The purpose of metoidioplasty is to make the penis (of individuals designated female at birth) longer and more visible. This is accomplished by releasing some of the structures which keep it in an folded position. Many individuals who undergo metoidioplasty also seek to combine the procedure with urethral lengthening and/or masculinization of the perineum (the area between the penis/genitalia and the anus)
This operation releases the suspensory ligament of the clitoris, allowing it to fall more forward, as well as the urethral plate, which helps it project more. This creates a more prominent penis, although the individual, unassisted by a urinary funnel, still needs to pee while sitting down (because the urethra is left alone), and the vagina is left open.
Metoidioplasty without urethral lengthening, but with perineal masculinization
This operation combines the simple release with closure of the vagina and removal of the labia minora. A rudimentary, cleft scrotum can be made as well, usually as a delayed procedure. The urethra is left alone so the individual, unassisted by a urinary funnel, must still urinate while sitting. This procedure removes most of the tissue used to perform urethral lengthening. Thus, this procedure is not recommended for individuals who wish to consider urethral lengthening at a later date.
Metoidioplasty with urethral lengthening and perineal masculinization
This operation utilizes the labia minora and a portion of the vaginal lining to lengthen the existing urethra and make the penis more visible. The goal of this operation is to be able to urinate while standing. The vagina is also closed and a rudimentary, cleft scrotum can be made, usually as a delayed procedure.