Clitoral hoodplasty in females with disorders of sex development.
BACKGROUND
The surgical management of girls with masculinized genitalia is gradually changing towards a more conservative approach. Reports on loss of clitoral sensitivity and related impairment of sexual function in women after feminizing genital surgery in childhood have been pivotal in this evolution. An exposed clitoral glans is occasionally seen at follow-up, and while patients may complain of aesthetics, no clitoral discomfort secondary to glans exposure has been reported. A technique has been developed to reconstruct the clitoral hood and the present study reports the preliminary results.


OBJECTIVE
To report the novel technique and preliminary results of clitoral hood reconstruction to cover an exposed glans after previous clitoroplasty in patients with congenital adrenal hyperplasia (CAH).


METHODS
Six female patients (mean age 13, range 4-21 years) with CAH sought medical help for clitoral concerns after previous reduction clitoroplasty. In two of the six patients, the main complaint was clitoral hypersensitivity or even pain. The clitoral glans was completely exposed in all patients, who were subsequently treated with a bi-laminar V-Y clitoral hoodplasty to create a mobile and natural-looking clitoral hood composed of an inner and outer preputial skin layer.


RESULTS
Postoperative covering of the glans was complete in five patients, and partial in one. The two patients with pre-operative pain became asymptomatic; all six patients were pleased with the cosmetic postoperative results.


CONCLUSIONS
Clitoral hoodplasty provides simple, yet effective, relief for women with cosmetic concerns or clitoral discomfort after previous feminizing surgery.
Department of Urology and Pediatric Urology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, Netherlands.
K P
KP
Wolffenbuttel
Children's Health - Children's Medical Center Dallas and Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
V S
VS
Menon
Children's Health - Children's Medical Center Dallas and Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Phoenix Children's Hospital, Phoenix, AZ, USA.
G M
GM
Grimsby
Department of Gynecology, Erasmus Medical Center, Rotterdam, Netherlands.
M J
MJ
Ten Kate-Booij
Children's Health - Children's Medical Center Dallas and Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: linda.baker@childrens.com.
L A
LA
Baker
D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000150:complications* / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D002987:Clitoris / Q000601:surgery*; D015331:Cohort Studies; D012734:Disorders of Sex Development / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005836:Genitalia, Female / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013536:Suture Techniques; D016896:Treatment Outcome; D013519:Urogenital Surgical Procedures / Q000379:methods; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
Clitoral hoodplasty; Clitoral hypersensitivity; Congenital adrenal hyperplasia; Disorders of sex development; Feminizing surgery