Girth-reduction clitoroplasty — a new technique: experience with 37 patients

Abstract

A new method of clitoroplasty is described that more closely simulates normal clitoral anatomy than previously described methods. The technique has been used successfully over the past 15 years in 37 patients whose underlying conditions were: congenital adrenal hyperplasia (24); mixed gonadal dysgenesis (6); partial androgen insensitivity (5); and exogenous androgen stimulation (2). The key points of this new technique are: (1) minimisation of blood loss; (2) reduction in clitoral girth rather than length; (3) preservation of the vascular and nerve supplies; and (4) creation of a hair-pin bend in the shaft of the clitoris, which simulates normal female anatomy as well as achieving an apparent reduction in length. Irrespective of the cause or severity of the virilisation, all patients obtained a good cosmetic result, 78% being regarded by their parents as appearing like a normal female. Five early patients required further surgery to achieve the desired results. Confident from experience that a good cosmetic result can be achieved without major surgical risk, even in a neonate, we now advocate surgical correction at the earliest possible age: as soon as an accurate diagnosis has been made, the parents have accepted the gender assignment, and the infant's metabolic condition has been stabilised.