How should I prepare for metoidioplasty?
You’ll work with healthcare providers for at least a year to prepare you for metoidioplasty. Your preparations may include:
- A physical exam to assess your overall health and learn more about your medical history.
- Patient education, including literature and conversations with a provider so you fully understand the risks, benefits and postsurgical care requirements.
- A mental status exam from a qualified mental health provider (therapist, psychiatrist or social worker) to ensure your understanding of the procedure. They’ll ask why you want a metoidioplasty, explain how the procedure will affect your life and ask about your expectations. You’ll need surgery referral letters from two mental health providers.
- Take hormone therapy for at least one year.
- Live for at least one year in a manner consistent with your gender identity.
- Health recommendations to help reduce your risk of complications, such as quitting smoking.
Can I get other gender-affirming surgeries with a metoidioplasty?
Yes, you may also get other gender-affirming surgeries or additional changes at the same time as your metoidioplasty. These may include:
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- Making your urethra longer (urethroplasty).
- Creating a scrotum (scrotoplasty) to add testicular prostheses.
- Closing your vagina (vaginectomy), which must include removing your uterus (hysterectomy) and may include removing your ovaries (oophorectomy).
What happens before metoidioplasty?
In general, before metoidioplasty, you’ll need to:
- List all of your allergies.
- List all of your prescription or over-the-counter (OTC) medications, including herbal supplements.
- Temporarily stop all blood-thinning medications, if you take them.
- Not eat or drink eight to 12 hours before your surgery.
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If you must take some medications before surgery, you may take them with a small sip of water.
What healthcare providers make up a metoidioplasty team?
The following healthcare providers may make up your metoidioplasty team:
- Reconstructive urologist.
- Plastic surgeon.
- Anesthesiologist.
What happens during metoidioplasty?
An anesthesiologist will first give you general anesthesia before surgery. General anesthesia puts you to sleep. You won’t feel pain or experience any other sensations during surgery.
Then, a surgeon will use the tissue from your enlarged clitoris to form a penis. Depending on the type of approach your surgeon may use, they’ll:
- Release the clitoris by using a surgical knife (scalpel) to cut the ligaments that connect the clitoris to your pubic bone. This is a simple metoidioplasty.
- Insert a plastic tube (catheter) into your urinary bladder. They’ll thread the catheter through your neophallus to keep your urethra open.
- Use tissue from your vagina or cheeks (buccal mucosa) to make your urethra longer.
- Use vaginal tissue to increase the length and girth (circumference) of your neophallus.
How long does metoidioplasty take?
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It depends on several factors, including whether or not your metoidioplasty care team performs other gender-affirming procedures at the same time. But in general, a metoidioplasty may take two to five hours to complete.
What happens after metoidioplasty?
After the procedure, healthcare providers will stitch your incisions and cover them with bandages. You’ll also stop receiving anesthesia. After a few minutes, you’ll be conscious (awake) but will likely feel groggy. Providers will monitor your overall health and manage your pain once you fully wake up.
Once the providers determine you’re healthy enough and no longer require monitoring, you can go home. Most people go home after spending a day or two in the hospital.
You’ll need time to heal after a metoidioplasty. Sometimes, your healthcare team will perform the surgery in several steps. You may need other surgeries that take place four to six months after your first surgery.
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