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Journal articles on the topic 'Clitoral surgery'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Kelling, Joseph A., Cameron R. Erickson, Jessica Pin, and Paul G. Pin. "Anatomical Dissection of the Dorsal Nerve of the Clitoris." Aesthetic Surgery Journal 40, no. 5 (2019): 541–47. http://dx.doi.org/10.1093/asj/sjz330.

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Abstract Background The clitoris is the primary somatosensory organ of female sexual response. Knowledge of its neural anatomy and related landmarks is essential for safe genital surgery. Objectives The aim of this study was to describe the distal course of the dorsal nerves of the clitoris and associated structures. Methods Clitorises of 10 fresh cadavers were dissected. Measurements of the dorsal nerves, suspensory ligament, clitoral body, clitoral hood, and clitoral glans were obtained. The course of the dorsal nerves was examined. Results The dorsal nerves of the clitoris were larger than expected, ranging from 2.0 to 3.2 mm in diameter, on average, along their course in the clitoral body. In 9 of 10 specimens, the dorsal nerves could be traced to within 6 mm of the glans. They traveled deep to a superficial clitoral fascia but superficial to the tunica albuginea, were variably located between 10 and 2 o’clock, and were separated by the deep suspensory ligament (DSL) of the clitoris. The mean length of the descending clitoral body, from the angle to the base of the glans, was 37.0 mm. The mean distance from the pubic rim to the DSL was 37.7 mm. Conclusions The clitoral body is substantial in length, mostly lying superficially under the clitoral hood and mons pubis. The dorsal nerves of the clitoris are large and superficial, terminating at or near the base of the clitoral glans. Knowledge of this anatomy is critical prior to performing surgery near the clitoris.

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2

Vukadinovic, Vojkan, Borko Stojanovic, Marko Majstorovic, and Aleksandar Milosevic. "The Role of Clitoral Anatomy in Female to Male Sex Reassignment Surgery." Scientific World Journal 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/437378.

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Introduction. Controversies on clitoral anatomy and its role in female sexual function still make clitoral reconstructive surgery very challenging. We evaluated the role of clitoral anatomic features in female to male sex reassignment surgery.Material and Methods. The study included 97 female transsexuals, aged from 18 to 41 years, who underwent single stage metoidioplasty between March 2008 and January 2013. The operative technique involved vaginectomy, the release of clitoral ligaments and urethral plate, urethroplasty by combining buccal mucosa graft and genital flaps, and scrotoplasty with insertion of testicle prostheses. Postoperative questionnaire was used to evaluate aesthetic, functional, and sexual outcome.Results. The mean followup was 30 months. The mean length of the neophallus was 7 cm, compared to mean preoperative length of the hypertrophied clitoris of 3.3 cm. Complications occurred in 27.84% of all patients, related mostly to urethroplasty. Voiding while standing was achieved in all cases. None of the patients had problems in sexual arousal, masturbation, or orgasms.Conclusion. Accurate knowledge of the clitoral anatomy, physiology, and neurovascular supply is crucial for a successful outcome of female to male sex reassignment surgery. Our approach appears to ensure overall satisfaction and high quality of sexual life.

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3

Okaneya, Tetsuya, Kiyoshi Onishi, Michio Saze, Kei Iwakura, and Hiroko Sakuma. "A Case of Clitoral Hypertrophy of Unknown Origin." Case Reports in Obstetrics and Gynecology 2018 (November 1, 2018): 1–3. http://dx.doi.org/10.1155/2018/7865832.

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Clitoral hypertrophy is caused by disorders of sex development and it is observed from birth in most cases. We encountered a patient in whom normal morphology at birth may have acquired deformity and hypertrophy. The patient was a 10-year-old girl with a chief complaint of pudendal deformity. The clitoral hood was enlarged and the clitoris size was 8 x 5 mm on the first examination. Various tests were performed. Sex chromosome or hormonal abnormalities and tumorous lesions were not detected, and the ovaries, uterus, and vagina were normal, indicating that disorders of mullerian development were negative. In surgery, reconstruction of the vulva was performed following the Marberger method. The present case may have been a very rare case of acquired hypertrophy of unknown origin.

