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Extensive metoidioplasty as a technique capable of creating a compatible analougue to a natural penis in female transsexuals and post operative penile improvement protocol.

Shahryar Cohanzad

 Aesthetic understanding concerning the process of lipoatrophy Introduction of operative technique  ‘‘extensive metoidioplasty’’ in female TS surgery,for achieving an effective reconstruction of a male-appearing,normally functioning, fully sensate and erectile external genitalia.

10 fully consented patients(46 xx karyotype) 20 - 40 years of age underwent EM ; mean operative time of 171 min (45–211, SD 19.55 min) between 2007-2014.Subjects were closely followed for the mean time of 68.4 months. All participants were thoroughly rehearsed about the nature of their surgical procedure.

We extensively detached the native clitoris to the point of a nearly complete detachment from pubic arch and approximated the originally divergent corporal bodies to each other. We were also able to increase the penile size by the application of PIP, a protocol which is in practice at our clinic. Postoperatively all ten patients achieved a mean penile length of 8.7 (6–12) cm and 7/10 (70 %) were capable of obtaining erection, rigid enough for intromission.We did not observe any significant PO complications. EM in association with the application of PIP could result in a natural-looking, erotically fully sensate and functional penis in majority of female transsexuals. This operative technique should be given serious considerations in well-informed female transsexual. Larger studies may be needed to validate this technique and its associated Protocol (PIP) further