Nerve-Sparing Reconstructive Surgery for Cosmetic Repair in Idiopathic Clitoral Glans Enlargement: Clinical Experience with 23 Patients

Abstract

OBJECTIVE: In this study, we aim to share our experiences and surgical outcomes using our original clitoral glans reconstruction technique in patients with isolated clitoral hypertrophy MATERIALS and METHODS: A single-center retrospective case series was conducted between January 2018 and November 2024. Twentythree patients, aged 16 to 23, who presented with complaints of excessive clitoral head growth during and immediately after puberty were examined. RESULTS: A total of 23 clitoroplasty procedures were performed and no serious life-threatening complications developed. Viability of all glans was preserved. Two minor complications occurred in two patients: In the first patient, the stitches were opened within the first week after surgery and were quickly re-stitched under local anesthesia. The second complication was that one of our patients developed superficial subcutaneous necrosis in a10% part of the clitoral glans, but 0.5 cc platelet rich plasma was applied to increase the blood circulation of this area and the area healed over time. No significant change was observed in FSFI (Female Sexual Function Index) values before and 6 months after the procedure in sexually active patients. As a result, it was observed that there was no negative impact on sexual function with a low complication rate and successful recovery. CONCLUSION: Clitoral hypertrophy revision surgeries have evolved from amputation surgery to reduction surgery with the development of modern surgical techniques. Further studies with a larger number of patients are required to confirm the data of this study.

Keywords

• Clitoris/surgery
• clitoris/abnormalities
• reconstructive surgical procedures/methods
• cosmetic techniques
• female sexual function index
• treatment outcome
• adolescent

İdyopatik Mega Boyutlu Klitoral Glansta Sinir Koruyucu Rekonstrüksiyon Tekniğinin Kozmetik Onarımda Kullanımı

Abstract

AMAÇ: İzole idyopatik klitoromegali nadir görülen bir durumdur ve cerrahi deneyimler sınırlıdır. Bu çalışmada mega boyutlu klitoral glansta sinir koruyucu rekonstrüksiyon tekniği ile kozmetik onarım sonuçlarımız sunulmaktadır. GEREÇ ve YÖNTEM: 2020–2023 yılları arasında izole idyopatik klitoromegali tanısı alan 23 hasta (16–23 yaş) retrospektif olarak değerlendirildi. Tüm hastalara sinir koruyucu klitoral glans rekonstrüksiyonu uygulandı. Bulgular arasında komplikasyon oranları, glans canlılığı ve FSFI (Kadın Cinsel Fonksiyon İndeksi) ile cinsel fonksiyon değerlendirmesi yer aldı. BULGULAR: Tüm olgularda glans canlılığı korundu. İki minör komplikasyon gözlendi (dikiş açılması ve yüzeyel nekroz). Cinsel aktif hastalarda (n=8) FSFI skorlarında ameliyat öncesi ve 6 ay sonrası arasında anlamlı fark saptanmadı. SONUÇ: Bu yeni sinir koruyucu teknik, düşük komplikasyon oranı ve cinsel fonksiyon korunumu ile etkili kozmetik onarım sağlamaktadır. Bulguların doğrulanması için daha geniş prospektif çalışmalara ihtiyaç vardır.

Keywords

• Klitoris ameliyatı
• klitoris/anormallikler
• rekonstrüktif cerrahi işlemler/yöntemler
• kadın cinsel fonksiyon indeksi
• tedavi sonucu
• ergen

References

1. 1. Iezzi ML, Lasorella S, Varriale G, Zagaroli L, Ambrosi M, Verrotti A. Clitoromegaly in Childhood and Adolescence: Behind One Clinical Sign, a Clinical Sea. Sex Dev. 2018; 12: 163-174.
2. 2. Wahyudi I, Islianti PI, Situmorang GR, Rodjani A. Genital reconstruction in an adult female patient with idiopathic clitoromegaly: A case report. Int J Surg Case Rep. 2020; 76: 545-548.
3. 3. Puppo V. Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction. Clin Anat. 2013; 26: 134-152.
4. 4. Oyama IA, Steinberg AC, Holzberg AS, Maccarone JL. Reduction clitoroplasty: a technique for debulking the enlarged clitoris. J Pediatr Adolesc Gynecol. 2004; 17: 393-395.
5. 5. Horejsí J. Acquired clitoral enlargement. Diagnosis and treatment. Ann N Y Acad Sci. 1997; 816: 369-372.
6. 6. Daniłoś J, Morawska D, Stachowicz N, Kotarski J. [Clitoromegaly--treatment with the harmonic knife (case description)]. Wiad Lek. 2013; 66: 262-264.
7. 7. Copcu E, Aktas A, Sivrioglu N, Copcu O, Oztan Y. Idiopathic isolated clitoromegaly: A report of two cases. Reprod Health. 2004; 1: 4.
8. 8. Young H. Genital abnormalities, hermaphroditism & related adrenal diseases. (No Title). 1937.

9. 9. Zhang X, Li B, Mao J, Richolsik, Zhang R, Faiz S, Zhao M. A Bibliometric and Visualisation Analysis on the Research of Female Genital Plastic Surgery Based on the Web of Science Core Collection Database. Aesthetic Plast Surg. 2024; 48: 2975-2993.
10. 10. Uzan C, Marchand F, Schmidt M, Meningaud JP, Hersant B. Clitoral reduction: Technical note. Ann Chir Plast Esthet. 2020; 65: e7-e13.
11. 11. Minto CL, Liao LM, Woodhouse CR, Ransley PG, Creighton SM. The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a cross-sectional study. Lancet. 2003; 361: 1252-1257.
12. 12. Nordenström A, Frisén L, Falhammar H, Filipsson H, Holmdahl G, Janson PO, et al. Sexual function and surgical outcome in women with congenital adrenal hyperplasia due to CYP21A2 deficiency: clinical perspective and the patients' perception. J Clin Endocrinol Metab. 2010; 95: 3633-3660.
13. 13. Gastaud F, Bouvattier C, Duranteau L, Brauner R, Thibaud E, Kutten F, Bougnères P. Impaired sexual and reproductive outcomes in women with classical forms of congenital adrenal hyperplasia. J Clin Endocrinol Metab. 2007; 92: 1391-1396.
14. 14. Meston CM, Freihart BK, Handy AB, Kilimnik CD, Rosen RC. Scoring and Interpretation of the FSFI: What can be Learned From 20 Years of use? J Sex Med. 2020; 17: 17-25.
15. 15. Rawat J, Singh S. Sensation-preserving clitoral reduction surgery: A preliminary report of our experience. Afr J Paediatr Surg. 2022; 19: 23-26.