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4

Uzan, C., F. Marchand, M. Schmidt, J. P. Meningaud, and B. Hersant. "Clitoral reduction: Technical note." Annales de Chirurgie Plastique Esthétique 65, no. 4 (2020): e7-e13. http://dx.doi.org/10.1016/j.anplas.2019.10.002.

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5

Jordal, Malin, Hannes Sigurjonsson, Gabriele Griffin, and Anna Wahlberg. "The benefits and disappointments following clitoral reconstruction after female genital cutting: A qualitative interview study from Sweden." PLOS ONE 16, no. 7 (2021): e0254855. http://dx.doi.org/10.1371/journal.pone.0254855.

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Female genital cutting or mutilation refers to the cutting of girls’ external genitalia. Due to migration from contexts where female genital cutting is common, it is estimated that around 38 000 cut women and girls live in Sweden. Clitoral reconstruction, a relatively new form of surgical healthcare offered to women with female genital cutting, was established in Sweden in 2014. This surgery aims at restoring clitoral function and anatomy, but there is yet a dearth of evidence demonstrating the effects of the surgery. The aim of this study was to explore how women undergoing clitoral reconstruction in Sweden between 2016 and 2019 experienced the surgical process and its aftereffects from a physical, sexual and psychosocial perspective. Eighteen women who had undergone clitoral reconstruction at a university hospital in Sweden agreed to participate in the study. The women were interviewed using semi-structured interviews, which were recorded, transcribed and analysed using thematic analysis. The results, based on self-categorization and labelling theory, demonstrated both benefits and disappointments following the surgery. Several women reported positive outcomes in terms of sexual, psychosocial and aesthetic terms. They experienced reduced genital pain, improvements in their sex lives, and a sense of feeling more empowered and at ease in their bodies. Yet, some women reported aesthetic, functional and process-related disappointment related to clitoral reconstruction. Nonetheless, the women expressed gratitude for the possibility of undergoing the surgery. In conclusion, the women reported that they experienced physical, sexual and psychosocial benefits of the surgery.

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6

Patel, Neil, Alexandra Hamilton, and Natasha Fievre. "Clitoral HOOD granulosa cell tumor; case report and review of literature." Obstetrics & Gynecology International Journal 12, no. 4 (2021): 253–54. http://dx.doi.org/10.15406/ogij.2021.12.00586.

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Background: Granulosa Cell tumors (GCT) are a sex-cord stroma tumor comprising of 1-2% of ovarian malignancies. Derived from Schwann cells, GCTs are comprised of granulosa cells, a cell of the ovarian stroma. Patients with these tumors present with signs of increased estrogen such as vaginal bleeding, irregular menstruation and rarely hirsutism and virilization.8,10-12 The majority of GCTs are found in the skin, subcutaneous tissue and submucosa with a handful of case reports discussing primary GCTs in the clitoris.3,7 Surgery is required for definitive tissue diagnosis and staging. In this case report, we present a case with tissue diagnosis for granulosa cell tumor found on the clitoral hood. Case: A 56-year-old, female, G6P3033 initially presented for evaluation of persistent clitoral cyst for >2 years Initial evaluation was significant for 1 cm clitoral cyst that was firm, smooth and fluctuant with no irregular borders; with worsening vulvodynia. The patient underwent clitoral hood mass excision. The mass was excised entirely and the post-operative recovery was uncomplicated. Pathology findings were significant for completely excised granulosa cell tumor; margins were negative for tumor. Immunohistochemical stain was positive for CD56, CD68, Vimentin, and S-100, and negative for AE1/13, CD31, CD34, SMA, and Desmin. Conclusion: When evaluating chronic, persistent, or recurrent masses, it is important to take into consideration both benign and malignant causes. Definitive diagnosis is established pathologically. Patients with confirmed GCT should be thorough evaluated pre-operatively with blood work and appropriate imaging. Upon diagnosis, patient with GCT should be regularly followed for recurrence and surveillance.

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7

Chan, John K., Huyen Pham, Valerie Sugiyama, Joanne Rutgers, Kathryn Olsann, and Bradley J. Monk. "Conservative Clitoral-Sparing Surgery in Vulvar Carcinoma." Obstetrics & Gynecology 99, Supplement (2002): 90S. http://dx.doi.org/10.1097/00006250-200204001-00203.

