Metoidioplasty, also referred to as “meta,” is a type of lower surgery that involves forming genital tissue, including the clitoris, into a penis.

A person may decide to have a metoidioplasty alone or in conjunction with other lower surgeries, such as a hysterectomy, vaginectomy, or urethral lengthening.

In this article, we look at the different types of metoidioplasty and describe what the procedures involve, including recovery and risks.

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A surgeon can perform a metoidioplasty with a variety of techniques.

There are several types of metoidioplasty, and surgeons can perform them with a variety of techniques. The specific method will depend on the surgeon’s training and experience.

Anyone who is looking for a detailed description of the procedure beforehand should speak with their surgeon.

A metoidioplasty can take 2–5 hours, depending on the type of procedure.

The 2015 U.S. Transgender Survey found that, among respondents who identified as gender nonbinary and who had been assigned female at birth, 4% had undergone metoidioplasty and 24% wanted to have the procedure in the future.

The same survey found that, among respondents who identified as transgender men, 1% had undergone the surgery, and 25% hoped to have it.

Simple metoidioplasty

A simple metoidioplasty is also known as a clitoral release. During this procedure, the surgeon severs the ligaments that attach the clitoris to the pubic bone.

They then construct the penile shaft from the clitoral skin and labia minora and majora.

Full metoidioplasty

A full metoidioplasty involves a clitoral release, vaginectomy, and urethroplasty.

First, the surgeon removes the vagina and closes the vaginal opening. This is a vaginectomy. They then perform the clitoral release.

Using tissue from the cheek, clitoris, or labia minora, they extend the urethra through the newly created penis. This is a urethroplasty.

They then position the urethral opening in the head of the neopenis, which allows the person to urinate while standing.

Ring metoidioplasty

A ring metoidioplasty is similar to a full metoidioplasty, but it involves a different technique of cutting the ligaments attached to the clitoris.

Also, in a ring metoidioplasty, the surgeon performs the urethroplasty using a skin graft from the vaginal wall instead of the cheek.

They then use a portion of the labia minora to form the shaft of the neopenis. After that, the surgeon will either remove excess labia minora skin or use it to cover the suture line at the bottom of the shaft.

Centurion metoidioplasty

A centurion metoidioplasty involves releasing the round ligaments located on either side of the labia and repositioning them under the clitoris to add girth to the penis.

A phalloplasty is another type of lower surgery. The steps are similar to those of a metoidioplasty and can include vaginectomy and urethroplasty.

A phalloplasty may also involve a scrotoplasty — the creation of a scrotum and insertion of testicular implants.

There are other differences: A metoidioplasty uses the person’s existing genital tissue, while a phalloplasty uses a large skin graft from another part of the body, such as the arm, thigh, or abdomen.

As a result, a phalloplasty produces a larger penis than a metoidioplasty.

However, a penis created during metoidioplasty can become erect, while a penis created through phalloplasty cannot become erect without additional procedures.

A person may choose to have a phalloplasty after a metoidioplasty.

Before a metoidioplasty, a person needs to take hormone therapy to enlarge their clitoris.

A metoidioplasty can sometimes be an outpatient procedure, which means that the person does not have to stay in the hospital overnight. In this case, it is important to arrange for transportation from the hospital ahead of time.

Also, a person who has a simple metoidioplasty may receive a lighter form of sedation than a person who has the full procedure.

Achieving the desired outcome from lower surgery can require more than one procedure. Additional procedures may take place immediately after a metoidioplasty or in separate visits.

During a full metoidioplasty, the surgeon performs the vaginectomy first. This involves removing the mucous membrane lining the vagina and closing the vaginal opening.

They may take a skin graft from the vaginal wall during this step if they are performing a ring metoidioplasty.

The next steps include releasing the clitoris, lengthening the urethra, and constructing the neopenis.

The surgeon will place a suprapubic catheter into the urethra, which will remain in place for 5–7 days or until the urethra heals.

