Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience.

Posted: June 3, 2010 in Bottom Surgery, DHT, Growth, Metiodioplasty, Post-op, Transgender, Urethral Extention, Vaginectomy

J Sex Med. 2009 May;6(5):1306-13. Epub 2009 Oct 27.

Djordjevic ML, Stanojevic D, Bizic M, Kojovic V, Majstorovic M, Vujovic S, Milosevic A, Korac G, Perovic SV.

University Children’s Hospital-Urology, Belgrade, Serbia.



Metoidioplasty represents one of the variants of phalloplasty in female transsexuals. Its main characteristic is that it is a one-stage procedure. It involves lengthening and straightening of hypertrophied clitoris to create a neophallus, urethral lengthening to enable voiding while standing, and scrotal reconstruction with insertion of testicle prostheses.


Our aim is to describe our technique and highlight its advantages.


Between September 2002 and April 2007, 82 female transsexuals, aged 18-54 years (mean age 31) underwent one-stage metoidioplasty. Clitoris is lengthened and straightened by division of clitoral ligaments and short urethral plate. Urethroplasty is done with combined buccal mucosa graft and genital skin flaps. Scrotum is created from labia majora in which two testicle prostheses are inserted. Simultaneously, female genitalia are removed.


Patients’ personal satisfaction about sensitivity and length of neophallus, possibility to void in standing position, real length of reconstructed urethra as well as complication rate comparing to other published data.


The median follow-up was 32 months (range 14-69). The mean neophallic length was 5.7 cm (range 4-10). Voiding in standing position was reported in all patients, while dribbling and spraying were noticed in 23 cases and solved spontaneously. There were two urethral strictures and seven fistulas that required secondary minor revision. All patients reported preserved sensation and normal postoperative erection. Testicle prostheses rejection was not observed in any of the patients.


Metoidioplasty is a single-stage and time-saving procedure. It could be an alternative to total phalloplasty in female transsexuals who do not wish to have sexual intercourse. Also, it represents a first step in cases where additional augmentation phalloplasty is required.

PMID: 19175859 [PubMed – indexed for MEDLINE]

  1. Zephyr says:

    ‘It could be an alternative to total phalloplasty in female transsexuals who do not wish to have sexual intercourse.’
    Not necessarily. If you were born with a naturally large clitoris which then becomes larger under influence of testosterone and they also lengthen it during the operation, then it can be big enough to have sexual intercourse.
    Of course, in most case where patiens started out with a ‘normal sized’ clit which then grew larger under influence of hormones, you are right. If they then go for metoidplasty, often the penis isn’t large enough for intercourse.

    • toyneboi says:

      If you actually read the post you will see i did not write this. It’s a medical article written by the Belgrade Team themselves a few years ago. The mean size for this articles study was about 10 cm out of 82 patients. Im over that mean size pre op, I’ve been penetrating since 6 months on T so I know all too well after Meta I will be able to continue to do so. The Belgrade team sees metoidioplasty as an alternative to any phalloplasty and/or a first stage in phalloplasty. Also I have seen some who were born larger then others and the majority tend not to get that much larger post T. Fuller yes but added length no.

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