Clitoroplasty in Intersex: a New Technique

Mollard, P; Juskiéwenski, S; Sarkissian, J. S.

doi:10.1111/j.1464-410x.1981.tb03200.x

Cited by 58 publications

(19 citation statements)

References 6 publications

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“…Surgical treatment consisted of clitoroplasty, which was usually done by "tucking" a portion of the erectile tissue under the symphysis pubis [2][3][4], and vulvovaginoplasty, which involved initial exteriorization of the vaginal and urethral orifices [5,6]. These procedures are done between 6 and 18 months of age [2][3][4].…”

Section: Figure 7 Genitography-vaginal Hypoplasia and Obvious Communmentioning

confidence: 99%

“…These procedures are done between 6 and 18 months of age [2][3][4]. Some authors believe vaginoplasty should be delayed until after the patient is 6 years old to achieve better results [6]; however, confining the number of surgical procedures by doing both clitoroplasty and vaginoplasty at the same time is better psychologically for the patient and family.…”

Section: Figure 7 Genitography-vaginal Hypoplasia and Obvious Communmentioning

confidence: 99%

See 1 more Smart Citation

Congenital Adrenal Hyperplasia

Salman¹,

Abanamy²,

Basset³

et al. 1991

Ann Saudi Med

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The incidence of congenital adrenal hyperplasia in Saudi Arabia and the frequency of the carrier rate are not well known. Both figures should be high, considering the commonness of first-degree consanguinity in this part of the world. We present 25 cases of congenital adrenal hyperplasia, most of them due to a defect of the 21 hydroxylase enzyme, diagnosed and followed over three years at Suleimania Children's Hospital in Riyadh. There were ten boys and 15 girls exhibiting all degrees of masculinization, mostly Grade III (53%) and Grade IV and V (13.3% each). The degree of masculinization of the external genitalia in the girls (46XX) was sufficiently pronounced in seven patients to lead to sex identity errors at birth. This aggravated the psychological reactions in the families, particularly before the surgical correction. The frequency of neonatal deaths in the patients' families related to a similar disorder was high (12%). The mean age at onset of the salt-losing crises in affected infants was 9 days in females and 25 days in males and this was the most common clinical presentation of the disorder (80%). Systematic neonatal screening and intrauterine diagnosis in at risk families must be done to provide hormonal intervention and thus prevent the formation of ambiguous genitalia and avoid the resulting plastic surgery that must be performed in female patients. Congenital adrenal hyperplasia is common in Riyadh, where marriages between first-degree relatives are frequent. As everywhere, and particularly under the local sociocultural conditions, discussion is focused on the genetic sex which isnot always easy to determine, depending on the degree of masculinization of otherwise genetically defined females. The surgical correction and the psychological consequences in the affected families also contribute to the problems. Intrauterine and neonatal screening are therefore important. Likewise, intrauterine treatment may prevent genital abnormalities and the neonatal deaths caused by salt-losing crises. The etiology, medical and surgical treatment, and follow-up of clinical, radiological, and biological features are discussed, along with the problems of neonatal and intrauterine screening. Patients and MethodsCongenital adrenal hyperplasia was diagnosed in 25 patients who were followed up at the Suleimania Children's Hospital in Riyadh over a period of three years. Nationality and supposed sex as well as family history were recorded. The age of onset and clinical presentation, particularly the presence or absence of a salt-losing syndrome,

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Section: Figure 7 Genitography-vaginal Hypoplasia and Obvious Communmentioning

confidence: 99%

Section: Figure 7 Genitography-vaginal Hypoplasia and Obvious Communmentioning

confidence: 99%

Congenital Adrenal Hyperplasia

Salman¹,

Abanamy²,

Basset³

et al. 1991

Ann Saudi Med

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“…Clitoro-labioplasty as suggested by the authors differs from the standard technique of reduction clitoroplasty described by Mollard et al [12] in that it also includes labioplasty. The latter is done by excising the protruded parts of the labia minora and suturing their edges with subcuticular stitches of chromic catgut number 2 zero.…”

Section: Methodsmentioning

confidence: 53%

Reduction Clitoro-Labioplasty versus Clitoro-Labiectomy in Managing Adult Onset Clitoro-Labiomegaly

Ali

Thabet²

2009

Gynecol Obstet Invest

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Objectives: To compare a new procedure of reduction clitoro-labioplasty to clitoro-labiectomy in the management of adult onset clitoro-labiomegaly, and to show the disadvantages of the latter procedure that produces female genital mutilation and sexual dysfunction. Methods: This controlled, descriptive, comparative and prospective cohort study was performed at Kasr El-Aini School of Medicine, Cairo University, Egypt. 47 cases of clitoro-labiomegaly, 12 with known causes of intersex, were diagnosed and treated by reduction clitoro-labioplasty. In addition, a control group of 53 more cases, 6 with known causes of intersex, were followed after treatment by clitoro-labiectomy. Clitoro-labioplasty was performed by excision of the anterior part of the fused corpora after separation at the glans-corporal junction and a reduction in the size of the remaining part of the corpora to reform a normal clitoral size. The neurovascular bundles were essentially preserved during this procedure. The protruded parts of the labia minora are then excised to preserve their normal dimensions. The main outcome measures were the postoperative anatomical result, patient’s satisfaction, the pre- and postoperative sex scoring, and sexuality. Results: Restoration of normal anatomy was successfully obtained after clitoro-labioplasty compared to partial or complete loss of these sensitive parts after clitoro-labiectomy. In addition, significant operative and postoperative complications were recorded in 27 cases with clitoro-labiectomy compared to none of the clitoro-labioplasty cases. The sex scores and sexuality improved significantly after the clitoro-labioplasty operation compared to clitoro-labiectomy (p < 0.005). Normalization of the sex scores and sexuality was found to be significantly related to preservation of critical clitoral length necessary for producing clitoral orientation and interest in sexuality. Conclusion: The new clitoro-labioplasty technique is able to preserve proper clitoral and labial anatomy and restore normal sexuality. Therefore it must be considered an essential line of treatment for clitoro-labiomegaly.

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“…These authors appear to be the first to suggest the use of the dorsal excess foreskin to reconstruct the labia minora, which are often absent, or rudimentary, although Fowler was already using these techniques 10 years earlier (personal communication). Gradually, surgeons started including glanuloplasty and labioplasty in the technique of clitoroplasty [12][13][14]. In the 1980s, the technique of a single stage surgery for clitoral reduction and creation of an adequate vagina was developed [15,16].…”

Section: Historymentioning

confidence: 99%