Metoidioplasty and phalloplasty are two primary surgical options available for transgender men and non-binary individuals seeking gender-correction surgery. While both procedures aim to construct male genitalia, they differ significantly in terms of technique, outcomes, and recovery.

Metoidioplasty

Metoidioplasty is a procedure that utilizes the patient’s naturally enlarged clitoris, which has grown in response to testosterone treatment. This method is less invasive compared to phalloplasty and offers several unique advantages:

Sensation Preservation: One of the key benefits of metoidioplasty is that it preserves the natural sensation of the clitoris, allowing for greater sexual function post-surgery. Since the clitoris is used to form the neophallus, the ability to experience orgasm often remains intact.
Less Invasive: Metoidioplasty is generally a simpler procedure compared to phalloplasty. It does not require extensive tissue grafting from other parts of the body (such as the thigh or pubis), and the recovery time tends to be shorter.
Smaller Neophallus: The neophallus formed in metoidioplasty is smaller than that achieved in phalloplasty, which may limit the ability to engage in penetrative sexual intercourse. However, many patients find the procedure suitable for their needs, especially if maintaining sensation and functionality is a priority.
Urethral Lengthening: Metoidioplasty can include urethral lengthening, allowing the patient to urinate while standing. However, urethral lengthening is a complex step, and it carries risks such as the development of fistulas or urinary tract infections.
Additional Procedures: Patients who opt for metoidioplasty may also undergo hysterectomy, oophorectomy, and scrotoplasty (with or without testicular implants) to achieve a more masculine appearance.

Phalloplasty

Phalloplasty, on the other hand, is a more extensive surgical procedure that involves constructing a larger penis from tissue taken from donor sites like the forearm, thigh, or abdomen. Here are some key differences and features:

Tissue Grafting: Phalloplasty requires tissue expansion and grafting from other areas of the body. The donor tissue is shaped into a neophallus, which more closely resembles a biological human penis in terms of length and appearance.
More Complex Surgery: Phalloplasty is a more complicated procedure, often involving multiple stages. The surgeon must connect the nerves, blood vessels, and erectile tissue to ensure that the neophallus functions correctly. Recovery from this surgery can take several months, and the risk of complications like hematomas, seromas, and infection is higher.
Penile Implants for Erection: Many patients who undergo phalloplasty also opt for penile implants to achieve erection. These implants allow for penetrative intercourse, though there are risks involved with implant rejection or mechanical failure.
Sensation Loss: Unlike metoidioplasty, which preserves sensation in the clitoris, phalloplasty often results in reduced sensation in the neophallus due to the use of external tissue. However, surgeons aim to preserve as much sensation as possible by connecting nerves from the donor site to the recipient area.
Better Aesthetic Outcome: Phalloplasty tends to provide a more aesthetically masculine result, with a larger neophallus that closely resembles a biological penis. Patients often find this important for body image and self-esteem.
Urinary Function: Like metoidioplasty, phalloplasty can include urethral lengthening to allow for standing urination. However, this carries the same risks of fistulas and urinary tract infections.

Comparison of Outcomes

Aesthetic vs. Functional Goals:
- Metoidioplasty offers better preservation of sexual function and sensation, but results in a smaller neophallus. It may not be ideal for those seeking a larger, penetrative penis.
- Phalloplasty provides a larger, more masculine-looking penis but often involves more surgeries and higher risks of complications. Sensation may be diminished, and recovery is longer.
Complexity and Recovery:
- Metoidioplasty is less invasive, typically requires fewer stages, and has a quicker recovery period.
- Phalloplasty is more complex, requires multiple surgeries, and comes with a higher risk of complications, but offers a larger neophallus.
Urethral and Sexual Function:
- Both surgeries offer the option for urethral lengthening to enable standing urination, but this step carries risks for both.
- In terms of sexual intercourse, phalloplasty generally offers better outcomes for penetrative intercourse due to its larger size and the availability of penile implants.

Choosing Between Metoidioplasty and Phalloplasty

The decision between metoidioplasty and phalloplasty often comes down to personal preferences regarding aesthetic appearance, sexual function, and willingness to undergo multiple surgeries.

Transgender and non-binary gender individuals considering these surgeries must consult with their health care providers, who will assess their overall health, anatomy, and goals for surgery.

Both options is tailored to meet the unique needs of the patient. Advances in medical research and surgical techniques continue to improve outcomes, giving individuals more control over their transition process.