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8

Abdulcadir, Jasmine, Omar Abdulcadir, Martin Caillet, et al. "Clitoral Surgery After Female Genital Mutilation/Cutting." Aesthetic Surgery Journal 37, no. 9 (2017): NP113—NP115. http://dx.doi.org/10.1093/asj/sjx095.

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9

Hunter, John G. "Response to “Clitoral Hood Reduction”." Aesthetic Surgery Journal 36, no. 7 (2016): NP232. http://dx.doi.org/10.1093/asj/sjw062.

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10

Goldstein, Irwin. "Surgical Techniques: Dorsal Slit Surgery for Clitoral Phimosis." Journal of Sexual Medicine 5, no. 11 (2008): 2485–88. http://dx.doi.org/10.1111/j.1743-6109.2008.01019.x.

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11

Slijper, Froukje ME. "Clitoral surgery and sexual outcome in intersex conditions." Lancet 361, no. 9365 (2003): 1236–37. http://dx.doi.org/10.1016/s0140-6736(03)13026-7.

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12

Tovar, Juan A. "Clitoral surgery and sexual outcome in intersex individuals." Lancet 362, no. 9379 (2003): 247–48. http://dx.doi.org/10.1016/s0140-6736(03)13924-4.

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13

Minto, CL, LM Liao, CR Woodhouse, PG Ransley, and SM Creighton. "Clitoral surgery and sexual outcome in intersex individuals." Lancet 362, no. 9379 (2003): 248. http://dx.doi.org/10.1016/s0140-6736(03)13925-6.

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14

Fraser, Sylvan. "Constructing the female body: using female genital mutilation law to address genital-normalizing surgery on intersex children in the United States." International Journal of Human Rights in Healthcare 9, no. 1 (2016): 62–72. http://dx.doi.org/10.1108/ijhrh-05-2015-0014.

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Purpose – The purpose of this paper is to explore the harms suffered by intersex children who are subjected to medically unnecessary genital-normalizing surgery (GNS) and the possible applicability of statutes prohibiting female genital mutilation (FGM) to certain cases of GNS to redress this harm in the USA. Design/methodology/approach – Consulting publications by medical researchers and intersex activists alike, this comment reviews the procedures undertaken as part of GNS (most commonly including clitoral reduction) and the reasons behind these procedures. It also parses the language of federal and state statutes prohibiting FGM in the USA. Findings – Surgical practices that include clitoral cutting when the procedure is not necessary to the health of the person on whom it is performed constitute FGM and are punishable under federal and certain state laws in the USA. GNS with clitoral reduction fits the definition of FGM because it is performed for cosmetic and social reasons, not medical necessity. Originality/value – Acknowledging GNS with clitoral reduction as FGM is a crucial strategy to ensure that female-assigned intersex children’s rights to bodily autonomy are protected to the same extent as non-intersex children’s rights. Intersex legal activists in the USA should press for enforcement of FGM statutes as to female-assigned intersex children until the medical practitioners who continue to defend and perform GNS see the procedures as illegal genital mutilation.

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15

Hamori, Christine A. "Postoperative Clitoral Hood Deformity After Labiaplasty." Aesthetic Surgery Journal 33, no. 7 (2013): 1030–36. http://dx.doi.org/10.1177/1090820x13502202.

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Auricchio, Valeria, Simone Garzon, Paola Pomini, et al. "Clitoral reconstructive surgery after female genital mutilation: A systematic review." Sexual & Reproductive Healthcare 29 (September 2021): 100619. http://dx.doi.org/10.1016/j.srhc.2021.100619.

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17

Jordal, Malin, and Gabriele Griffin. "Clitoral reconstruction: Understanding changing gendered health care needs in a globalized Europe." European Journal of Women's Studies 25, no. 2 (2017): 154–67. http://dx.doi.org/10.1177/1350506817742679.

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The migratory flows of recent decades that have exercised Europe as a socio-political and economic entity have produced extensive responses and interventions from European gender scholars. One relatively recent phenomenon in this context is the question of reparative surgical interventions, specifically clitoral reconstruction, in cases where women who have migrated to Europe have experienced female genital cutting. Clitoral reconstruction, which this article begins to explore, is recent in part because the related surgery was only established in the 1990s and is to date only practised in a few European countries, and in part because the research with women who ask for and have undergone such surgery has also only recently begun. This article is therefore an initial attempt to map some of the related terrain and to suggest further work that needs to be done in this increasingly important area.

