Pre-Meta (Clitoral Release)
Pre-metoidioplasty (aka clitoral release) is the first portion of metoidioplasty where the surrounding skin of the clitoris is removed and “released” from the pubis. The suspensory ligament may be partially divided. Labial ligaments and the urethral plate are released, which allows the penis to extend further outward.
Motivations for choosing pre-meta (clitoral release)
- Patients who do not wish to undergo the full metoidioplasty procedure. They may not want a full metoidioplasty or scrotoplasty.
- Patients who prefer to do the procedure in stages because of financial limitations. Pre-metoidioplasty is less expensive than metoidioplasty. However, a single-stage procedure may be more cost effective in the long-run.
- Patients who are unsure if metoidioplasty is sufficient for them, but who are comfortable with the results of the pre-meta procedure.
Pre-metoidioplasty is performed to create a neophallus that resembles a very small male penis. The glans usually appears circumcised. Some surgeons can create an uncircumcised appearance upon request. Generally, the surrounding skin of the clitoris is removed and released to create the impression of more length.
Pre-meta genital masculinization is the first portion of a metoidioplasty. Pre-meta is distinguished from a full metoidioplasty because the scrotum is not constructed and the urethra is not lengthened.
Pre-meta usually results in no apparent surgical scarring. Clitoral sensitivity is not impacted. A benefit of pre-meta is that it allows the recipient to undergo later genital reconstructive procedures, similar to metoidioplasty. Patients may later choose to complete the metoidioplasty at a later date by opting for a scrotoplasty with expanders or implants. In addition, patients may later opt to have urethral lengthening.
Patients should prepare to take a minimum 5 day leave of absence from work. Bed rest and ice packs are recommended for a minimum of 24 hours. Patients should refrain from lifting over 10 pounds for one week. Sutures should dissolve in 2-3 weeks.
Pre-meta is distinguished by a low level of surgical complications. Minor complications occasionally occur. Major complications rarely occur. The degree of risk is impacted by the health of the recipient. It is important to have a consultation with the surgeon before undergoing the procedure so that he or she may evaluate the risks particular to the patient.
Most surgeons follow the WPATH Standards of Care to determine eligibility for pre-metoidioplasty. The prerequisite standards include pre-operative psychological counseling, two letters of support, hormone therapy, and at least one year living as male. Inquire with your surgeon for their specific requirements.
As with all surgeries, the best candidates are individuals in stable health. Obesity and smoking are associated with an increase in adverse surgical outcomes. Patients should be at least 18 years old for optimal results. Genital growth following hormones will increase the results of the procedure. Thus, patients are encouraged to delay pre-metoidioplasty until they have been on testosterone treatment for at least 2 years. This ensures that clitoral growth attributed to HRT is at its threshold size. Some surgeons recommend that candidates “pump” before the procedure. Pumping the clitoral area increases blood flow to the organ, which increases growth beyond HRT results.
Patients should be willing to accept the limitations of the surgery. The procedure results in a very small micropenis. It will likely not be large enough for penetration, although this has been disputed, as many trans men have been able to perform intercourse after they fully recover.