Thank you for your question. Metoidioplasty involves lengthening of the clitoris and does not make it an ejaculatory structure. Another option to metoidioplasty is neophalloplasty. A neophalloplasty is the creation of a penis. There are different techniques. One technique involves creating the penis from forearm skin, which can be disfiguring. The other technique uses abdominal skin, which typical leaves one with a more appealing abdominal scar, is less invasive, and the cost is typically much less. The abdominal skin technique is the one offered at our practice. I was personally trained on this technique of neophallus creation by the creator of this technique. The new penis would not have a urethra and would not be able to obtain an erection without the insertion of an artificial device, if one chooses. Prior to surgery, all patients require evaluation by an appropriate psychologist and receive the appropriate counseling. I hope that this answer helps.
Jeffrey S. Palmer, MD, FACS, FAAP (Cosmetic Urologist -- Cleveland, Ohio)