference to the neo-penis. This part will take two to three weeks to heal.

Finally, the third step will be to create the neo-penis.

At the same time as this operation, a scrotoplasty (also called oscheoplasty) can also be performed, which consists of creating the scrotum intended to receive the testicular implants.

Vaginectomy (also called colpectomy) can be performed during this operation, as can hysterectomy if it has not taken place previously.

There is an alternative technique to this operation that can be performed if it is not intended to expand the urethra and create the scrotum. This operation is then called "clitoral release". It is less expensive financially but has the disadvantage of not urinating while standing.

However, it involves less risk, in particular because the urinary system is not extensive while offering the same visual appearance as metaidoplasty and also the possibility of using the neopenis for sexual penetration.

Since it requires no skin and nerve grafts, no other parts of the body are affected.

The operation lasts between three and four hours while the convalescence is all the same 2 to 3 months since the part concerned by this operation is very delicate and sensitive.

Generally in Europe, these operations are done in three stages spread over a year: first of all the realization of the neo-penis, then the construction of the scrotum and finally the installation of the testicular implants. In America, where the best surgeons meet, this duration is markedly shortened.

Possible complications

The most common complication, when the urethra has been stretched, is swelling of the urethra, which disappears over time without any surgical intervention. Only a small risk of urethral stricture is possible and requires regular monitoring.

Another complication is constituted by the fistulas (hole in the urethra). This situation requires a minor intervention without consequences.

A complication linked to urethroplasty is a leak or a stricture of the urethra. Both of these issues require reoperation.

Other complications, as in all other surgeries, are healing problems, superficial infection, hematomas or complications related to anesthesia.

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