Tissue-preserving feminizing clitoroplasty: A preliminary report

Abstract

Objective To describe a tissue-preserving feminizing clitoroplasty that potentially allows for future total reversal to male and report on its initial result. Material and methods A potentially reversible operation for feminizing clitoroplasty that preserves all available tissue was performed in three patients: two girls with congenital adrenal hyperplasia and a ‘46XY male’ with androgen insensitivity. The phallus was disassembled into its individual components of the phallic skin, left and right corpus cavernosum, dorsal neurovascular bundle with the dorsal portion of the glans, and ‘urethral plate–corpus spongiosum complex’ with the ventral portion of the glans attached. Each corpus cavernosum was folded upon itself and then hidden in the subcutaneous fat to increase the size of the labia majora. The partially divided urethral plate was used to form the inner part of the labia minora and the clitoral hood. The phallic skin was partially divided and used to form the outer part of the labia minora. This operation allowed feminizing clitoroplasty to be completed without significant excision of any tissue, including the corpora cavernosa. Results The operation was completed successfully in all three patients, two with concomitant inverted ‘V’ flap vaginoplasty. One patient had postoperative haematoma. All three have a cosmetically acceptable ‘female look’ to the satisfaction of themselves and their parents. Conclusion This preliminary result suggests that a cosmetically acceptable feminizing clitoroplasty can be performed with preservation of all phallic tissue, in particular the corpora cavernosa. This potentially reversible operation may be advantageous when feminizing genitoplasty has to be performed in a young child with disorders of sex development.