Metoidioplasty

What is metoidioplasty?

Metoidioplasty is the surgical creation of a penis using your existing genital tissue. It is a less-extensive procedure than phalloplasty and is performed after the clitoris has been enlarged through the use of testosterone therapy. It is possible to undergo phalloplasty after a metoidioplasty, but the reverse is not true.

The clinicians in the Center for Gender Surgery at Boston Children's Hospital offer metoidioplasty as a gender affirmation procedure to eligible patients age 18 and over who have been living in their identified gender full time for at least 12 months. Our skilled team includes specialists in plastic surgery, urology, gender management and social work, who work together to provide a full suite of options for transgender teens and young adults.

Gender affirmation surgeries are a group of surgical procedures that some transgender and gender diverse people use to help affirm their gender identity. Metoidioplasty is a type of "bottom surgery" (surgery on the genitals) available to transgender men, or those who identify as transmasculine. It involves the surgical creation of a penis from your existing genital tissue.

Who is eligible for metoidioplasty?

Surgery is never the first step in a gender transition. It is something that happens after you have already explored social and medical transition options. People who choose to undergo metoidioplasty usually do so after taking other steps in the gender affirmation process, such as taking supplemental hormones and undergoing chest surgery. To qualify for metoidioplasty at Boston Children's Hospital, you must be at least 18 years old and meet certain criteria.

What happens during metoidioplasty?

Although they have different functions, the clitoris and penis are both derived from the same tissue. Metoidioplasty takes advantage of this fact by creating a penis from the clitoris after it has been enlarged through the use of testosterone therapy. Often, a scrotoplasty (surgical creation of a scrotum from the labia majora) is performed at the same time.

Metoidioplasty may also include surgical construction of a glans and lengthening of the urethra. The first option improves the resemblance to a cisgender male's penis. The second makes it possible for you to urinate while standing up. It is possible to have a phalloplasty after a metoidioplasty but the reverse is not true.

What happens after metoidioplasty?

Metoidioplasty can take between 2 and 5 hours and you may need to stay in the hospital for a day or two. Because the healing process can take time, you shouldn't engage in strenuous physical activity or heavy lifting in the first 6 weeks after metoidioplasty.

If you undergo urethral lengthening as part of metoidioplasty, you will also likely need to urinate through a catheter for 3 to 4 weeks after surgery. Your clinical team will give you detailed instructions on how to care for the catheter, and how to check for signs of infection at the surgical site, such as redness and swelling. You will likely be able to walk around and engage in light activity within a week after surgery, and healed enough to go back to all activities at around 6 weeks. This surgery has a very long healing process that can take 12 to 18 months.