This procedure is classified as a "Bottom" procedure.

Metoidioplasty is a surgical procedure that creates a small penis by releasing the ligaments that hold the clitoris against the body. In order to increase the size of our penis, some of us do daily “pumping” which involves applying vacuum pressure to our clitoris/penis both before and after surgery. Sometimes pumping is done in combination with taking erection enhancing medications such as Viagra or applying DHT cream to our genitals. Pumping devices and medications should only be used under the guidance of a surgeon or primary care provider, as incorrect use can cause serious injury and long-lasting problems to our sexual organs. The metoidioplasty procedure to create the new penis shaft, involves only release of the clitoral ligaments and repositioning of the clitoris. This can be done as a stand-alone procedure sometimes called “Simple” metoidioplasty. It can also be combined with urethral lengthening to allow for urination from the penis, vaginectomy (removal of the vagina), scrotoplasty (creation of a scrotum) and testicular implants, and monsplasty (pubic lift/reduction). There is no surgery that allows us to produce sperm. The process of creating a longer urethra (the tunnel through which we pass urine) through the new penis is one of the most difficult parts of a phalloplasty or metoidioplasty. It is usually performed by a urologist, a surgeon who has gone through special training and focus on the penis and urinary system. Some urologists have additional training in genital reconstruction, and specialize in fixing a urethra has been damaged by trauma. Urethral lengthening is needed for us to be able to pee through the tip of the new penis.