The goal of female to male gender reassignment surgery is to create a male body, with appropriate external genitalia. Said genitalia should permit normal urinary function (i.e. urinating from a standing position) and satisfactory erogenous stimulation. To achieve this, there are two general types of surgical technique: metaidoioplasty and phalloplasty.
Metaidoioplasty is the surgical technique that permits the reconstruction of a microphallus or neo-penis some three to six centimetres in length and one and a half to two in girth. This neo-penis provides many of the functional requirements, but the result does not permit sexual penetration.
Metaidoioplasty employs the clitoris, previously hypertrophied from hormone therapy, to create a micropenis. The result is a penis that is small yet sensitive, erogenous and erectile. The procedure is always carried out under general anaesthetic and usually lasts five to six hours.
Due to the preceding androgenic treatment, the female clitoris will have increased considerably in size, and may even have an appearance similar to that of the male penis.
To construct a urethra from the base to the tip of the clitoris, the surgeon will use a graft from the anterior wall of the vagina (some 5 to 7.5 centimetres in length and 2 to 3 in width) and a graft of skin from the labia minora. With all this, the surgeon creates a tube with which to lengthen the urethra.
During the procedure, the labia majora are moved sideways and joined together in the middle to make a new scrotum. Once the scrotal sac has been created, silicon testicular implants are put in place. The implanting of prosthetic testicles may be carried out during this procedure or later in a second operation. The decision on this will depend on the assessment made by the surgeon of the patient’s medical history.
During the procedure, two drainage catheters are placed in the area of the perinea. These are generally removed after 24 hours. Two days after the operation, patients will be allowed to move again.
For the week following the metaidoioplasty, patients must follow a low-fibre (waste-free) diet. Although they will be released five or six days after the operation, patients must wear a bladder catheter for at least three weeks, although it may be possible to remove this after 24 hours (if the doctor deems fit) and replace it with a suprapubic one.
Possible complications of this procedure may require additional surgery and are as follows:
• Bleeding: It is possible to experience a bleeding episode during or after surgery.
• extrusion of the testicular prosthesis.
• urethra-cutaneous fistula: a report of the urethra with the scrotal skin.
• Urethral stricture decreased diameter of the urethra.
• vesico-vaginal fistula: communication between the bladder and vagina