Abstract
Gender dysphoria is a condition where there is a discrepancy between the gender assigned at birth and the desired gender, leading the patient to pursue surgical intervention. Reconstruction of the neophallus for transmen is still challenging, even though there are many surgical techniques with satisfying results. The aim of neophallic reconstruction in gender affirmation surgery (GAS) for transmen is to provide stand-up voiding, erotic sensation, orgasm and penetration ability, and acceptable donor site morbidity with minimal scarring and complications. Metoidioplasty as a variant of phalloplasty for transmen is a one-stage procedure that results in male-like external genitals, with minimal scarring, ability of standing micturition, and full erogenous sensation with the ability to achieve orgasm during sexual intercourse. Metoidioplasty is a method of choice for those transmen who wish to have GAS in one procedure without multi-staged procedures to create the adult-male-sized neophallus.
Highlights
Gender affirmation surgeries usually represent the final step in the transition process of an individual suffering from gender dysphoria
It is still difficult to assess the real prevalence of gender dysphoria, but the latest studies report an increase in prevalence for individuals assigned male at birth to 0.014-0.015, while, for individuals assigned female at birth, it is 0.002-0.003
Preoperative counseling with a sexologist, the treating surgeon, and a psychotherapist is very important to reveal the patient’s sexuality and sexual functioning before the surgery, but will be of essential importance after the GA[18]. From the time it was first introduced as a genital reconstruction procedure using hypertrophied clitoris, metoidioplasty has been refined by several authors in order to gain neophallic length, achieve more naturallooking male-like genitalia, and to provide voiding while standing[10,19]
Summary
Gender affirmation surgeries usually represent the final step in the transition process of an individual suffering from gender dysphoria. In the majority of patients, metoidioplasty enables voiding in standing position and full erogenous sensation, but penetration during sexual intercourse is possible in only rare cases (by self-report)[5,9]. Metoidioplasty can be considered as the method of choice, for those individuals requiring male genitalia reconstruction in single surgery to complete their transition and who do not wish to have stigma scars outside the genital area.
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