She's Got Clitoral Legs 

The anatomy of going from female to male.

Dear Carol,
When metoidioplasty is conducted, does this decrease sensitivity in the legs of the clitoris? (I'm asking you because I had never heard of the "legs" before.) Right now I'm considering the construction of my body, but am only willing to lose so much sensitivity, you know what I mean? Also, when this surgery is conducted, is the entire shaft, spongy tissue and all, released from the hood? If so, does this sever some of the nerve endings of the clitoris? I heard that the urethra is only connected to the clitoris later, though I really don't know how this would occur without something being cut in half (shiver). --Nervous FtM

Dear NFtM,
A little anatomy first, some of which you probably know (but other readers may not). Each aspect of the male genitals has a counterpart in female genitals, and vice versa. This is one reason sex reassignment surgery works, and, particularly in the case of female-to-male transsexuals (FtMs), is one reason why reassignment can be accomplished with little genital surgery. Instead, once testosterone has made the clitoris grow, the doc can release the enlarged phallus from its hood and cut the ligament that attached it to the body. Now it can get visibly erect (it was already getting erect when it was a clit, but the hood and the ligament limited its ability to stand away from the body the way an erect penis does). Unless the doc is very hacksterish there shouldn't be too much nerve damage from this procedure alone. Yes, the spongy tissue is released, but that is related to the growth of the phallus--it's not like the inner clit is brought outside the body, but that it grows away from the body and is no longer closely attached. The innards of a clit--and of a testosterone-enlarged FtM penis--are fundamentally similar to the innards of a penis, except for the positioning of the urethra. More about this in a sec.

The old labia majora, stretched to become the new scrotum, get testicular implants--actually, it's silicone shaped like testicles. Some FtMs stop there, while others have a complete hysterectomy. In addition, some elect to undergo a procedure called "urethral lengthening." The point is being capable of standing to pee--maybe. According to one physician's Web site, "A vaginal mucosal flap is used for the extension of the urethra from the native urethral opening (without disturbing that opening directly and endangering sphincter function). In this situation the labia minora flaps are used to protect the vaginal flap urethral extension as well as provide girth. This procedure is more complex and entails additional risks such as fistula formation (urinary leakage)." Okay! Thanks, Doc! In this part of the procedure you get a urethra that runs the length of the penis, but on the bottom, not right through the middle. This surgery is more invasive than the previously described work, because they use vaginal tissue to do it.

The clitoral legs, like all the other parts, have a counterpart in guys born male--the penis has legs, too. (In both cases they are also known as crura, and in both cases they consist of erectile tissue, like the rest of the penis/clit/phallus.) In persons born female, these legs extend into the body much like the legs of a wishbone, one on either side of the vagina. Got that pictured? So--if you elect to have either a full hysterectomy or vaginal removal (including the procedure that is done in urethral lengthening), you run the risk of damage to the crura, because really, the genitals are all packed into rather limited acreage, which is all threaded through with nerves. Each part is very close to every other part--especially in female-born folk. When you choose a surgeon, you will want to make sure that s/he has a very good record when it comes to limited surgical complications and high maintenance of genital sensation. That means educating yourself as much as possible about anatomy and sex reassignment procedures before choosing a surgeon, and talking with him/her about your concerns. If the doc says, "What do you mean, clitoral legs?" continue doctor-shopping!

By the way, if you do a Web search on "metoidioplasty" (the ten-dollar name for this whole procedure), the first hits are the plastic surgeons who specialize in doing this work. There is another procedure, phalloplasty, which can result in a more sizeable penis, but it is somewhat more prone to complications and many transmen don't think the technology is advanced enough to allow the new penis to function as well as they'd like. A big, big advantage of metoidioplasty is that it allows the old, nerve-filled clitoris to grow naturally into the new, nerve-filled penis. For those guys whose primary goal is an erotically functional male body--that is, erotically sensitive and orgasmic--metoidioplasty is often the procedure of choice. Guys who are more interested in a large enough penis to achieve penetration might be more likely to opt for phalloplasty. Sadly, for most transmen, it's an either-or situation. Many metoidioplasties do not achieve enough length to allow for easy penetration of a partner.

You could elect to have just the external work done, and not have the hysterectomy or urethral lengthening. Whether this degree of reassignment will be sufficient for you on a psychic/emotional level I can't say. Some transmen want all vestiges of their female bodies gone and it is very important to them to assume as masculine a presence in the world as possible--making up for lost time, perhaps. For them, the knowledge that a uterus remains in their bodies is purely unacceptable. For others, the extraordinary results of hormone therapy--which include a full complement of masculine secondary sex characteristics--make them feel "male enough." But only you can be the final arbiter.


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