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18

Soloviev, A. E. "EPISPADIAS IN GIRLS." Russian Journal of Pediatric Surgery 23, no. 3 (2019): 166–68. http://dx.doi.org/10.18821/1560-9510-2019-23-3-166-168.

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Purpose. To study the clinical picture, diagnosis and treatment of epispadias in girls. Material and methods. 22 girls with epispadias of various forms were under supervision for 50 years. During diagnostics the following issues were used: anamnesis, examination, catheterization and uroflowmetry, cystoscopy of the bladder, ultrasound and X-ray examination. Results and discussion. Out of 22 girls with epispadias, clitoral epispadia (partial ) was in 10 patients; sub-symphisal (subtotal) - in 4; symphisal (total) - in 8 girls. In 10 girls with the clitoral form, urological examination was made because of changes in the urine. Girls with sub-symphisal epispadia complained of irritation and itching in the vulva. All had vulvitis, cystitis, chronic pyelonephritis. In 2 patients, renal doubling was diagnosed; in other 2 patients ureterohydronephrosis and kidney dystopia were diagnosed. Uroflowmetry revealed hyperactive bladder in all. 8 girls with the total (symphisial) form of epispadia and urinary incontinence were operated by the Derzhavin technique; after the surgery the function of bladder sphincter was restored and the patients could have a normal quality of life. Conclusion. Epispadia in girls is a rare case . There are clitoral, sub-symphisal and symphisal (total) forms of epispadias. Cluster and sub-symphisial forms do not require surgical treatment. While in the symphisial (total) form, plastic surgery on the bladder neck by the Derzhavin technique is recommended. It is a good option for recovery.

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19

Sarhan, Osama M., Mustafa S. Al-Ghanbar, and Ziad M. Nakshabandi. "Post-female-circumcision clitoral epidermal inclusion cyst." Annals of Pediatric Surgery 10, no. 2 (2014): 61–63. http://dx.doi.org/10.1097/01.xps.0000445135.05723.49.

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20

Ogiwara, Hideki, and Nobuhito Morota. "Pudendal Afferents Mapping in Posterior Sacral Rhizotomies." Neurosurgery 74, no. 2 (2013): 171–75. http://dx.doi.org/10.1227/neu.0000000000000235.

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Abstract BACKGROUND: The effectiveness of pudendal afferents mapping in posterior sacral rhizotomies needs to be reviewed. OBJECTIVE: To evaluate the effectiveness of pudendal afferents mapping for both the dorsal penile or clitoral nerve and the inferior anal nerve to decrease the risk of postoperative bowel and bladder dysfunction when the sacral nerve roots are candidates for rhizotomies. METHODS: A retrospective review of 101 Asian children who underwent functional posterior rhizotomies with pudendal afferents mapping for spastic paresis was performed. RESULTS: Pudendal mapping was successful in 75 of 81 patients. The highest activity of afferent fibers of the dorsal penile or clitoral nerve was demonstrated at the S1 roots in 13.3%, at the S2 in 79.3%, and at the S3-5 in 7.3%. Considerable activity of the dorsal penile or clitoral nerve was recorded at 40% of the S1 roots, at 99.3% of the S2 roots, and at 52% of the S3-5 roots. The highest activity of afferent fibers of the inferior anal nerve was demonstrated at S2 roots in 42% and at S3-5 roots in 58%. Considerable activity of the inferior anal nerve was recorded at 10.7% of S1 roots, at 89.3% of S2 roots, and at 76.7% of S3-5 roots. The pathological S1 roots were divided into 3 to 4 rootlets, and the rootlets with significant afferent activity were preserved. None of the 75 patients experienced long-term bowel or bladder complications. CONCLUSION: Pudendal afferent mapping identified the sacral rootlets involved with genital and anal sensation. The preservation of such rootlets in sacral rhizotomies is considered to be important for minimizing postoperative bladder and bowel dysfunction.

