title: Extensive Metoidioplasty as a Technique Capable of Creating a Compatible Analogue to a Natural Penis in Female Transsexuals.
abstract: OBJECTIVE
  To introduce the operative technique of "extensive metoidioplasty" (EM) in female transsexual surgery, for achieving an effective reconstruction of a male-appearing, normally functioning, fully sensate and erectile external genitalia.
  
  
  METHODS
  Ten female transsexuals (46 xx karyotype) between the ages of 20 and 40 years underwent EM as their sex reassignment surgical procedure with the mean operative time of 171 min (45-211, SD 19.55 min) between 2007 and 2014 in a general hospital in Tehran, Iran. Subjects were closely followed for the mean time of 68.4 months. All participants were thoroughly rehearsed about the nature of their surgical procedure and an informed written consent was obtained before surgery. We extensively detached the native clitoris to the point of a nearly complete detachment from its attachments to the 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 PEP, a procedure which is in practice at our clinic.
  
  
  RESULTS
  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 postoperative complications.
  
  
  CONCLUSIONS
  EM in association with the application of PEP could result in a natural-looking, erotically fully sensate and functional penis in majority of female transsexuals undergoing this procedure. This operative technique should be given serious considerations in well-informed female transsexual. Larger studies may be needed to validate this technique further.
  
  
  METHODS
  This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Sexual Dysfunction and Abnormalities Clinic, Pars General Hospital, Keshavarz Blv, Tehran, 1415944911, Iran. shahryar@shahryarcohanzad.com.
authors.forename: Shahryar
authors.initials: S
authors.lastname: Cohanzad
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010410:Penile Erection; D010413:Penis / Q000502:physiology / Q000601:surgery*; D057830:Gender-Affirming Surgery / Q000379:methods*; D014189:Transsexualism / Q000601:surgery*; D055815:Young Adult
keywords: Gender identity disorder; Metoidioplasty; Sex reassignment surgeries; Surgical technique; Transsexualism