Metoidioplasty and Phalloplasty

Innovations in the field of medicine mean there are now a range of effective procedures available to surgically create a penis or vagina. For transman looking for surgery aimed at creating neophallus (literally means “new penis”), the following 2 techniques are the most common: metoidioplasty and phalloplasty. The choice of which method is utilized is dependent on the individual’s unique requirements and situation.

What is metoidioplasty?
Metoidioplasty is a form of surgery that uses tissue from the clitoris that has been enlarged through hormone therapy to create a microphallus. Hence, for best results, those wishing to undergo this procedure must first have received continuous testosterone therapy for at least a year and be in possession of a clitoris measuring at least 3cm in length. The aim is to enable individuals to urinate while standing, but they will not be able to engage penetrating sexual activity due to size (5 – 7cm in length in most cases). Those looking to achieve the latter objective should instead consider phalloplasty.
The surgery begins with surgeons removing the clitoral hood and suspensory ligaments to provide some length to the neophallus, which is then pulled forward and stitched into position. Any tissue capable of becoming stiff is kept at the front, as is the sensitive tissue that can produce pleasure during intercourse. After that, surgeons insert a catheter into the bladder that is threaded through the neophallus. If this procedure will be done at the same time of vaginal closure, surgeons will incorporate some of vaginal linings into new urethra. In case the individuals have already had vaginal closure before metoidioplasty, other tissues such as buccal mucosa will be used to achieve the same result.
  • Urethral stricture and urethral leakage
  • With regard to standing while urinating, 90–95% of these surgeries achieve this objective.
  • Infection, scarring, wounds not healing, and post-surgery bleeding
Phalloplasty is a procedure aimed at creating a neophallus that is similar in size to that of a regular erect penis. The procedure involves transplanting tissue from the arm, leg, abdomen, or groin for use in creating the neophallus to enable both urination while standing and penile-vaginal intercourse. The surgery may be the patient’s first procedure or take place following successful metoidioplasty.
The most common forms of phalloplasty used today are radial forearm and anterolateral thigh graft, which take tissue from the forearm or thigh respectively to build the neophallus. Such transplantation requires surgeons to stitch veins and nerves together to enable sensitivity in the region, with the clitoris’ nerves connected to the neophallus being able to feel pleasure. However, if the patient wishes to experience an erection during sex, they will be required to have penile prostheses that may come in the form of an inflatable implant or a semi-rigid rod, the latter of which may involve transplantation of bone tissue from another area of the body if the patient does not want artificial materials used.
  • Urethral stricture, urethral leakage, incomplete emptying, hairs growing inside the urethra, or urine flowing from the bladder back into the kidney or ureter.
  • Flap failure
  • Lack of sensation in the neophallus or the neophallus being unsuitable for intercourse
  • Donor site morbidity
  • Infection, scarring, wounds not healing, and post-surgery bleeding
  • There may be scarring at the donor site.
  • Redo procedures may be necessary to ensure best results.
Both procedures have their own potential benefits and drawbacks, so it is essential that patients consult their doctor to ensure they fully understand what these are before deciding on a technique. They should also inform the doctor of what they are looking to achieve, so they can advise them on which surgery could provide them with the results they are hoping for, as well as its potential impacts on the patient’s physicality thereafter.
Pride Clinic at Bumrungrad Hospital offers gender affirmation procedures performed by experienced surgeons with high levels of expertise in the field, who help their patients achieve their own unique objectives in the safest manner possible. Our team consists of surgeons specializing in the field of gender affirmation working alongside experts in various other related fields to ensure our patients receive the care and attention they deserve.

To find out more details, please contact:
Pride Clinic 
Tel:  063-221-0957 or 02-066-8888 ext. 1378

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