LGBTQ+ & Gender Care Services

Phalloplasty and Metoidioplasty: Female to Male (FTM) Genital Reconstruction Surgery

Female to male genital reconstruction surgery is more challenging than male to female reconstruction and requires experience, expertise and preparation for optimal outcomes. With careful patient selection, preoperative planning and meticulous surgical techniques, the skilled gender-affirmation surgery team at University Hospitals can create an aesthetically pleasing and functional penis.

Things to Consider Before Having Female to Male (FTM) Genital Transition Surgery

If you would like to preserve your ability to have biological children in the future, talk to your doctor about harvesting and freezing your eggs prior to having surgery. Egg freezing is a multiple-step process and, if you want to freeze embryos, you will need to take the additional step of having your eggs fertilized.
Risks: Tissue necrosis (dead or damaged tissue) in the surgically created penis; blood clots in deep veins and/or the lungs; Fistulas - an abnormal opening between two body parts, such as in the urinary tract. Phalloplasties in particular have the potential for many complications so you should talk to your doctor about the risks and benefits of the procedure before proceeding.
It is always recommended that patients talk with a therapist in the months leading up to surgery to ensure they are mentally and emotionally prepared for the transition.
In accordance with the World Professional Association of Transgender health (WPATH) standards of care, we require that patients be on appropriate cross-gender hormone therapy for a year, live in the gender-congruent role for a year, and have 2 mental health letters endorsing their suitability for surgery.

Most genital gender affirmation surgeries are covered by insurance. In cases where they are not, your surgeon’s office will guide you through the self-pay options.

Surgical Techniques for Female to Male (FTM) Transition

There are two primary surgical procedures that may be offered for female to male genital transition – phalloplasty and metoidioplasty.

This procedure creates a penis from the clitoris. The individual must first undergo testosterone hormone therapy which, over time, will cause the clitoris to elongate and enlarge – ultimately to a length of 3 – 8 centimeters (approximately 1 – 3 inches) when not sexually stimulated. Once the optimal enlargement has been achieved, the surgeon performs a metoidioplasty – a procedure by which the enlarged clitoris is released from the ligaments that hold it in place and lowered to approximate the position of a penis. The surgeon may also extend the urethra using tissue grafted from your body – usually the lining of the mouth. The lengthened urethra is then passed through the enlarged clitoris, making stand-up urination possible. With this procedure, genital sensations are fully retained.

Recovery after a metoidioplasty can take up to 4 weeks. During the initial recovery period, a catheter will be placed in your urethra to drain urine from the body while it heals.

Phalloplasty is the surgical creation or reconstruction of a penis through a series of procedures. The first step is to take a large amount of skin from your forearm or thigh. The skin is rolled into the shape of a penis and attached to your body just above the clitoris. Additional procedures include:

Lengthening and repositioning of the urethra to allow for urination through the penis
Grafting of nerves and blood vessels to enhance genital sensations
Plastic surgery to sculpt the head of the penis

Recovery after a phalloplasty can take up to 12 weeks, depending on the procedures that are done. During the initial recovery period, a catheter will be placed in your urethra to drain urine from the body while it heals. Generally, the entire process takes 2-3 surgeries over a course of 6-9 months.

The newly created penis will not be capable of erection. Some patients may choose to have a device called a penile implant placed inside the penis to allow for sexual intercourse.

In addition to phalloplasty or metoidioplasty, patients undergo the following genital procedures as part of their gender transition:

Vaginectomy: Surgical removal of all or part of your vagina
Scrotoplasty: Surgical creation of a scrotum using labial skin and tissue. Egg-shaped artificial testicles made of silicone may then be implanted in the newly created scrotum.
Total hysterectomy: Some female to male (FTM) genital gender affirmation procedures may make it difficult or impossible to have pap tests for cervical cancer. Therefore, your doctor may recommend the removal of your uterus, cervix and ovaries to reduce your risk of certain cancers.