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The Ultimate Guide: Is a Metoidioplasty Right for You?

Medically reviewed by Nicole M, RN on October 3, 2024.

Welcome to our page on metoidioplasty. The two types of bottom surgeries that our practice offers for patients wishing to create or enlarge a phallus are (1) the phalloplasty and (2) the metoidioplasty, which is sometimes called a “meta.” Dr. Ley (she/her) is the board-certified gender affirming surgeon who performs metas and other types of bottom surgeries for patients of all gender identities. Dr. Ley along with the rest of our surgical team, work to make patients feel comfortable and in-control at every step of the surgical journey. No question or concern is too small for us.

Below you will find an introduction to our most frequently asked questions from patients about the metoidioplasty. If you have more specific questions or concerns, you can always request a consultation with Dr. Ley.  We encourage you to read on if you are curious about the following topics:

• How a metoidioplasty is performed
• The aesthetic results of a metoidioplasty
• The risk of sensation loss
• What procedure type enables patients to urinate while standing
• Whether a vaginectomy (removing the vaginal canal) is necessary to have a meta
• Surgical recovery and possible complications

What is a metoidioplasty?

A meta or metoidioplasty is a procedure that enlarges a patient’s phallus. This is accomplished by releasing the erectile tissue (sometimes called the clitoris), which has often grown from testosterone, from its surrounding ligaments.

This procedure is often pursued by patients who would experience euphoria from having increased bottom growth and/or from being able to urinate with ease while standing. However, patients who are interested in having a phallus large enough to easily engage in penetrative sex tend to opt for a phalloplasty.

Our practice offers two types of metoidioplasty procedures: (1) the simple meta and (2) the “meta with PUL,” which stands for primary urethral lengthening. The meta with PUL gives patients the ability to urinate standing up. We have provided some information below to help you make the decision about which procedure would be right for you.

If you are concerned about recovering from surgery, know that metas involve a less intense recovery than a phalloplasty. Also, they generally do not involve multiple, staged surgeries unless a patient would like an additional bottom surgery procedure—for example, a hysterectomy (removal of the uterus) or a scrotoplasty with testicular implants (to create the appearance of testicles).

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Simple metoidioplasty vs. meta with primary urethral lengthening (PUL):

• Do I need to take testosterone and/or experience “bottom growth” to have a metoidioplasty?

• Patients do not need to undergo testosterone hormone replacement therapy (HRT) to have a metoidioplasty with the Gender Confirmation Center. Patients who are taking testosterone HRT are recommended to wait 1-2 years after beginning treatment to maximize their chances of bottom growth. That said, the natal erectile tissue (sometimes called a penis or clitoris) does not always grow as a result of exposure to testosterone. Bottom growth is also not a requirement to undergo this surgery with us.

• If I want to be able to urinate standing up, which procedure can help me achieve that?

• A meta with PUL takes the labia minora to reposition and lengthen the urethra so that it comes out at the end of the penis shaft. It is precisely the urethral lengthening which will allow the patient to urinate from their penis and stand to pee.

  On the other hand, a simple meta would not change the location of the urethra. This means that a patient would still likely need an external apparatus, like a specialized packer, to urinate standing up.

• What is the risk of sensation loss?

• With any metoidioplasty, there is a very low chance of losing any sensation in your penis or other tissue in your groin. Both procedure types are ideal for patients hoping to achieve an enlarged phallic structure with preserved erogenous sensation.

• Can I get an erection? If having penetrative sex and/or maximizing penis size is a priority for me, which procedure should I choose?

• Generally speaking, a metoidioplasty can allow patients to experience erections since their natal erectile tissue is preserved and released. This would not require the surgical insertion of an erectile device, as is the case with phalloplasties. If the results are healing well, a patient can begin to use a penis pump after about 3 months post-op to enlarge their size and better facilitate the possibility of penetration.

  That said, if a patient’s greatest priority is achieving a great amount of phallic girth and length, a phalloplasty might be their best option. More concretely, the size of the penis created by a metoidioplasty, compared to a phalloplasty, will be smaller and may be less easily used for penetrative sex with a partner. However, in any metoidioplasty procedure, some of the labia minora tissue can be used to help give the shaft of the penis more girth if that would help a patient meet their goals.

• What is scarring from a metoidioplasty like?

• One reason why many patients opt for a metoidioplasty instead of a phalloplasty is because both the recovery process is far less intense and scars are much less visible. Light scarring may result from taking the labia to extend the urethra or create a scrotum if a patient opts for those additional procedures.

• What is the recovery process for a metoidioplasty?

• If you get a simple meta, you will most likely be discharged from the hospital the day of your operation. If you get a meta with PUL you can expect to stay in the hospital for two nights and use a catheter to urinate for 2-3 weeks. It is completely normal to experience swelling and bruising around your genital area; this will slowly decrease over the next few weeks. For most patients, after about 6 months, the swelling is expected to completely resolve and you should be able to clearly see your final surgical result. For some, this may take longer.

