Survey Results: Metoidioplasty and Phalloplasty

Back in February, I came across an article in the Victoria Times Colonist that suggested that it’s discriminatory for British Columbia’s Medical Services Plan to fund MTF surgery but not FTM surgery. While I agree with this view of MSP’s coverage, I found it troubling that the article pushed for phalloplasty funding without any mention of metoidioplasty, a procedure that I *assumed* was more in demand by transgender men.

I decided to find out if my assumption about this was correct. I created a survey that asked: “If money were no object, would you choose to have a metoidioplasty or a phalloplasty?”

Obviously, the survey was directed at transgender men who have an interest in bottom surgery; not all trans men do. Also, I was limited to just 100 respondents as I used a free service to host the survey. My survey was less than scientific, but the responses are nevertheless quite intriguing. Let’s take a closer look…

Survey Respondents

Her’s how the geolocation of the respondents was spread out:

It’s quite clear looking at this that we have not only a North American slant, but a predominantly American voice in the final data. My outreach for the survey was limited to the exposure I could generate for it via this blog, my personal YouTube channel and my twitter account, and this explains the heavily weighted North American representation. It would have been interesting to directly poll transgender men in B.C. (as it was the politics of this province that inspired the survey to begin with) but I wasn’t convinced that I could generate 100 responses from this smaller group.

Part 1

If money were no object, would you choose to have a metoidioplasty or a phalloplasty?

96 people (96%) responded to this question while 4 (4%) people opted not to answer.

What intrigues you about metoidioplasty?

I sifted through the responses to this question then grouped and ordered them according to “popularity.” Please note that the following responses are opinions—not necessarily medical facts.

1. Erotic sensation: Better, low probability of loss, stimulation and sensation that is familiar, you can get your own erection, sensations of oral sex, my body’s ability to respond more naturally to me
2. More “natural”: Not fashioned from another body part—it’s just my dick, it’s all you, accentuates your own hormonal growth
3. Less impact: Minimal alterations, low probability of post-op tissue death, possibility of no scars, no grafting needed, less of a toll on the body, complication rate is lower, less recovery time, vaginectomy not necessary
4. Appearance: Looks nice, like a small biological penis, better aesthetics, more attractive, unique transmale genitalia
5. Functionality: Possibly the ability to stand to pee (with urethroplasty)
6. Lower cost

85 people (85%) responded to this question while 15 (15%) people opted not to answer.

Why do you think you might choose metoidioplasty over phalloplasty?

Other responses:

• Less to recover from
• Don’t like plastic in my junk
• Natural unassisted erection like a natural penis
• Better appearance
• Less scarring
• Less risk of post-op tissue death

93 people (93%) responded to this question while 7 (7%) people opted not to answer.

What intrigues you about phalloplasty?

I sifted through the responses to this question then grouped and ordered them according to “popularity.” Please note that the following responses are opinions—not necessarily medical facts.

• Appearance: Adult sized penis, more realistic, length and girth, aesthetically appealing results (radial forearm free flap), bulk in underwear without havin to pack, gym and locker rooms comfortability, scrotoplasty looks in proportion, genitalia that matches my gender
• Functionality: Deeper penetrative sex without a strap-on, tactile sensation (radial forearm free flap), fully functional, standing to pee, jerk off with whole hand
• Nothing
• Feeling “at one” with my penis

76 people (76%) responded to this question while 24 (24%) people opted not to answer.

Why do you think you might choose phalloplasty over metoidioplasty?

Other responses:

• Stand to pee
• I don’t think phallo is well-developed enough to deliver on these promises.
• Many more reasons
• Comfort of having something there attached to me
• Benefits do not offset the vast downsides

78 people (78%) responded to this question while 22 (22%) people opted not to answer.

Part 2: Questions for respondents who have had a metoidioplasty

Did the metoidioplasty sufficiently suppress your dysphoria?

• Yes: 8 / 80%
• No: 2 / 20%

10 people (10%) responded to this question while 90 (90%) people opted not to answer.

Do you have any regrets about not opting for a phalloplasty instead? *

• Yes: 2 / 20%
• No: 8 / 80%

10 people (10%) responded to this question while 90 (90%) people opted not to answer.

Part 3: Questions for respondents who have had a phalloplasty

Did the phalloplasty sufficiently suppress your dysphoria?

• Yes: 5 / 55.6%
• No: 4 / 44.4%

9 people (9%) responded to this question while 91 (91%) people opted not to answer.

