Metoidioplasty is a gender-affirming genital surgery for trans men and transmasculine people. After 1–2 years of testosterone therapy, the clitoris grows larger. During surgery, the enlarged clitoris is released from the surrounding tissue so it projects further, then wrapped in local skin to form a small penis (neophallus).
In a full metoidioplasty, the urethra is also lengthened to the tip of the new penis using tissue from the vaginal wall and labia minora, so you can urinate standing up. Fat is removed from the pubic mound to create a flatter, more typically male shape, and the labia majora are shaped into a scrotum, with the option of testicular implants.
The resulting penis is usually about 3–8 cm long. It keeps the sensation of the clitoris and can become erect naturally, but in most cases it isn’t large enough for penetrative intercourse. If size and penetration are your main goals, phalloplasty may be more suitable.
2 Types of Metoidioplasties at Kamol Hospital at Kamol Cosmetic Hospital
- Simple Release: This procedure focuses on surgically releasing the clitoris from the surrounding tissue. This enhances the visibility and shape of the clitoris, making it appear more penis-like. It does not involve creating a urethra or closing the vagina. Urination remains unchanged. This procedure is less invasive and takes approximately 2 hours.
- Full Metoidioplasty: This is a more comprehensive surgical procedure that lengthens the clitoris by releasing it from surrounding tissue, making it more prominent. The procedure also extends the urethra to the tip of the clitoris using tissue from the vagina. This allows the individual to stand and urinate like a male. Additionally, the vagina can be closed, and artificial testicles can be inserted during the same procedure. This surgery takes approximately 3-4 hours.
Benefits and Limitations of Metoidioplasty
Benefits
- Lower risk than phalloplasty, with no free tissue transfer and no donor site on the arm, thigh, or back.
- More affordable, and fewer surgical stages.
- Multiple procedures in one operation — vaginectomy, urethral lengthening, phallus construction, and testicular implants together in a single 5–6 hour surgery.
- Retains erotic sensation. Because the phallus is built from the clitoris itself, sensitivity is preserved. This is the single biggest advantage over phalloplasty.
- Natural engorgement. The tissue responds to arousal as it did before, without an implanted device.
- Minimal scarring, confined to the genital area.
- Faster recovery. Patients typically stay four nights in hospital and return to daily routine within about three weeks.
Limitations
- Size is limited — roughly 3 to 8 cm, generally not sufficient for penetrative intercourse.
- Testosterone therapy is required beforehand, continued until the clitoris has grown enough for surgery (usually at least 2–3 cm). For most patients that takes one to two years, which is a significant wait.
- Urethral complications are the main risk. Urethral lengthening carries a meaningful rate of fistula and stricture — the most common reason for further surgery, and worth understanding clearly before you commit.
- Standing urination isn’t guaranteed. Most patients achieve it, but not all, and some need revision to get there.
A Good Candidate
- Trans men and transmasculine people seeking genital reconstruction that preserves sensation
- On testosterone therapy long enough for adequate clitoral growth (usually 2–3 cm or more)
- Physically and emotionally stable, with realistic expectations about size and function
- Living in their affirmed gender
- Aged 20 or over, the age of legal consent for this surgery in Thailand
- A non-smoker, or willing to stop
- At a healthy weight, as excess pubic fat affects both the surgery and the visible result
Preparation
- Consult a plastic surgeon experienced in gender-affirming surgery about the procedure, preparation and medications, and complete a physical examination, blood tests and chest X-ray.
- Be assessed by at least two psychiatrists, to make sure you feel confident in your decision.
- Take testosterone for at least 1 year, until the clitoris is large enough for surgery.
- Stop hormones for at least 2 weeks before surgery.
- Maintain a healthy weight, with a BMI under 24, to reduce surgical risks.
- Stop smoking for at least 2 weeks before surgery.
- Stop medicines and supplements that affect blood clotting, such as aspirin and vitamin E.
- Plan time off work, prepare mentally, and arrange support for wound care after surgery.
See Preparing for Gender-Affirming Surgery for the full pathway.
Post-operative Care
- After surgery, you’ll stay in the recovery room for 3–4 hours before moving to your hospital room. The hospital stay is about 4 nights.
- A urinary catheter stays in place for at least 3 weeks while the new urethra heals. Keep the catheter secure, as advised, and empty the urine bag often.
- Keep the new penis raised and upright to reduce swelling, and avoid any pressure on it, to protect its blood supply.
- Wound cleaning and checks continue for 2–3 weeks after surgery.
- Stitches are removed 7 days after surgery.
- Itching, swelling, some blood in the urine bag, constipation and nausea are common in the first 1–2 weeks.
Recovery
Recovery depends on which procedure you had. After full metoidioplasty, allow at least three weeks before returning to work, and avoid heavy lifting. Normal exercise can resume after about two months.
The catheter period is the most demanding part, and it’s worth planning your travel and time off around it rather than around the surgery date alone.
