Reduction Clitoroplasty by Ventral Approach: Technical Refinement

Abstract

Background Aesthetic alteration of the genitalia is increasingly sought by women who are unhappy about the size, shape or overall appearance of their vulva. Clitoral hypertrophy is usually seen in congenital malformations, specifically in intersexual stages of hormonal expression. A large clitoris has an appearance of a small penis, is psychologically disturbing and interferes in sexual activity.

“Waking up” the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature

“…A total of 29 records (38.7%) included medical photographs of the patient’s body or body parts. In most cases, they were close-ups of genitals—mainly from infants or children (AbouZeid & Mohammad, 2020 ; Barham et al, 2016 ; Baskin, 2017 ; Deeb et al, 2016 ; Fadil Iturralde et al, 2020 ; Goncalves et al, 2019 ; Heo et al, 2018 ; Jayanthi et al, 2017 ; Jesus et al, 2018 ; Kearsey & Hutson, 2017 ; Marei et al, 2016 ; Matsumoto et al, 2017 ; Morozumi et al, 2018 ; Nasir et al, 2019 ; Ochi et al, 2019 ; Saikia et al, 2019 ; Şimşek et al, 2016 ; Sperling & Meyer, 2017 ; Wagner-Mahler et al, 2019 ), but in a few cases also of adolescents (Chouhan et al, 2017 ; Hunter et al, 2016 ; Tambo et al, 2016 ) and adults (Larios García & Bautista Delgado, 2016 ; Patil et al, 2019 ; Singh et al, 2016 ). Three papers also contained images of breasts (Singh et al, 2016 ) and/or fully body shots (Khare et al, 2017 ; Mirshahvalad et al, 2018 ) of adolescents whose eyes were obscured with a black line.…”

“…normal vagina, normal penis, normal ovaries, normal testes, normal labia, normal ovarian tubes, normal fallopian tubes, abnormality of scrotum). Only in some occasions did the authors explain in more detail why these organs were considered (ab)normal, namely in terms of appearance (Adrião et al, 2020 ; Barham et al, 2016 ; Chen et al, 2018 ; Chowdhury et al, 2018 ; Fadil Iturralde et al, 2020 ; Hernández et al, 2016 ; Nasir et al, 2019 ; Ochi et al, 2019 ; Özdemir et al, 2019 ; Patil et al, 2019 ; Roth et al, 2018 ; Schteingart et al, 2019 ; Weaver et al, 2019 ), size (Adrião et al, 2020 ; Marei et al, 2016 ; Matsumoto et al, 2017 ; Mondal et al, 2016 ; Rich et al, 2016 ; Schteingart et al, 2019 ), length (AbouZeid & Mohammad, 2020 ; Finlayson et al, 2019 ; Goncalves et al, 2019 ; Morandi et al, 2018 ; Raveenthiran, 2017 ; van Leeuwen et al, 2019 ), location (Finlayson et al, 2019 ), and function (Heo et al, 2018 ; Lepais et al, 2016 ; Poyrazoglu et al, 2017 ; Raveendran et al, 2019 ; Raveenthiran, 2017 ). Some examples include: normal looking genitalia, normal appearing uterus, normal penis size, abnormal enlargement of clitoris, vagina with normal length, normally descended testes, abnormal location of the urethral meatus, and normal testicular function.…”

“…The studies touched on some important DSD-specific themes such as: (delay in, correct, timely etc.) diagnosis (Ameyaw et al, 2019 ; Caputo et al, 2019 ; Fadil Iturralde et al, 2020 ; Mondal et al, 2016 ; Şimşek et al, 2016 ; Teasdale & Morton, 2017 ; Xu et al, 2018 ), medical decision-making (Hernández et al, 2016 ; Khare et al, 2017 ; Teasdale & Morton, 2017 ; Witchel, 2018 ), multi-disciplinary teams (Berberoğlu & Şıklar, 2018 ; Caputo et al, 2019 ; Chowdhury et al, 2018 ; Heo et al, 2018 ; Hernández et al, 2016 ; Kearsey & Hutson, 2017 ; Nasir et al, 2019 ; Özdemir et al, 2019 ; Şimşek et al, 2016 ; Witchel, 2018 ; Wu et al, 2017 ) follow-up care (Berberoğlu & Şıklar, 2018 ; Chouhan et al, 2017 ; Hertweck & Rothstein, 2019 ), genetic screening (Kornman et al, 2018 ; Wu et al, 2017 ), fertility and reproduction (Adrião et al, 2020 ; Greeley et al, 2017 ; Hertweck & Rothstein, 2019 ; Pattamshetty et al, 2020 ; Witchel, 2018 ), the risk for tumor development of gonads (Chen et al, 2018 ; Chouhan et al, 2017 ; Heo et al, 2018 ; Huang et al, 2019 ; Lepais et al, 2016 ; Matsumoto et al, 2017 ; Pan et al, 2019 ; Şimşek et al, 2016 ) and sexuality (Baskin, 2017 ; Mendonca et al, 2016 ; Patil et al, 2019 ).…”

“…Many papers (Caputo et al, 2019;Heo et al, 2018;Hunter et al, 2016;Kearsey & Hutson, 2017;Larios García & Bautista Delgado, 2016;Patil et al, 2019;Poyrazoglu et al, 2017;Raveenthiran, 2017;Rich et al, 2016;Saikia et al, 2019;Schteingart et al, 2019;Şimşek et al, 2016;Singh et al, 2016;Touzon et al, 2019;Wagner-Mahler et al, 2019;Yan et al, 2019) also referred to (ab) normal hormonal levels or (ab)normal hormone production (e.g. testosterone, estrogen, luteinizing hormone (LH), follicle stimulating hormone (FSH), Anti-Müllerian hormone (AMH)), at times with the indication of a reference range (Adrião et al, 2020;Morandi et al, 2018;Raveendran et al, 2019;Şimşek et al, 2016;Sperling & Meyer, 2017;Teasdale & Morton, 2017;Wu et al, 2017;Xu et al, 2018).…”