Metoidioplasty surgery is the creation of a small penis (microphallus) using the original clitoris, which has enlarged due to testosterone hormone use.
Therefore, candidates for this surgery must have been on testosterone hormone for at least 1 year and should have a clitoris size of at least 3 centimeters to achieve good surgical results.
The purpose of the surgery is to enable standing urination, but it is not possible to have penetrative sexual intercourse because the average length is only 5-7 centimeters. However, patients can later undergo phalloplasty to create a larger penis.
How is metoidioplasty surgery performed?
The surgery begins by releasing the clitoral hood and the suspensory ligament to increase the length of the penis and elevate its position forward.
The erectile tissue and the parts responsible for sexual sensation are preserved. After that, the surgeon will create a urethral extension to open at the tip of the penis. If metoidioplasty is performed together with vaginoplasty closure,
the surgeon will use the vaginal wall tissue removed during closure to form the urethral wall. However, if the patient has previously had vaginoplasty closure, tissue grafts from other areas, such as the cheek, may be required.
What are the limitations and complications?
- Urethral stricture and urethral fistula
- Regarding standing urination, about 90-95% of patients achieve good results
- Infection, wound dehiscence or incomplete healing, bleeding from the surgical wound
What is phalloplasty surgery?
Phalloplasty surgery creates a penis size close to that of an erect penis by transplanting tissue from other parts of the body,
such as the arm, leg, abdomen, or groin. Phalloplasty allows standing urination and penetrative sexual intercourse, and it can be the first surgery or performed after metoidioplasty.
How is phalloplasty surgery performed?
Currently, tissue from the arm (radial forearm) and the outer thigh (anterolateral thigh) is commonly used to create a new penis. Tissue transplantation usually requires microsurgical connection of blood vessels and sensory nerves.
The surgeon will connect nerves from the clitoris to the nerves of the new penile tissue to provide sensation during sexual intercourse.
For erectile function, it can be created by implanting penile prostheses, either semi-rigid or inflatable, or by bone grafting surgery to avoid having implants in the body.
What are the limitations and complications?
- Urethral stricture, urethral fistula, incomplete urination, hair growth inside the urethra, or urine reflux from the bladder
- Urine reflux to the kidney or ureter
- Flap failure (tissue graft failure)
- The constructed penis has no sensation or cannot be used for sexual intercourse
- Scarring at the donor site
- Infection, wound dehiscence or incomplete healing, bleeding from the surgical wound
- Possible scarring at the tissue donor site, such as the arm or thigh
- Multiple surgeries may be required to achieve optimal results
Summary: New innovations in penile lengthening
New innovations in penile lengthening involve two surgical methods, each with different advantages and limitations. Patients should consult with their doctors to clearly understand the benefits and limitations of each method.
They should also communicate their desired surgical outcomes so the doctor can select the most appropriate method for each individual, considering their needs, health, anatomy, and physical characteristics.
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