Is clitoral release with urethra lengthening possible without having scrotioplasty or closing off the vagina?

I am a 47 year old ftm who has gone through the official HB Standards of Care process. I am 3 years on testosterone and I am 1 month double incision post op and looking to go further. I do not wish to pursue scotoplasty surgery as I still enjoy intercourse. I am hoping it's possible to only have clitoral release done with urethra lengthening so I can pee standing up and have the micro "penis".

Doctor Answers 1

Options.

Thank you for your question.   I first would like to congratulate you.   

Urethral lengthening can be associated with complications, which should be taken into consideration.  One complication is leakage of urine through a urethral fistula of the reconstructed urethra.  Another complication is injury to your own urethra.  

Although I respect your desire to stand to urinate, if you are willing not to undergo urethral lengthening and to learn to urinate while standing (if that continues to be of importance to you), then there are several options available. One option is to undergo just a metoidioplasty. Another option is to under a phallic reconstruction using abdominal skin which eliminates the deformities associated with reconstruction using the forearm. The phallic reconstruction using abdominal skin would result in a longer and wider penis than with metoidioplasty.  Both surgeries would allow one to have intercourse and do not require a scrotoplasty.  However, the metoidioplasty may affect stimulation while the phallic reconstruction would not involve the clitoris thereby reducing the risk of affecting stimulation. 

I would recommend seeking an experienced reconstructive genital surgeon even if that requires traveling.

Best of luck.   

Jeffrey S. Palmer, MD, FACS, FAAP (Cosmetic and Reconstructive Urologist -- Cleveland, Ohio)


Cleveland Urologist
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