Rigi10™ Malleable Penile Prosthesis
Also Known As
Meta, Clitoral release, Masculinizing genitoplasty, Neophalloplasty (subtype)
Definition
Metoidioplasty, often referred to as “meta,” is a gender-affirming surgical procedure primarily for transgender men (female-to-male, FTM) or gender non-binary individuals assigned female at birth, which creates a neophallus (a new penis) from the existing clitoris that has been enlarged through testosterone hormone therapy. The procedure involves surgically releasing the clitoris from its suspensory ligaments and surrounding tissues, allowing it to extend outwards and downwards, thereby forming a small phallus. Depending on the specific technique and patient goals, metoidioplasty can be a single-stage or multi-stage procedure and may include urethral lengthening (urethroplasty) to enable voiding while standing, scrotoplasty (creation of a scrotum, often with testicular implants), and vaginectomy (removal of the vagina). The primary purpose of metoidioplasty is to create male-appearing external genitalia that aligns with the individual’s gender identity, allows for standing urination, and preserves erogenous sensation, as the clitoral tissue, which is rich in nerve endings, forms the basis of the neophallus. While the resulting phallus is typically smaller than that achieved through phalloplasty (another type of neophallus construction using tissue grafts), metoidioplasty generally involves fewer surgical stages, a lower complication rate, and often retains the capacity for erection of the neophallus due to the preservation of native erectile tissues. The specific outcomes, including neophallus size and functional capabilities, vary depending on the individual’s anatomy, the extent of clitoral hypertrophy from testosterone, the surgical techniques employed, and whether ancillary procedures are performed. It is considered a significant step in the medical transition process for many transgender individuals, aiming to alleviate gender dysphoria and improve quality of life.
Clinical Context
Metoidioplasty is clinically indicated for transgender men and gender non-binary individuals assigned female at birth who experience gender dysphoria and desire masculinization of their external genitalia.¹ It is a gender-affirming surgery that aims to create a neophallus from the hormonally enlarged clitoris, enabling a more congruent physical appearance with their gender identity. Patient selection criteria typically include a confirmed diagnosis of gender dysphoria, capacity to make an informed decision, being of the age of majority, and having undergone at least 12 months of continuous testosterone therapy leading to adequate clitoral hypertrophy, which is crucial for the neophallus size.¹˒² The World Professional Association for Transgender Health (WPATH) Standards of Care provide guidelines for eligibility, often requiring letters of support from mental health professionals.²
The surgical procedure itself can vary but generally involves the clitoral release (degloving and transection of suspensory ligaments) to allow the clitoris to project more like a penis.¹ Depending on the patient’s goals and the surgeon’s technique, metoidioplasty may be performed as a simple clitoral release or a more complex, full metoidioplasty. Full metoidioplasty often includes urethroplasty, which is the extension of the urethra through the neophallus to allow for voiding while standing. This can be achieved using various tissues, such as buccal mucosa grafts or local flaps from the labia minora or vaginal wall.¹˒² Scrotoplasty, the creation of a scrotum from the labia majora, and the insertion of testicular prostheses are also common ancillary procedures performed concurrently or in a staged manner to enhance the masculine appearance of the genitalia.¹˒³ Vaginectomy, the removal of the vagina, may also be performed as part of a full metoidioplasty if desired by the patient and deemed appropriate by the surgical team.³
Expected outcomes of metoidioplasty include the creation of a small, sensate neophallus (typically 4-10 cm in length, though this varies), the ability to urinate while standing (if urethroplasty is successful), and preserved capacity for orgasm and sexual arousal due to the clitoral origin of the neophallus.¹˒²˒³ Patient satisfaction rates are generally high, with many reporting significant improvement in gender dysphoria and quality of life.² However, it is important for patients to understand that the neophallus created via metoidioplasty is typically not sufficient for penetrative intercourse without the use of assistive devices, unlike phalloplasty which can create a larger phallus.² Complication rates are relatively low compared to phalloplasty, but can include urethral fistulas (abnormal openings in the urethra) or strictures (narrowing of the urethra), wound infections, hematoma, and issues with testicular implants if used.¹˒² Smoking is a significant risk factor for complications.³ Recovery typically involves a hospital stay of a few days, with a urinary catheter in place for about a week if urethroplasty is performed. Full healing and return to strenuous activities can take several weeks to months.³