Clitoral Hood Reduction/ Clitoroplasty

What is Clitoris?

Clitoris is analogous to penis in females. It is located anteriorly where two labia minora lips get fused. Labia minora lips split anteriorly to cover over the clitoris as a hood shaped prepuce and cover it posteriorly too. Clitoris has two parts; body (corpus) and glans like penis. Clitoris is a very important organ for the sexual life of a woman, as it is an erogeneous organ, rich with nerve endings and high blood supply. Its glans is covered by a mucosa extremely rich in sensory receptors for sensing temperature changes ( especially cold) and feeling pleasure.There are three times more sensors on the clitoris glans than on the clitoris penis, much larger for such a small surface.

Defects of Clitoris

It may be hypertrophied (enlarged) in some females due to hormonal derangements, may be absent in ambiguous genitalia or may be covered with a large prepuce hood.

Clitoral hood reduction can be done by a cosmetic gynecologist but clitoroplasty is complicated vaginal plastic surgery and is accompanied with vaginoplasty & labiaplasty in gender transformation surgery which requires a well trained Plastic surgeon.
We are privileged in this sense as we have a perfect blend of Cosmetic gynecologist and Plastic Surgeon at PCOSmetic gyne clinic, to perform such complicated vaginal plastic surgeries. We take pride in performing a few complicated cases of clitoroplasty at our center in enlarged clitoris patients with touch, pain and sensitivity retained.

 

Surgeries of Clitoris

Clitoral Hood Reduction:

Labia minora splits anteriorly to run over and under the glans of the clitoris. The more anterior folds unite to form the hood shaped prepuce of the clitoris, (analogous to prepuce of glans penis), whereas the posterior folds insert into the underside of the glans clitoris as the frenulum.If this clitoral hood prepuce is abnormally large, it hinders the function of clitoral sensitivity during sex hence such females have decreased or no pleasure.

In this surgery, a triangular wedge of skin is excised from the clitoral hood, reducing its size, and exposing more of the sensitive clitoral tissue for enhanced sexual pleasure. The method can be conducted during labiaplasty or as a separate procedure.

Clitoroplasty

Clitoroplasty is complicated vaginal plastic surgery which is performed in patients with enlarged clitoris, disorders of sex development or ambiguous genitalia. This procedure deals with the surgical transformation of the clitoris, which caters to conditions involving increased tissue volume of clitoris. It can also aid in creating clitoris in transgender women.
There should be two goals for perfect clitoroplasty:
➡️ good cosmetic appearance of the external genitalia correspond to gender
➡️ Sensitivity of clitoral glans remains intact.

Ambiguous genitalia is the genitalia phenotype (physical appearance) which does not represent either boy or of girl in a newborn baby. In such cases, with female karyotype 46 XX ,female gender is if proposed, surgical correction should be performed as early as possible, by the age of 3 years as it is surgically safe at that time and so as to develop one’s sexual identity of a girl in early years. Feminizing genitoplasty includes clitoroplasty, creating labia minora and vaginoplasty.
This surgical correction must create the appearance of external genitalia that correspond to the gender.

In the past, hypertrophied clitoris was excised but since glans of clitoris is an important erotic sensitivity organ of a woman and its ablation is a mutilating and illogical practice.Thus the preservation of a sensitive glans called clitoroplasty has become the common practice. In patients with Congenital Adrenal Hyperplasia, clitoris may be enlarged which is reduced in size by reducing the length of the body of the clitoris and diameter of glans but preserving its nerve and blood supply. Thus, these patients after surgery of clitoroplasty; may have normal cosmetic appearance of female external genitalia which otherwise gives a picture of ambiguous genitalia due to enlarged clitoris. Over that the big advantage is the quality of their sexual life doesn’t get affected as sensitivity of glans clitoris is kept intact.

Female Genital Cosmetic Surgery or Cosmetic Gynecology is not all about cosmetic appearance of loose or lax vagina, it is much beyond that as it deals even with sexual and gender identity of one person. Thus, Cosmetic gynecology/ Vaginal Plastic Surgery is  big savior in patients with ambiguous genitalia or transgender woman as brings them tremendous psychological relief and mental trauma that would be caused to them otherwise.