Metoidioplasty vs Phalloplasty? Here Are 4 Tips to Help You Decide!
Metoidioplasty and phalloplasty are two main options for trans men, transmasculine and nonbinary individuals seeking gender-affirming genital surgery.
Metoidioplasty is a surgery where the existing genital tissue of the testosterone-enlarged clitoris is used to create a phallus. This gender-affirming procedure can be done with or without lengthening the urethra, including creating the scrotum.
Phalloplasty is a more complex multi-staged procedure where a penis is created using a donor site, often radial forearm free flap RFFF or anterolateral thigh flap ALT. Phalloplasty may include a variety of different procedures, including lengthening the urethra, creating the tip (glans) of the penis, creating the scrotum, removal of the vagina, and placing erectile and testicular implants.
Both surgeries carry risks and benefits, making deciding which procedure to have challenging.
To help you decide, here are four tips I encourage you to consider.
#1 SENSATION
Sensation remains to be a primary essential factor for many. In metoidioplasty, preservation of erotic sensitivity remains fully intact, and individuals are able to get aroused and orgasm.
Whereas sensation in neophallus post-phalloplasty varies depending on numerous factors and is shown to continue to improve post-surgery.
A recent study How Sensitive Is the Neophallus? Postphalloplasty Experienced and Objective Sensitivity in Transmasculine Persons concluded neophallic tactile sensitivity was reduced yet increased significantly with follow-up time.
If sensitivity is an absolute top priority for you, it is important to consider not only the potential loss of sensitivity, which may occur after phalloplasty, but also the potential for it to re-occur after the prolonged healing period.
#2 AESTHETIC RESULTS
Aesthetic results are subjective territory. What one individual aesthetically desires will vary from another, including how one defines what they find aesthetically pleasing.
Metoidioplasty offers great aesthetic results as long as the length and size of the penis are not a priority.
If size and length are a priority, phalloplasty can get great anatomic results.
#3 ABILITY TO HAVE PENETRATIVE SEX
With varying metoidioplasty results, people often assume one cannot have penetrative intercourse due to size. It depends, but the answer is not a “no.”
Different people have different results but do keep your expectations real and define for yourself what penetrative intercourse means to you! If penetrative depth is important to you, you may want to consider the phalloplasty option.
Phalloplasty, on the other hand, offers an opportunity for penetrative sex, but obtaining rigidity after phalloplasty remains a challenge for some, with complications reported (Hage et al. 1993; Hoebeke et al. 2010; Leriche et al. 20018).
#4 STANDING TO PEE
Being able to void while standing is often desired by many folks and is achievable with urethra lengthening UL in both phalloplasty and metoidioplasty.
Often, people inaccurately assume higher complication rates are associated solely with UL in phalloplasty procedures when the complication rates are equally common in metoidioplasty.
Research demonstrates urethral complications account for more than half the complications seen in individuals who undergo metoidioplasty with UL, even in the hands of a highly skilled surgeon.
But even with urethroplasty, metoidioplasty carries lower complication rates.
Out of 38 participants who got metoidioplasty, all 38 reported voiding while standing up.
Only two complications were reported, fistulas and one urethral erosion from a testicular implant (Djordjevic et al. 2009).
When deciding between phalloplasty vs. metoidioplasty, considering all four factors and seeing which one carries the most desired outcomes can help aid in decision-making.
YOU MAY ALSO FIND THE FOLLOWING HELPFUL:
SOURCES
Pigot GLS, Al-Tamimi M, Nieuwenhuijzen JA, van der Sluis WB, Moorselaar RJAV, Mullender MG, van de Grift TC, Bouman MB. Genital Gender-Affirming Surgery Without Urethral Lengthening in Transgender Men-A Clinical Follow-Up Study on the Surgical and Urological Outcomes and Patient Satisfaction. J Sex Med. 2020 Dec;17(12):2478-2487. doi: 10.1016/j.jsxm.2020.08.004. Epub 2020 Oct 16. PMID: 33071204.
Elfering L, van de Grift TC, Al-Tamimi M, Timmermans FW, de Haseth KB, Pigot GLS, Lissenberg-Witte BI, Bouman MB, Mullender MG. How Sensitive Is the Neophallus? Postphalloplasty Experienced and Objective Sensitivity in Transmasculine Persons. Sex Med. 2021 Oct;9(5):100413. doi: 10.1016/j.esxm.2021.100413. Epub 2021 Aug 20. PMID: 34425361; PMCID: PMC8498953.
Nassiri, N., Maas, M., Basin, M., Cacciamani, G. E., & Doumanian, L. R. (2021). Urethral complications after gender reassignment surgery: a systematic review. International Journal of Impotence Research, 33(8), 793-800.
de Rooij, F. P., van de Grift, T. C., Veerman, H., Al-Tamimi, M., van der Sluis, W. B., Ronkes, B. L., ... & Pigot, G. L. (2021). Patient-reported outcomes after genital gender-affirming surgery with versus without urethral lengthening in transgender men. The Journal of Sexual Medicine, 18(5), 974-981.
Veerman, H., de Rooij, F. P. W., Al-Tamimi, M., Ronkes, B. L., Mullender, M. G., B. Bouman, M., ... & Pigot, G. L. S. (2020). Functional outcomes and urological complications after genital gender affirming surgery with urethral lengthening in transgender men. The Journal of Urology, 204(1), 104-109.
Hage, J., Bouman, F., de Graaf, F., and Bloem, J. (1993). Construction of the Neophallus in Female-to-Male Transsexuals: The Amsterdam Experience. Journal of Urology. Volume 6, 1463-1468.
Hoebeke, P., Decaestecker, K., Beysens, M., Opdenakker, Y., Lumen, N., Monstrey, S. (2010). Erectile Implant in Female-to-Male Transsexuals: Our Experience in 129 Patients. European Urology. Volume 57, Issue 2, 334-341.
Leriche, A., Timsit, M., Morel-Jourel, N., Bouillot, A., Dembele, D., and Ruffion, A. (2008). Long-term Outcome of Forearm Free-flap Phalloplasty in the Treatment of Transsexualism. BJU International. Volume 101(10): 1297-1300.
Djordjevic, M., Bizic, M., Stanojevic, M., Bumbasirevic, V., Koovic, M., Majstorovic, M., Acimovic, S., Pandey, S., Perovic, V. (2009). Urethral Lengthening in Metoidioplasty (Female-to-male Sex Reassignment Surgery) by Combined Buccal Mucosa Graft and Labia Minora Flap. Reconstructive Urology. Volume 74, Issue 2.
