title: Nerve Sparing Clitoroplasty is an Option for Adolescent and Adult Female Patients with Congenital Adrenal Hyperplasia and Clitoral Pain following Prior Clitoral Recession or Incomplete Reduction.
abstract: OBJECTIVE
  In the past many female patients with congenital adrenal hyperplasia and atypical genitalia were surgically treated with clitoral recession or incomplete reduction of erectile bodies. We report the results of repeat clitoral surgery performed for clitoral pain or enlargement using a nerve sparing reduction clitoroplasty technique.
  
  
  METHODS
  We identified 6 female patients with congenital adrenal hyperplasia who had undergone prior clitoral recession or incomplete reduction elsewhere. They then presented to our center with clitoral pain or enlargement, where they were treated with nerve sparing clitoroplasty between 2000 and 2010. We collected patient reported data relating to clitoral sensation and sexual function outcomes.
  
  
  RESULTS
  Mean ± SD age at evaluation for repeat clitoral surgery was 21 ± 7 years and mean age at clitoroplasty was 22 ± 8 years. Median postoperative followup was 9 months (IQR 32-6). All patients showed improvement with resolution of clitoral pain or enlargement.
  
  
  CONCLUSIONS
  Clitoral pain and enlargement upon arousal can be a major concern for women with clitoromegaly and congenital adrenal hyperplasia after clitoral recession is performed. Our series suggests that clitoral recession or incomplete reduction in childhood may be an inadequate initial solution in the congenital adrenal hyperplasia population due to the potential for future androgen elevation and the possibility of later symptom development. In addition we found that patients may be successfully treated with nerve sparing clitoroplasty, resulting in resolution of pain and ability to engage in sexual activity.
authors.affiliation: Comprehensive Center for Congenital Adrenal Hyperplasia and Institute for Pediatric Urology, Komansky Center for Children's Health, Department of Urology, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Reifsnyder
authors.affiliation: Comprehensive Center for Congenital Adrenal Hyperplasia and Institute for Pediatric Urology, Komansky Center for Children's Health, Department of Urology, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
authors.forename: John
authors.initials: J
authors.lastname: Stites
authors.affiliation: Comprehensive Center for Congenital Adrenal Hyperplasia and Institute for Pediatric Urology, Komansky Center for Children's Health, Department of Urology, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
authors.forename: Kerlly J
authors.initials: KJ
authors.lastname: Bernabé
authors.affiliation: Comprehensive Center for Congenital Adrenal Hyperplasia and Institute for Pediatric Urology, Komansky Center for Children's Health, Department of Urology, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
authors.forename: Denise
authors.initials: D
authors.lastname: Galan
authors.affiliation: Comprehensive Center for Congenital Adrenal Hyperplasia and Institute for Pediatric Urology, Komansky Center for Children's Health, Department of Urology, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York.
authors.forename: Diane
authors.initials: D
authors.lastname: Felsen
authors.affiliation: Comprehensive Center for Congenital Adrenal Hyperplasia and Institute for Pediatric Urology, Komansky Center for Children's Health, Department of Urology, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York. Electronic address: dpoppas@med.cornell.edu.
authors.forename: Dix P
authors.initials: DP
authors.lastname: Poppas
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000601:surgery*; D000328:Adult; D002648:Child; D002987:Clitoris / Q000294:innervation* / Q000601:surgery*; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D059351:Organ Sparing Treatments; D010146:Pain / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
keywords: adrenal hyperplasia, congenital; clitoris; female; reoperation; virilism