Possible Risks and Complications
Urethral complications (full metoidioplasty only)
- Urethral fistula: a small leak forming an opening along the new urethra, which may need surgical repair.
- Urethral stricture: narrowing of the new urethra, which may need urethral dilation or further surgery.
General risks
- Wound separation
- Bleeding
- Delayed healing
- Infection
- Pain, swelling and bruising
- Scarring
- Rejection or displacement of testicular implants
- Risks from anesthesia
Why Choose Kamol Hospital in Bangkok for Metoidioplasty
- Ring flap technique in a single operation: Urethral lengthening, vaginal closure, scrotum creation and testicular implants can be combined into one surgery, so most patients need only one trip.
- Both metoidioplasty and phalloplasty available: Your surgeon can explain the honest differences between the two and help you choose what fits your goals.
- Complete female-to-male care: Psychiatric assessment, hormone therapy, top surgery, hysterectomy and facial masculinization under one roof.
- Inpatient care and close follow-up: About 4 nights in hospital, catheter care for 3 weeks, and regular wound checks by the surgical team.
- Hospital-level safety: Surgery under general anesthesia with a dedicated anesthesia team, in a JCI-accredited hospital.
- Support for international patients: Multilingual staff, accommodation options in partner hotels and serviced apartments, and Kamol Trip planning.
Frequently Asked Questions (FAQs)
What is metoidioplasty?
Metoidioplasty is a surgical procedure used in female-to-male (FTM) gender-affirming surgery to create a neophallus (new penis) from the clitoris. It involves releasing the clitoris from its surrounding tissues and lengthening it to create a more masculine appearance.
Should I choose metoidioplasty or phalloplasty?
There are several techniques for performing metoidioplasty, including:
- Simple release: This involves releasing the clitoris without further lengthening or urethral construction.
- Full metoidioplasty: This typically involves clitoral release, urethral lengthening, and sometimes vaginectomy (removal of the vagina) and scrotoplasty (creation of a scrotum).
- Ring flap metoidioplasty: This technique utilizes a flap of tissue from the anterior vaginal wall and labia minora to create the urethral extension.
What are the benefits of metoidioplasty compared to phalloplasty?
It depends on your priorities. Metoidioplasty creates a smaller penis (usually 3–8 cm) from your own clitoral tissue, keeps natural sensation and erections, and is usually done in one operation with a shorter recovery. Phalloplasty creates a larger penis using tissue from another part of the body, which allows penetrative sex with an implant, but it’s more complex, involves several stages and leaves a donor-site scar. Your surgeon will help you weigh up the options.
Will I be able to urinate standing up?
After a full metoidioplasty with urethral lengthening, most patients can urinate standing up. It may take some practice, and some patients notice spraying or dribbling at first. After a simple release, the urethra isn’t lengthened, so urination stays as it was before surgery.
Will I keep sensation and be able to orgasm?
Metoidioplasty uses the clitoris itself, along with its nerves and blood supply, so erotic sensation and the ability to orgasm are usually preserved. The new penis can also become erect naturally when aroused, though it isn’t usually firm or long enough for penetration.
Do I need a hysterectomy before metoidioplasty?
A hysterectomy isn’t always required for a simple release. If the vagina is being closed during a full metoidioplasty, your surgeon may recommend removing the uterus first or in a planned sequence. See FTM Hysterectomy for more information.
Can I have phalloplasty later if I want a larger penis?
In many cases, yes. Metoidioplasty doesn’t rule out phalloplasty later, and some patients choose to start with metoidioplasty and decide afterwards. If you think you may want phalloplasty in future, mention it at consultation, as it may affect how the first surgery is planned.
How long do I need to be on testosterone first?
Usually at least 1–2 years. Testosterone gradually enlarges the clitoris, and more growth generally means a longer result. Your surgeon will examine you to check whether the clitoris has grown enough for surgery.
Is it worth travelling to Bangkok, Thailand for metoidioplasty?
For many patients, yes. Thailand has performed gender-affirming genital surgery at high volume for decades, so surgeons here have real depth of experience with procedures that remain uncommon elsewhere — and waiting lists are short or non-existent compared with public systems in many countries. Cost is typically a fraction of the equivalent in the US, UK, or Australia, even including flights and accommodation.
The main consideration is duration. Because the catheter stays in for around three weeks with wound care alongside it, plan roughly four weeks in Bangkok rather than flying home early. We can advise on recovery accommodation, and our staff speaks English and other languages.
How long should I stay in Bangkok after metoidioplasty?
After a full metoidioplasty, plan to stay in Bangkok for about 3–4 weeks. This includes about 4 nights in hospital and around 3 weeks with a urinary catheter, until your surgeon confirms the urethra has healed. A simple release usually needs a shorter stay. Thailand is one of the world’s most experienced destinations for gender-affirming surgery, and Kamol Trip can arrange accommodation close to the hospital.
