Step-by-Step Approach for Nerve-sparing Reduction Clitoroplasty

Study Objective To describe a stepwise demonstration of a vaginal approach for nerve-sparing reduction clitoroplasty. Design Video of a case report. Setting Tertiary, academic hospital (Women's Hospital, University of Campinas). Interventions An 18-year-old nulliparous woman consulted with complaints of primary amenorrhea, small development of breasts, and an increase of the clitoris in the last months. A physical examination revealed a 5-cm clitoromegaly, normal but small breasts, and normal vulvar pili. Laboratory examinations showed XY karyotype and increased levels of dehydroepiandrosterone sulfate and follicle stimulating hormone. Surgical planning for reduction clitoroplasty, laparoscopic bilateral gonadectomy, plus removal of the rudimentary uterus was done and performed. The main steps were as follows: (1) An inverted T incision at the clitoral gland was performed, and the exposition of the ventral area of the clitoris was done. (2) A lateral approach between the neurovascular bundle and the corporal cavernosa was used, until both structures were separated. (3) Dissection was performed proximally to the bifurcation of the corporal cavernosa, and both structures were identified and clamped. (4) The base of the clitoral glans was sutured laterally to this area, and suturing was performed to reapproximate the labia minora from the clitoris. The patient was discharged 20 hours after the procedure. The immediate and late postoperative periods occurred with no complications (wound dehiscence, hematoma), and clitoral sensitivity was restored according to the patient's self-report. Conclusion This case shows the importance of nerve-sparing reduction clitoroplasty for reducing the risk of sensitivity loss and/or other complications.