If the person is undergoing a scrotoplasty, the surgeon will create a neoscrotum from the labia majora. They then insert testicle implants into the scrotum and suture the incisions.

If the surgeon is using tissue expanders to stretch the labia before inserting larger testicle implants, the scrotoplasty will take place at a later date.

After a metoidioplasty, the clinical team will instruct the person on how to check for infection. The person should also use extreme care when standing, sitting, or walking.

Usually, the person attends a follow-up appointment with their surgeon, during which the surgeon checks for swelling and look for signs of infection and other complications.

It is important to rest and avoid strenuous physical activities, such as exercise and contact sports, for at least 6 weeks after a metoidioplasty.

Full healing can take 12–18 months.

On average, a metoidioplasty results in a penis that is 4–10 centimeters (cm) long.

The length may not allow for penetrative sex. If this is a concern, a person may decide to undergo a phalloplasty after a metoidioplasty.

Following a metoidioplasty, a person can expect to experience excellent sensation in their penis, which can become erect.

Like any surgery, metoidioplasty carries risks, including:

  • infection
  • bleeding
  • pain
  • swelling
  • allergic reactions to anesthesia

Complications specific to metoidioplasty include:

  • infection or tissue loss at the base of the penis
  • infection or tissue loss along the shaft
  • urinary catheter issues, such as clogging or leaking
  • bladder infections
  • urethral stricture, which occurs when scar tissue blocks the flow of urine
  • urethral fistula, a hole in the urethra that can cause urine leakage
  • rejection of testicular implants

According to estimates reported in 2019 in the journal Translational Andrology and Urology, urethral fistulas occur following 7–15% of metoidioplasty procedures, and urethral stricture develops after 2–3%.

Smoking increases the risk of significant complications by 40%. People may be ineligible for metoidioplasty if they smoke, vape, or use other nicotine products.

A surgeon can perform the following during a metoidioplasty:

  • Vaginectomy: This is the removal and closure of the vaginal canal.
  • Urethroplasty: This is the extension of the urethra through the neopenis. The goal is to allow the person to urinate while standing.
  • Scrotoplasty with testicular implants: This is the creation of a scrotum using the labia majora. The surgeon then inserts the implants.
  • Hysterectomy: A total hysterectomy involves removing the uterus and cervix. A partial hysterectomy involves removing the uterus but leaving the cervix in place.
  • Bilateral salpingo-oophorectomy: Also known as a BSO, this involves removing the fallopian tubes and the ovaries.

It is important to research specific procedures and potential surgeons thoroughly.

A person may start by looking for primary care physicians in their area who specialize in care for transgender people. These doctors can provide recommendations and referrals to suitable healthcare professionals, including surgeons.

A person can also look for surgeons in their area who specialize in metoidioplasty.

When choosing a surgeon, a person should consider:

  • their training and experience
  • the range of procedures that they offer
  • what previous patients have to say
  • the types of health insurance that they accept

Financial cost can present a barrier for people who wish to have gender-affirming surgery.

The cost of a metoidioplasty can depend on several factors, including:

  • the exact type of procedure
  • any additional procedures
  • health insurance coverage
  • surgeon fees
  • hospital facility costs
  • medication prescriptions

An insurance provider may classify a metoidioplasty as a reconstructive procedure.

Some public and private insurance providers now offer coverage for costs of care specific to transgender people.

Metoidioplasty is a form of lower surgery that involves creating a penis from a genital tissue.

A full metoidioplasty involves vaginectomy and urethroplasty. A person may also decide to have a scrotoplasty with testicular implants.

The penis created through a metoidioplasty tends to be about 4–10 cm long. A person can expect it to be very sensitive and become erect.

A phalloplasty is a similar procedure. However, the resulting penis will be longer, and having erections will require additional surgery.

It is important to research the various procedures thoroughly and choose a surgeon carefully.

Metoidioplasty procedures can be expensive, but some insurance providers offer coverage for care specific to transgender people.