Metoidioplasty is a gender-affirming, lower body surgery that creates a penis by cutting ligaments around the erectile tissue (clitoris) to release it from the pubis and give the shaft more length (4 to 6 cm).
The urethra can be lengthened and incorporated into the penis. Skin from the external genitals (labia or outer labia) is wrapped around the penis to add girth. A scrotum can be created from the external genitals (labia or outer labia). Testicular implants can be inserted in the scrotum in a separate surgery months later. The goal is to create a penis with sexual sensation that can get erections without the assistance of an implant and to enable the ability to pee while standing if someone chooses urethral lengthening. The goal is not to enable sexual penetration. 

Referral & consult

Referral & consultation process


Complete surgical care planning

To get started, you will need one surgical recommendation, which is made after surgical care planning. This recommendation must be completed by a provider on Trans Care BC’s list of clinicians who are qualified to do surgical care planning for genital surgeries. Part of the surgical care planning process includes assessing whether you meet the WPATH criteria required for this surgery and whether you are ready for surgery. After you have completed your care planning and have received a surgical recommendation, your primary care provider will refer you to the Gender Surgery Program BC. Additional information or consultation with specialists may be required at the discretion of the surgeon. Contact Us for help finding a clinician qualified to do surgical care planning for genital surgery.

2Review referral options

Visit the surgery referral page for steps required in the referral options for metoidioplasty. 

3Speak to your surgeon

You may want to speak to your surgeon about:

  • The gender-affirming surgery goal you have after surgery (i.e. standing to pee, sexual penetration, passing in the change room)
  • The list of medications you should avoid around the time of your surgery
  • The different surgical techniques available
  • The advantages and disadvantages of each technique
  • What your options are if you are not satisfied with the appearance of your surgical results
  • What your options are if you are having difficulty with sexual function
  • Whether they have before-and-after photographs of their own patients, including those of both successful and unsuccessful outcomes
  • The risks and possible complications of the various techniques
  • The surgeon's own complication rates for each procedure

The procedure

Surgical techniques vary from surgeon to surgeon. 

  1. Before surgery, testosterone is taken to enlarge the erectile tissue (clitoris). Some may want to wait 2-3 years to achieve maximum growth before proceeding with surgery.
  2. The ligaments holding the erectile tissue (clitoris) in place under the pubic bone are cut.
  3. Some of the surrounding tissue is cut, releasing the erectile tissue (clitoris) and creating a penis.
  4. Your urethra may be extended and incorporated into your penis.
  5. Fat may be removed from the pubis and skin may be pulled upward to bring your penis forward.
  6. A flap of skin is removed from the external genitals (labia or outer labia) and grafted around the penis to add bulk.
  7. The internal genital (vagina) may be removed or closed (if desired).
  8. The external genitals (major labia) may be shaped into a scrotum (if desired).
  9. Testicular implants may be put in the scrotum at a later stage (if desired).

Preparing for surgery

Be sure to review the pre-operative surgical package provided by surgeon's office before surgery. For more information about preparing for this surgery and about your post-operative care, contact the surgical clinic directly.

While you wait for your referral to be processed, you should your personal information updated with all of your health care providers, including any change of name or contact information. This will ensure your health care professionals can reach you to schedule consultation and surgery appointments.

You may also want to visit the Preparing for Surgery page to help you create a plan for success after surgery.


All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and infection. These complications can, in extreme cases, result in death. It's important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise and respond to them appropriately. They will also inform you about what you can do to minimize your risks. Some complications are particularly associated with metoidioplasty. 

Below are a list of some possible complications of this surgery. Please note - this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

The risk of decreased sensation after metoidioplasty is less than with phalloplasty, but changes to sensation are still possible.


Some people may be dissatisfied with the size or shape of the penis. You can check with your surgeon to see if surgical revision is possible.

When blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.


You can take steps to prevent severe scarring by following your surgeon's advice about avoiding sun and doing massage exercises. Severe scarring may require surgical revision.


When clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery.

After surgery

Post-operative care

Details related to the time you will spend in hospital after surgery and your post-operative plan will depend on your surgical site. Ask your surgeon for details related to your recovery.

You will likely receive painkillers and antibiotics to prevent infection and other medications such as stool softeners, muscle relaxants, anti-nausea medication and medication to reduce bladder spasm. Your surgeon will provide you with a list of medications to avoid around the time of your surgery.

During the healing process, you should expect:

  • Some bleeding
  • Swelling of the genital region for up to about 6 weeks
  • Bruising that can extend from your belly to your thighs (This can take a few weeks to settle down)
  • Itching and occasional small, shooting electrical sensations as your nerve endings heal
  • Numbness around the incisions, which could last several months
  • Difficulty urinating while standing for the first few weeks
  • Pink or red scars on your genitals that will pale over time


The number of check-ups needed varies from person to person and between surgeons. If possible, see your primary care provider about a week after you return from surgery and then every two to four weeks for the first few months. When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound healing problems. They will ask questions about pain, bleeding, urination, bowel movements, fever, and how you are feeling physically and emotionally.

Recovery time

Recovery time varies from person to person, so always follow the advice of your surgeon. Over the six weeks following surgery, you will gradually resume your usual activities. The first week will involve plenty of bed rest. Some activities, such as driving, heavy lifting, exercise, sex, and soaking in hot tubs, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities.

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