Clitoral Surgery


“The clitoris is a long, complicated organ with a dense nerve and blood supply. It is a very important part of the genital anatomy and responsible for much of the sexual satisfaction and pleasure experienced by women.

For some women the clitoris is too prominent or exposed resulting in increased friction (due to rubbing against undergarments and clothes) leading to discomfort and hypersensitivity or concerns due to the size and prominence. Both concerns often co-exist in women who complain of clitoral enlargement.

Clitoral enlargement (clitoromegaly) can be present at birth or develop later in life. Most often, exposure to androgens (mainly testosterone) causes this to occur in people designated female at birth. It is normal for the clitoris to increase in size during arousal but this increase will reverse when arousal has stopped. In true clitoromegaly, the visible part of the clitoris (the ‘glans’) remains larger than the typical ¾ to 1 inch. Other causes of clitoral enlargement include cysts, noncancerous tumours or  irritation to the external genitals (vulvitis), congenital conditions (present at birth) and hormonal changes in polycystic ovarian syndrome and increased androgen levels (particularly testosterone) in the blood stream.

Clitoral surgery has both functional and cosmetic components which are intricately linked. Clitoral surgery is very specialised surgery involving specific techniques and skill.

Dr Onuma is the author of So, You Want A Labiaplasty and The Ultimate V. These books are unique and aimed at women considering their options for labial, vaginal and pelvic floor improvement.

What is clitoropexy?

Clitoropexy is surgical procedure to lift the clitoris upward and inward towards the pubic bone. This reduces the length of the clitoral shaft and makes the clitoris less visible. The suspensory ligament is the main supporting structure of the clitoris and is comprised of three distinct components which are described as superficial, intermediate and deep. When Dr Onuma performs a clitoropexy, he attaches the more durable intermediate and deep components of the suspensory ligaments to the lateral (side) fascia of the clitoris. This is done on the left and right using permanent sutures.

This is an excellent surgical procedure for the enlarged and/or over exposed clitoris in most circumstances as no resection or removal of any part of the clitoris is required whilst still been able to reduce exposure significantly. Patients tend not to experience any decreased clitoral sensitivity as the sutures are not placed in the same area as the dorsal nerves of the clitoris.

What is clitoroplasty?

Clitoroplasty is surgery to reduce the thickness and/or the length of the clitoris by removing or cutting away clitoral tissue. Clitoroplasty is rarely needed and is much more invasive than clitoropexy, carrying with it a greater risk of nerve and vascular damage.

Clitoroplasty is sometimes required, often in combination with clitoropexy if the degree of clitoromegaly is such that elevation and repositioning still leaves a large amount of the clitoris exposed.

Clitoral and prepuce surgery - reduction/elevation

The clitoral hood is the fold of skin that sits above the clitoris. The extension of skin above the clitoral hood is known as the prepuce. Sometimes there is a distinct crease between the clitoral hood and prepuce but for some women these tissues are contiguous. The clitoral hood protects the clitoris, reducing its exposure and hence the risk of it rubbing on clothing.

The clitoral hood and prepuce vary in proportion to other vulval structures, however it is the clitoral hood size and shape which determine the degree to which the clitoris is covered. Inflammation or irritation of the clitoral hood or prepuce can result in a temporary increase in size which returns to normal size when the inflammation or irritation has resolved. Some women have a larger clitoral hood unrelated to inflammation or irritation, occurring as a natural event noticeable from birth or early childhood or developing with puberty or after childbirth.

Clitoral and prepuce surgery (reduction and/or elevation) are procedures which Dr Onuma performs for women who have a large clitoral hood which interferes with their access to the clitoris or which is of an aesthetic concern. This can be achieved through prepuce elevation without direct surgery on the clitoral hood, through clitoral hood elevation with elevation into the prepuce. If the prepuce is also bulky then prepuce reduction may also need to be carried out. Infrequently the clitoral hood itself requires tissue reduction. This procedure is known as hoodectomy. The specific procedure(s) required to achieve the desired outcome will depend on individual anatomy and will be individually tailored by Dr Onuma.

Clitoral hood reduction and prepuce elevation are procedures that are commonly performed with labiaplasty and clitoral surgery.

Excellence in Form and Function. Prevent, Treat and Maintain.

Dr Oseka Onuma has a particular interest and expertise in clitoral surgical procedures. He is highly trained and experienced in all aspects of clitoropexy, clitoroplasty and periclitoroplasty.

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