Metoidioplasty
The main aims of genital masculinisation surgery are to eliminate female reproductive function, masculinise the external appearance of the genitals, create a neourethra that allows you to urinate standing up, and form a neophallus with sufficient rigidity for sexual activity. To achieve this, different surgical procedures may be performed, including oophorectomy and hysterectomy, vaginal closure, vaginectomy, metoidioplasty or phalloplasty, either as a single operation or in several stages. It is important to note that not all of these procedures are necessary for everyone; each patient can choose the interventions that best suit their personal goals, preferences and medical needs.
What does the procedure involve?
One of the options for creating a neophallus is metoidioplasty, which makes use of clitoral growth stimulated by hormone therapy to create a micropenis measuring approximately 3–7 cm in length and 1.5–2 cm in diameter. This technique preserves erogenous sensation and erectile function, while also allowing you to urinate standing up and avoiding visible scars outside the genital area. To lengthen the urethra, tissue flaps from the anterior vaginal wall or skin from the labia minora may be used, or, in some cases, oral mucosa or foreskin tissue. The labia majora are repositioned to create a scrotum, where testicular implants can be placed during the same surgery or in a subsequent procedure.
International experience shows that metoidioplasty is a preferred option for people seeking a less invasive procedure, with fewer scars and preservation of sexual function. However, the resulting micropenis is usually small and generally does not allow penetrative sex.
The surgery is performed under general anaesthetic and usually takes between 3 and 4 hours. After the operation, a urinary catheter is kept in place for approximately three weeks, and a low-residue diet is recommended during the first week. You can usually begin mobilising from the second day onwards. Although the surgery can be performed in a single stage, complete urethral reconstruction generally has better outcomes when carried out in two stages. The most common complications include urinary tract infections, overactive bladder, small urethral fistulas and strictures, which may require additional surgery in some cases. The reported rate of urological complications varies between 8.9% and 35%.
In summary, metoidioplasty is an effective technique for genital masculinisation in trans men who want a less complex procedure that preserves sensation and sexual function while minimising external scarring. However, the final size of the neophallus limits penetrative sex, so in some cases phalloplasty may be considered as a subsequent step.
Importance of the medical team
International guidelines recommend that this surgery is performed by surgeons with specific training in gender-affirming surgery, working as part of a multidisciplinary team and providing clear information about the benefits, risks and post-operative care.
Timeline
Step-by-step explanation of the process
Additional information
Detailed information about the procedure
Further information
We have prepared some documents containing detailed information.
This is general information and should be tailored to each individual patient. This personalised assessment, together with a detailed explanation of the procedure and the opportunity to address any questions or concerns, takes place during consultations with Dr. García.
Your change starts here
We will contact you to schedule your first consultation. Dr. García will assess your case in detail and propose the best solution, explaining the pros and cons so you can make an informed decision.