Definition and Overview
A clitoroplasty is a surgical procedure that refines or improves the appearance of a woman’s clitoris. It can also be performed to create an artificial clitoris in men undergoing sex reassignment surgery. It is also known as clitoral hood reduction, as it can reduce the size of the clitoral hood in some patients.
The clitoris is a small but a very sensitive part of the female genitals. It is widely considered as the female equivalent of the penis. It is often concealed, either partially or completely, by the clitoral hood, also known as the clitoral prepuce, which is a fold of skin that makes up a part of the labia minora. The clitoral hood is considered as the equivalent of the male’s foreskin, particularly because of their similar composition of mucocutaneous tissues. However, unlike the foreskin, the clitoral hood does not have to be removed.
There are, however, some special circumstances wherein the clitoris or the clitoral hood has to be reduced in size or completely reconstructed such as in cases of a disease, trauma, congenital issues, or for cosmetic purposes.
Who Should Undergo and Expected Results
A clitoroplasty is used for both cosmetic and medical reasons. When used as a medical treatment, it restores the appearance of the clitoris following trauma or injury. It is also used as part of the treatment for some congenital disorders affecting the female genital area.
A clitoroplasty is therefore medically beneficial for patients who suffer from:
- Clitoromegaly or clitoral hypertrophy, a condition wherein the clitoris becomes abnormally enlarged, usually due to an existing disease (polycystic ovarian syndrome) or as a side effect of medications (such as anabolic steroids or testosterone supplements).
- Congenital adrenal hyperplasia, a birth defect that causes ambiguous genitalia, enlarged clitoris, or shallow vagina due to gene mutations during embryonic development
- Enlarged clitoral hood that prevents the patient from experiencing strong sexual sensations. In such cases, a clitoral hood reduction can expose the clitoris or clitoral glans to increase the patient’s sexual response and produce more powerful orgasms.
- Trauma to the clitoris, often as a result of or complication of previous genital surgery
- Injury to the clitoris or clitoral hood
Female genital mutilation or cutting, which can be repaired by a clitoroplasty
A clitoroplasty also offers cosmetic or aesthetic benefits for patients who:
Want to undergo sex reassignment surgery
- Want to improve the appearance of their genital area
At the end of a clitoroplasty, the patient can expect to have a normal-sized clitoris or clitoral hood with normal clitoral function, in that the clitoris and its hood are able to experience close-to-normal sexual sensations.
There may be a reduction or difference in the sexual response of the clitoris or clitoral hood following the surgery, but surgical techniques used in clitoroplasty are continuously being improved to maintain patients’ sexual sensations following the procedure.
How Does the Procedure Work?
A clitoroplasty is usually performed in a clinic’s procedure room, with the patient under local anaesthesia. It is a simple procedure that takes less than an hour and is associated with a relatively short recovery time, with most patients returning to their normal activities within two to three days. However, patients may be asked to wait until the wound and swelling have completely resolved before having sexual intercourse.
The specific manner in which a clitoroplasty is performed depends on the specific purpose of the procedure, i.e. girth or length reduction, or clitoral reconstruction.
In a clitoral hood reduction, the most common method is to remove the excess tissue and pull the clitoris up. Once the ideal appearance and size are determined, the surgeon then stitches it into place. Some doctors approach the clitoris from the underside, a clitoral hood reduction technique that avoids damaging the neurovascular bundle in the area. It also preserves the appearance of the clitoral glans, despite the reduced size of the hood.
One alternative technique has some surgeons creating a bend in the clitoral shaft, which reduces the length of the clitoral hood while also maintaining the normal appearance of the female genitals. This minimizes blood loss while also preserving the neurovascular supply in the area.
In a clitoral reconstruction surgery, the most common technique used is separating a man’s penile glans from the erectile tissues and reducing it in size to mimic the appearance of a woman’s clitoris. However, the result is not similar in appearance to the normal clitoris because of the difference in color and shape. Sexual response also tends to differ. Some doctors, therefore, preserve some erectile tissue and use a certain amount of foreskin to create the clitoral hood. This improves the sexual response and effectively imitates the clitoral engorgement that occurs during arousal.
Possible Risks and Complications
The following risks are involved in all cases of clitoroplasty, regardless of whether it is a hoodectomy (clitoral hood reduction) or a reconstructive procedure:
- Blood loss or excessive bleeding
- Scar tissue buildup
- Skin discoloration
- Necrosis or death of tissue due to the loss or lack of blood supply
Pudendal nerves, wherein nerves become less sensitive often due to some damage to the neurovascular bundle in the genital area
Goodman M P. Female cosmetic genital surgery. Obstet Gynecol. 2009;113(1):154–159
Scholten E. Female genital cosmetic surgery—the future. J Plast Reconstr Aesthet Surg.2009;62(3):290–291