Do you have any regrets about not opting for a metoidioplasty instead?

• No: 8 / 88.9%
• Yes: 1 / 11.1%

9 people (9%) responded to this question while 91 (91%) people opted not to answer.

Part 4: General Comments

“There are many guys that become comfortable with what they have, sometimes without a meta. Perhaps there is something to learn from them. We need to look more at how much of the fascination with the penis is tied to sexual stereotypes rather than its functionality.”

“While initially phalloplasty was out of my reach financially, I also found many other reasons why it would not be a good fit.”

“If there were more doctors that had more experience performing a phalloplasty I might feel slightly more comfortable going that route. To have to travel a great distance to find a good surgeon, and to spend time in a foreign place recovering, does not leave me feeling at ease. I might also give phallo a little more thought if there were more solutions for the scarring. I’ve also read online that the phallo doesn’t feel normal to the partner.”

“I do not intend to have any lower surgery until the results of a phalloplasty are much better. I would very much like to see improvement in this surgical field.”

“As much as I would love to have a ‘genuine penis’ so to speak, I think the stereotypes of phallo and meta conveyed in checkbox portion of the survey are a bit unrealistic. Most notably, both metas and phallos are both very prone to complication if urethral extension is involved, and this has more to do with the specific surgeons skill at doing urethral work than it does with the choice of strategy to construct the phallus.”

“The idea of genital surgery is VERY scary, regardless of which procedure.”

“Speaking from a partners point of view, the meta is way sexier, more natural in the sense that its still your genitals not a piece taken from another part of your body to fashion a penis, and seems to come with less risk and complications from what I have read.  Size is never a problem because if you are with someone you love the sex is ALWAYS going to be amazing. Deep penetration is over rated, sometimes painful.  The risk of losing the ability to have sensation too is just too much to risk in my eyes.  I would MUCH rather my man have a small penis that feels pleasure and sensation than a large penis that feel nothing (or very little).  I would much rather be with a man that can obtain a natural erection than with a man that has to pump to become erect.”

“I wish they could do penile transplants. If they could properly do the urethral hook-up, enable erection capabilities and could guarantee a high success rate, I’d opt for a bio penis transplant as it’d be as close to ‘authentic’ as possible.”

“I don’t know about ’suppressing my dysphoria.’ I just felt like I needed a phalloplasty to feel free to get on with my life; whether that’s the same thing, I don’t know. There’s a great relief in knowing that there are no more operations to think about or to have to plan my life round. I’m actually happier than I thought I would be with the result. I’d resigned myself to the results being a bit rudimentary but I like what I’ve ended up with.

“I actually doubt, at this point, that I’ll have any bottom surgery. If money and sick time allowed, I’d definitely go for a metoidioplasty. I’ve seen a forearm scar in person, and I like my forearms enough to not want that. I think my lack of desire for a phalloplasty is definitely fear, in large part. Fear of complications, fear of the loss of sexual sensation in particular. I imagine it’s improved a lot since the last time I looked at it seriously, but in realistic terms I’m never going to have the money, so…  What I’m really interested in, actually, is the procedure to create a scrotum by stretching the labia. I’d love to have that, in combination with a metoidioplasty.”

25 people (25%) responded to this question while 75 (75%) people opted not to answer.

Conclusions

My assumptions proved correct: of the 100 respondents, the majority would opt for a metoidioplasty rather than a phalloplasty.

When it comes to provincially funded gender confirmation surgeries, shouldn’t governments be looking at covering the procedures that the target constituents desire?

Government funded SRS (aka GRS / GCS) is a public health issue, not a political or religious issue. In my opinion, B.C. MSP is required to fund FTM bottom surgeries, for health and human rights reasons. Additionally, both phalloplasty and metoidioplasty procedures should be covered. The cost for metoidioplasty is considerably less than phalloplasty (in line with costs associated with MTF bottom surgery) and the procedure requires less OR time and shorter hospital stays. While both meta and phallo have the potential for complications, metoidioplasty is less invasive and presumably lower risk.

I want to conclude this by offering my sincerest appreciation to the men who completed this survey and shared such personal information. I have learned a lot by reading your responses, and trust that this information will be of great assistance to those who are considering metoidioplasty and phalloplasty to complete their medical transition.

* UPDATE: When this information was originally published, I had mistakenly reversed the display of the response for, “Do you have any regrets about not opting for a phalloplasty instead?” I have since corrected this oversight and apologize for any confusion that error might have caused.