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Clitoral reduction for clitoromegaly

Dr. Reed,  My clitoris seems to be somewhat larger than normal.  I can send you some photos, and if you agree, can this be easily reduced without loss of sensitivity.

Pamela

Dear Pamela,

I have received your photos and concur.  Our approach is to reduce the clitoris from the underside avoiding the nerves.  (so called ventral clitoroplasty reduction).  For girth we can take out a wedge of tissue and for an overly long clitoris we have reduced length. The reasons for clitoral enlargement include normal variation, perhaps androgen effects during gestation, steroid usage which I have seen in professional female athletes.  This is a well understood procedure and has been reported with successful outcome in the literature.  Below is a pre-op photo of one of our patients who required also a hood reduction and labiaplasty.

4/1 - Pre-op (note scrotalization of labia majora).

Table 1 

Current surgical recommendations on feminizing genitoplasty and clitoral surgery.

The attachment of the clitoris to the pubic arch should not be disrupted
Dorsal neurovascular bundles should be preserved. There may be significant lateral branches along the corporal tissue
The neurovascular bundles branch distally in a fan fashion toward the glands clitoris
Reduction of the clitoral erectile tissue is better achieved with a ventral incision along the urethral plate
The urethra and vagina should not be separated
Dissection of the bladder from the uterus below the bladder neck should be avoided
Using labial and clitoral skin to cover the new introitus is more physiological than rotational skin flaps from the buttocks and perineum   (with credit to Dr. Lisandro Piaggio)

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