Abstract
BackgroundSurgery for clitoral reduction has been practised for over half a century. The aim of clitoral surgery is to achieve normal clitoral morphology without compromising sexual function. To achieve these purposes, many techniques were developed since Young first reported reduction clitoroplasty in 1937. As the importance of the neurovascular bundle was realized, attempts were made to preserve this structure aiming at preservation of the sensory supply to the clitoris to achieve sexual satisfaction.MethodsThe study was conducted on six patients with congenital adrenal hyperplasia, who were operated upon with reduction clitoroplasty with neurovascular bundle preservation as a part of the genital reconstruction; surgery was done by single author (first author). Whole surgically removed corporal bodies were processed. Examination of the sections was done for the presence of nerve bundles related to the anatomical location of the neurovascular bundle using S100 immunohistochemical staining.ResultsIn four cases, the presence of nerve fibers in the removed part of the corpus stained by S100 was high on the dorsal surface, with the presence of large nerve fibers (score 3–4), and low on the ventral surface with the presence of small nerve fibers (score 1). In the other two cases, it was low on both surfaces (score 1).ConclusionSubfacial clitoroplasty technique carries an inevitable risk of nerve injury and should be replaced by the subtunical technique.Level of evidenceIV. Type of study: case series with no comparison group.
Highlights
Surgery for clitoral reduction has been practised for over half a century
2 Methods The study was conducted on six patients with congenital adrenal hyperplasia, who were operated upon with reduction clitoroplasty with neurovascular bundle preservation as a part of the genital reconstruction
3 Results Six children with congenital adrenal hyperplasia underwent single stage clitorovaginoplasty in whom the corpus clitoris was excised with the tunica albuginea intact and stained with hematoxylin and eosin, and immunohistochemical staining using S100 was performed in all specimens
Summary
The aim of clitoral surgery is to achieve normal clitoral morphology without compromising sexual function To achieve these purposes, many techniques were developed since Young first reported reduction clitoroplasty in 1937. The aim of clitoral surgery is to achieve normal clitoral morphology without compromising sexual function [1]. Patients who had clitorectomy were shown to have sexual problems; attempts were restarted to perfect a technique of clitoral reduction with preservation of the glans clitoris [3]. Attempts were made to preserve this important neural and vascular network Some of these techniques involved dissection of the neurovascular bundles off the corpora, but this exposed them to possible damage. In 1982 Rajfer et al [5] suggested a ventral approach to prevent damage to the neurovascular bundle
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