  Starting the day after surgery, patients are encouraged to walk lightly to help reduce the risk of blood clots. Lighter physical activities should not be taken up until about 4 weeks post op. If there are no complications, patients can often return to work after about a month post-op. Many patients who undergo a simple meta can begin to engage in light sexual activity, like gentle manual stimulation, six weeks after surgery. We encourage patients who undergo urethral lengthening to wait 3 months before engaging in any sexual activity alone or with a partner. Likewise, at least three months should go by before a patient can use a penis pump to facilitate their ability to have penetrative sex.

  Having a urethral lengthening, vaginectomy and scrotoplasty as a part of your initial procedure can increase the levels of pain and complication risk that a patient will undergo during recovery. We encourage you to stay patient with the healing process, tap into your networks for emotional support and reach out to us for any questions about recovery in real-time. Once you are a GCC patient you will always be a GCC patient. We are committed to doing everything in our power to ease your recovery process so that you can enjoy your surgical results once you have fully healed.

• What complications may arise from a metoidioplasty?

• Many patients report that the emotional recovery process after any kind of bottom surgery is more difficult than the physical recovery process. This is especially the case if complications arise. The most common complications, like wound openings, resolve with time and proper home care. Even then, it is normal for complications to result in temporary feelings of frustration, sadness and even regret. It is hard to experience delays in the healing timeline: prolonging when you can get back to work, sit comfortably without a supportive pillow for long periods of time, or engage in sexual activity. We encourage you to be patient with your body as it heals from surgical affirmation, lean on your support network (friends, family and/or mental health professionals) and trust that any pain, discomfort and inflammation will eventually subside with the proper care.

  Any patient who undergoes urinary lengthening is expected to experience a certain level of discomfort––such as bladder spasms––while they use a catheter. The most common urinary complications that arise usually resolve on their own. We encourage you to share any concerns that arise around irregular urination––like the presence of blood, increased straining, urinary retention, frequent urination or a urinary tract infection––with your surgical team and local provider(s). No concern is too small for us. We are committed to doing everything in our power to support you through the difficulties of your recovery process.

  Additionally, wound opening, however slight, can occur when patients make harsh movements early on that stretch the groin. Wound opening can delay the amount of time required to heal, which can cause frustration and sometimes worry in patients as they experience prolonged discomfort and delays in returning to their normal life. We especially encourage scrotoplasty patients to be mindful of this risk. Thankfully, simple wound care should resolve the issue over time. We do not suture reopened wounds from bottom surgery due to infection risk. We encourage you to practice patience, compassion and trust with your body as it does its best to heal.

  To help manage and prevent complications, we will present you with recovery guidelines before your operation––such as mobility limitations, exercise, avoiding smoking and alcohol, and addressing your other medical conditions. Know that you can always count on our dedicated staff for support if any issue arises.

• Is a hysterectomy or vaginectomy required to get a metoidioplasty?

• A vaginectomy is a removal of the vaginal canal. We honor a patient’s decision to preserve their vagina or front hole when it aligns with their gender affirming goals. That said, whenever a urethral lengthening is performed, Dr. Ley requires a vaginectomy due to the very high risk of complications. Patients who opt for a simple meta can also get a vaginectomy if they choose, though it is not required.

  Patients who get a vaginectomy with a metoidioplasty can have both procedures conducted on the same day. That said, in order to undergo a vaginectomy, a patient must have undergone a hysterectomy, or removal of the uterus, beforehand. The removal of one or both of the ovaries, known as an oophorectomy, is not required.

• What other bottom surgery procedures can I get with or after a metoidioplasty?

• Whether you chose a simple meta or a meta with PUL, you can also opt to have a scrotoplasty, hysterectomy, oophorectomy, mons resection, testicular implants, or a variety of other procedures to help you feel as aligned as surgically possible with your body. If you would like to learn more about these additional procedures, you can click here. To learn more about how these additional procedures can fit into the timeline of a metoidioplasty, we encourage you to look over the section below.

  Additionally, some individuals who have undergone metoidioplasty may desire to have a phalloplasty in the future. This surgical option remains available even after undergoing a simple meta or a meta with PUL.

• How many operations will it take to meet my surgical goals? How long will I have to stay in the hospital after each procedure?

• In plastic and reconstructive surgery, when we talk about the number of procedures required to reach a certain goal, and how much time is required between procedures, we are talking about staging. Please note that metoidioplasty by itself is a single stage. Depending on the additional associated procedure(s) a patient wants to get with a meta, there may be a need for additional surgeries to be performed at later dates. Likewise, any patient that undergoes a metoidioplasty can eventually get a phalloplasty performed in the future if they choose.

  Metoidioplasty Staging
  Stage	Length of hospital stay	Procedure description
  STAGE I	No UL: Outpatient With UL/vaginectomy: 2 days	Metoidioplasty +/- urethral lengthening, vaginectomy, scrotoplasty
  STAGE II	Outpatient	(Optional, may be recommended) Mons resection
  STAGE III (3-4 months after stage I)	Outpatient	Insertion of scrotal tissue expanders
  STAGE IV (4-5 months after stage III)	Outpatient	Removal of scrotal tissue expanders, insertion of testicular implants