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Pediatr Surg Int (2007) 23:289293 DOI 10.1007/s00383-007-1893-y
REVIEW ARTICLE
Clitoroplasty: past, present and future
W. L. Lean J. M. Hutson A. V. Deshpande S. Grover
Accepted: 30 January 2007 / Published online: 28 February 2007 Springer-Verlag 2007
Abstract This paper reviews the history of clitoral surgery throughout the twentieth century. The changing operations, from amputation through to attempts to produce a normal clitoris mirror the changing attitudes and available knowledge. It also examines the current issues that arise out of available data on long-term outcomes of clitoroplasty.
Keywords Clitoromegaly Clitoroplasty Intersex Ambiguous genitalia Surgery
Introduction
Clitoromegaly is a feature of disorders of sexual development. It is the most obvious feature that heightens the parental anxiety and raises debate over sex assignment. Surgery for clitoral reduction has been practised for over half a century to allow female sex assignment and rearing in selected patients. The aim of
clitoral surgery is to achieve normal clitoral morphology without compromising sexual function. The surgery for clitoral reduction has changed as our knowledge of the anatomy has improved. We aim to review the history of clitoral surgery and present a brief analysis of the current issues concerning clitoroplasty.
History
Young rst reported reduction clitoroplasty in 1937 [1]. The technique of reduction involved reducing the corporal length, but the glans that had been preserved sloughed off later. Hence, the technique of clitorectomy was introduced supported by the theory that the clitoris had no function [2]. However, patients who had clitorectomy were shown to have sexual inhibition and ambivalence towards sexual activity [3] and hence attempts were restarted to perfect a technique of clitoral reduction. A technique of reduction and relocation of the clitoris preserving the sensitive tip of the glans was introduced by Lattimer [4]. Randolph and Hung modied this technique advocating reduction of the length of the exposed shaft (recession) and emphasised the need to maintain the anatomical position of the clitoris [5]. Some patients reported a painful erection with this technique. In the late 1960s and early 1970s, further modications of the techniques of reduction and recession were suggested [610]. In the 1970s, it was suggested that mucosa on the ventral aspect should be left untouched along a third of the circumference to preserve the blood supply to...