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Metoidioplasty Surgery

What is Metoidioplasty?

Content warning: the content below uses some anatomy/biological terms where it is important to be precise

This is a surgical procedure which creates a neo-phallus (small penis) from existing genital tissue. The clitoral tissue is detached from the labia and ligaments cut to form a masculine looking phallus, whilst retaining sensitivity. If you wish to pass urine through your neo-phallus, you can also have a urethroplasty (urethral lengthening plus connection (or hook-up) to the native water passage). The combination of the metoidioplasty and urethroplasty will allow you to urinate standing up. You are able to have the metoidioplasty element on its own, which would give you the neo-phallus, but allow you to keep your existing urethral opening.

You would need to urinate sitting down in this instance. Urethral lengthening without hook-up is often offered if you don’t want to consider the full urethroplasty, with the purpose to obtain a wider girth of the neophallus; choosing this last option will allow you to potentially have the connection (hook-up) of the urethra done in a second stage. Additional urethral reconstruction may be performed using tissue from the labia minora, or less frequently using a “buccal mucosa graft” (small flap of skin from the inner cheek). The buccal mucosa graft is harvested from the inner cheek. It is possible to also have the additions of scrotal implants and/or retention of the vagina. Whilst retaining sensitivity, it is a less effective surgical approach for patients wanting a phallus comparable in size to that of a cis male, or who wish to perform a penetrative role in sexual intercourse using their phallus.

What is Laparoscopic Hysterectomy?

We offer laparoscopic surgery (a minimally invasive keyhole approach) for almost all patients having gender-affirming hysterectomy. You’ll have either a robotic-assisted or a laparoscopic hysterectomy or sometimes a vaginal hysterectomy. With the robotic or laparoscopic types of hysterectomies, your surgeon will make several small incisions (surgical cuts) on your abdomen. They’ll put a laparoscope (a long, thin surgical tool with a video camera) through one of the incisions into your abdomen. The laparoscope lets your surgeon see the inside of your abdomen.

Carbon dioxide gas will be pumped into your abdomen to make space. This gives your surgeon more room to do your surgery. Your surgeon will also put long, skinny surgical tools into the other incisions on your abdomen. With a laparoscopic hysterectomy, your surgeon directly controls the surgical tools with their hands. They can see the images from the laparoscope on a television monitor. With a robotic-assisted hysterectomy, your surgeon sits at a console and controls a robot that moves the surgical tools. The console has a special monitor where they can see the images from the laparoscope on a high-definition 3D screen. With both types of hysterectomy, your surgeon will remove your uterus, cervix and fallopian tubes through your front-hole, if possible. If you have decided on having one or both ovaries removed, your surgeon will also remove these. If your uterus or cervix (+/- ovaries) can’t be removed through your front-hole (for example if your uterus is enlarged by fibroids or you have a big ovarian cyst), your surgeon will make one of your abdominal incisions bigger and remove your uterus and cervix from there. This is uncommon. Then they’ll close your incisions with sutures (stitches). Prior to surgery, your wishes for specific bottom surgery will be discussed so the incisions do not interfere with the next steps of the operation.

Hysterecotmy & Metoidioplasy Patient Information Document

Your surgical pathway

We offer patients an individualised consultation with a Clinical Nurse Specialist (CNS) with the aim to collect a detailed holistic history of the patient, and to identify potential matters that require referral to other services (e.g. dietician, endocrinology, physiotherapy, and psychologist). An appointment with one of our lead surgeons is then arranged. This will provide an opportunity for patients to ask any questions they may have regarding their surgery. The surgical case will then be discussed at our multi-disciplinary team (MDT) meeting where the outcome will determine whether the patient is fit for surgery.

If the outcome determines that the patient is not fit for surgery this will be communicated to the patient via telephone or via a virtual clinic with their surgeon. A second virtual surgical consult will take place following on from the MDT, where a clear understanding of the implications, risks, cosmetic and functional outcomes of the chosen surgical procedure will be discussed with the patient prior to their surgery date. Once a TCI (To come in) date for surgery has been provided to the patient, they can be expected to be admitted to the Surgical Admissions Lounge (SAL) on the day of surgery within the main hospital. Depending on which type of surgery the patient undergoes will depend on their length of admission and recovery, all details will be explained within our CNS and surgeon consultations.

Risks and complications

If you are accepted for surgery, your consent form will explain the potential risks and complications of your surgery. Details of this will also be discussed in your surgical consultations.