Metoidioplasty is a gender-affirming surgery that creates a small-sized penis from a person's clitoris. A scrotum is often created at the same time. And the urethra may be lengthened. Read on to learn more about this procedure and the recovery.

There are certain things you may need to do before having metoidioplasty:

• You will need to take testosterone for at least 12 months before metoidioplasty. This is to enlarge the clitoris before the surgery. Talk with the doctor who prescribes your hormones.
• Talk with your surgeon about whether you also want to have surgery to:
  • Remove the uterus (hysterectomy)
  • Remove the ovaries (oophorectomy)
  • Remove the vagina (vaginectomy)

Some of these procedures may need to be done a few months before metoidioplasty. A vaginectomy may be done during metoidioplasty.

• Talk with your surgeon about any fertility-preserving procedures you may want to have before the above surgeries. These may include freezing (cryopreservation) of ovarian tissue, eggs, or embryos.

There are several ways the procedure may be done, depending on the choices you choose. In general, this is what you can expect from a one-stage full metoidioplasty with urethral lengthening and scrotoplasty:

• You will be given general anesthesia. This medicine prevents pain and puts you to sleep during the procedure.
• You will be given antibiotic medicine through an I.V. (intravenous) line.
• You will be placed on your back on an exam table. Your feet will be in stirrups.
• You will have a thin, flexible tube (catheter) put in your urethra. This is to drain urine during the procedure if needed.

To remove the vagina (vaginectomy):

• The surgeon removes the vaginal lining.
• The vaginal opening is sewed closed.

To create the penis:

• The surgeon cuts the ligaments that hold the clitoris in place.
• Parts of the tissue around the clitoris are also cut. This releases the clitoris.
• The surgeon shapes the clitoris into a penis. They also use tissue from the existing external genitals, the inner and outer labia.

To lengthen the urethra:

• A new section of urethra is created, using tissue grafted from the inside of your cheek. This new section is extended into your penis.
• It is connected to your existing urethra using a part of the vaginal lining.

To make the scrotum (scrotoplasty):

• The outer labia are shaped into a scrotum.
• Testicular implants can be placed in the scrotum at a later date.

It may take a few months to fully heal from the surgery. Talk with your surgeon about what to expect.

• Take pain medicine as advised by your doctor.
• Your surgeon will advise when you can go back to taking your other regular medicines.
• Follow up with your doctor to see what hormones you need to take.
• The surgeon may remove the urinary catheter and any surgical drains before discharge. If not, they will be removed at a follow-up visit.

• If you go home with a urinary catheter and surgical drains, follow the instructions carefully. They will be removed at a follow-up visit.
• You will have regular follow-up visits with your surgeon to check how you are healing.
• Follow all advice from your surgeon about resting after surgery. You will likely need to rest for at least 6 weeks or more.
• Don't do any strenuous activity. Ask your doctor about taking some short walks each day. Don't lift anything heavy.
• Ask your doctor when it's okay for you to drive and when you can go back to work.
• Your doctor will tell you when you can have sex.

Contact your doctor if you have any of the following:

• Fever of 100.4°F (38°C) or higher, or as advised by your doctor
• Fluid leaking from your incision
• Trouble or pain when urinating
• Too much bleeding

Be sure you know what other problems you should watch for. Also know how to get help any time. This includes after office hours and on weekends and holidays.

Possible complications of this surgery include:

• Infection
• Urethral narrowing (stricture)
• Opening occurs in the urethra that leaks urine (urethral fistula)
• Urinary tract infections
• Need for another surgery if you are not happy with the results

Urethral complications are frequent after this surgery. Needing corrective surgery after the first surgery is common. Talk to your doctor to make sure you are aware of the serious risks.