Metoidioplasty

Metoidioplasty is a gender-affirming, masculinizing, lower surgery to create a penis and scrotum, done by cutting ligaments around the clitoris*clitoris* (with an asterisk) is used to acknowledge the many different words that are used for this body part. to add length to the shaft, grafting skin around the shaft to create added girth, lengthening the urethra so one can urinate from the shaft, and creating a scrotum.

What is the procedure for a metoidioplasty?

Surgical techniques vary from surgeon to surgeon. This is the procedure common at GRS Montreal:

  1. Being on testosterone creates an enlarged clitoris*.
  2. The ligament holding the clitoris* in place under the pubic bone is cut.
  3. Some of the surrounding tissue is cut, releasing the clitoris*/creating a phallus.
  4. Your urethra can be extended and incorporated into your phallus.
  5. Fat may be removed from the pubis*pubis* (with an asterisk) is used to acknowledge the many different words that are used for this body part. and skin may be pulled upward to bring your phallus forward.
  6. A flap of skin is removed from the labia minora*labia minora* (with an asterisk) is used to acknowledge the many different words that are used for this body part. and grafted around the phallus to add bulk.
  7. Vagina*vagina* (with an asterisk) is used to acknowledge the many different words that are used for this body part. is closed.
  8. The labia majora*labia majora* (with an asterisk) is used to acknowledge the many different words that are used for this body part. can be shaped into a scrotum.
  9. Testicular implants can be put in your scrotum 6 months later.

How long will my hospital stay be?

You will be admitted to the recovery residence in Montreal two days before your surgery. After your surgery, you will probably spend 3 nights in hospital. Then you will spend 7 more days in the recovery residence. (The number of days in hospital and the recovery residence will be shorter if you chose not to have your urethra lengthened in order to be able to urinate from your penis).

What will my post-operative care look like?

Please visit the GRS Montreal website for more information.

What medications will I be prescribed after surgery?

You will likely receive painkillers and antibiotics to prevent infection. Your surgeon will provide you with a list of medications to avoid around the time of your surgery.

What should I expect during the healing process?

  • Some bleeding
  • Swelling of the genital region for up to around 6 weeks
  • Bruising that can extend from your belly to your thighs. This can take a few weeks to settle down.
  • Itching and occasional small shooting electrical sensations as nerve endings heal
  • Numbness around the incisions that could last several months
  • Difficulty urinating while standing for the first few weeks
  • Pink or red scars on your genitals that will pale over time

What check-ups will be needed after my hospital stay?

The number of check-ups needed varies from person to person. If possible, see your primary care provider about a week after you return from Montreal and then every 2-4 weeks for the first few months. When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound healing problems. They will ask questions about pain, bleeding, urination, bowel movements, fever, and how you are feeling physically and emotionally.

How long will it take for me to get back to my usual activities?

Recovery time varies from person to person, so always follow the advice of your surgeon. Over the six weeks following surgery, you will gradually resume your usual activities. The first week will involve plenty of bed rest. Some activities, such as driving, heavy lifting, exercise, sex, and soaking in hot tubs, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities.

What complications are associated with metoidioplaty?

All surgical procedures involve some risks, including negative reactions to anesthesia, blood loss, blood clots and artery blockages. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise, and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

The list below includes some of the complications associated with metoidioplasty in particular. It does not replace a thorough consultation with your surgeon.

Hematoma

This is when blood collects in the surgical site, causing pain, swelling and redness. May require removal through surgery.

Abscess formation

An abscess is a collection of pus. It’s caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

Seroma

This is when clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon.

Urological complications

These are very common, though they often resolve with time. Examples include fistulas (flow of urine to areas other than urethra opening), stenosis (narrowing of the urethra, causing difficulty urinating), strictures (blockage of the urethra, causing difficulty urinating), and hairy urethras. If these problems don’t resolve on their own, they may require additional surgery.

Unsightly scarring

You can take steps to prevent severe scarring by following your surgeon’s advice about sun avoidance and massage exercises. Severe scarring may require surgical revision.

Dissatisfaction with the size and/or shape

Some people may be dissatisfied with the size and/or shape of the penis*. (Check with your surgeon to see if a revision is possible.)

Decreased sensation and ability to achieve orgasm

It seems likely that the risk of decreased sensation with metoidioplasty would be less compared to phalloplasty, but research is scarce. Check with your surgeon.

Implant complications

You may choose to get testicular implants. Complications associated with testicular implants include poor positioning and infection. If the positioning problems occur, the implant can be surgically removed and replaced. Infections can be treated with antibiotics and when necessary, abscesses can be drained.

What expenses are not covered by MSP?

Please see our Surgery Funding for more information.