Abstract
Management of the enlarged clitoris, because of its import for sexual function, has been and remains one of the most controversial topics in pediatric urology. Early controversy surrounding clitoroplasty resulted from many factors including an incomplete understanding of clitoral anatomy and incorrect assumptions of the role of the clitoris in sexual function. With a better understanding of anatomy and function, procedures have evolved to preserve clitoral tissue, especially with respect to the neurovascular bundles. These changes have been made in an effort to preserve clitoral sensation and preserve orgasmic potential. It is the goal of this manuscript to describe the different procedures that have been developed for the surgical management of clitoromegally, with emphasis on the risks and benefits of each. Equally important to any discussion of such a sensitive topic is an understanding of long-term patient outcomes. As we will see, despite its importance, there has been a dearth of data in this regard. Future work in the arena of patient satisfaction will undoubtedly play a major role in directing our surgical approach.
Highlights
Reviewed by: Maria Marcela Bailez, Garrahan Childrens Hospital Buenos Aires, Argentina Santiago Vallasciani, King Faisal Specialist Hospital & Research Centre, Saudi Arabia
Controversy surrounding clitoroplasty resulted from many factors including an incomplete understanding of clitoral anatomy and incorrect assumptions of the role of the clitoris in sexual function
With a better understanding of anatomy and function, procedures have evolved to preserve clitoral tissue, especially with respect to the neurovascular bundles. These changes have been made in an effort to preserve clitoral sensation and preserve orgasmic potential. It is the goal of this manuscript to describe the different procedures that have been developed for the surgical management of clitoromegally, with emphasis on the risks and benefits of each
Summary
A number of Disorders of Sex Development (DSD) possessing a cell line with a Y chromosome can result in a child with an enlarged phallus who may be assigned the female gender role. This choice should only be undertaken after extensive multidisciplinary assessment and counseling of the parents. In ovotesticular DSD (previously labeled true hermaphroditism), functional ovarian and testicular tissues are both identifiable In both conditions, the phallus will undergo some degree of enlargement due to endogenous testosterone production. This is felt most likely due to fetal programming causing a surge in LH and the overactivation of the pituitary– gonadal axis [14]
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