Reduction clitoro-labioplasty versus clitoro-labiectomy in managing adult onset clitoro-labiomegaly.
OBJECTIVE
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.


CONCLUSIONS
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.
Ali
Athmar Hussein
AH
Department of Obstetrics and Gynecology, Sana'a University, Yemen.
Thabet
Saeed Mohamad Ahmad
SM
D000293:Adolescent; D000328:Adult; D013734:Androgen-Insensitivity Syndrome / Q000473:pathology / Q000601:surgery; D002987:Clitoris / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012734:Disorders of Sex Development / Q000473:pathology / Q000601:surgery*; D004534:Egypt; D005260:Female; D006801:Humans; D008297:Male; D009948:Orgasm; D011446:Prospective Studies; D012725:Sexual Behavior / Q000502:physiology; D019529:Sexuality; D014564:Urogenital Abnormalities / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D013519:Urogenital Surgical Procedures / Q000379:methods* / Q000523:psychology; D014844:Vulva / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*