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21

CHAN, J. "Conservative clitoral-sparing surgery in vulvar carcinoma: is it a safe alternative?" Obstetrics & Gynecology 99, no. 4 (2002): S90. http://dx.doi.org/10.1016/s0029-7844(02)01870-7.

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22

Chan, John K., Valerie Sugiyama, Tania R. Tajalli, et al. "Conservative clitoral preservation surgery in the treatment of vulvar squamous cell carcinoma." Gynecologic Oncology 95, no. 1 (2004): 152–56. http://dx.doi.org/10.1016/j.ygyno.2004.07.004.

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23

Chan, J. K., V. Sugiyama, T. R. Tajalli, M. Gu, J. Rutgers, and B. J. Monk. "CONSERVATIVE CLITORAL PRESERVATION SURGERY IN THE TREATMENT OF VULVAR SQUMAOUS CELL CARICINOMA." Journal of Investigative Medicine 52 (January 2004): S157. http://dx.doi.org/10.1097/00042871-200401001-00444.

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24

İsbir, Caner, Özlem Elvan, Hakan Taşkınlar, Zeynep Çetin, and Gülhan Temel. "Assessment of clitoral anatomy in human fetuses." Surgical and Radiologic Anatomy 42, no. 4 (2019): 453–59. http://dx.doi.org/10.1007/s00276-019-02383-9.

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25

Alter, Gary J. "Aesthetic Labia Minora and Clitoral Hood Reduction Using Extended Central Wedge Resection." Plastic and Reconstructive Surgery 122, no. 6 (2008): 1780–89. http://dx.doi.org/10.1097/prs.0b013e31818a9b25.

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Hamori, Christein Annemarie. "Aesthetic Labia Minora and Clitoral Hood Reduction Using Extended Central Wedge Resection." Plastic and Reconstructive Surgery 124, no. 1 (2009): 337. http://dx.doi.org/10.1097/prs.0b013e3181a8394d.

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27

Gomes, Adriano Luís, Luciano Silveira Onofre, Jovelino Quintino de Souza Leão, et al. "Clitoral anomalies not associated with disorders of sex development." Journal of Pediatric Surgery Case Reports 1, no. 11 (2013): 403–5. http://dx.doi.org/10.1016/j.epsc.2013.11.003.

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28

Pumsup, Juthapot. "How to ensure clitoral bud survival in a sexual reassignment surgery for transsexualism." Journal of Cosmetic Medicine 2, no. 1 (2018): 57–62. http://dx.doi.org/10.25056/jcm.2018.2.1.57.

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29

Chan, J. K., V. Sugiyama, T. R. Tajalli, M. Gu, J. Rutgers, and B. J. Monk. "445 CONSERVATIVE CLITORAL PRESERVATION SURGERY IN THE TREATMENT OF VULVAR SQUMAOUS CELL CARICINOMA." Journal of Investigative Medicine 52, Suppl 1 (2004): S157.3—S157. http://dx.doi.org/10.1136/jim-52-suppl1-444.

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30

Liao, Lih-Mei, Peter Hegarty, Sarah Creighton, Tove Lundberg, and Katrina Roen. "Clitoral surgery on minors: an interview study with clinical experts of differences of sex development." BMJ Open 9, no. 6 (2019): e025821. http://dx.doi.org/10.1136/bmjopen-2018-025821.

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ObjectivesClitoral surgery on minors diagnosed with differences of sex development is increasingly positioned as a violation of human rights. This qualitative study identified how health professionals (HPs) navigate the contentious issues as they offer care to affected families.DesignQualitative analysis of audio-recorded semistructured interviews with HPs. All of the interviews were transcribed verbatim for theoretical thematic analysis.SettingTwelve specialist multidisciplinary care centres for children, adolescents and adults diagnosed with a genetic condition associated with differences of sex development.ParticipantsThirty-two medical, surgical, psychological and nursing professionals and clinical scientists in 12 specialist centres in Britain and Sweden formed the interview sample.ResultsAll interviewees were aware of the controversial nature of clitoral surgery and perceived themselves and their teams as non-interventionist compared with other teams. Data analyses highlighted four strategies that the interviewees used to navigate their complex tasks: (1) engaging with new thinking, (2) holding on to historical assumptions, (3) reducing the burden of dilemmas and (4) being flexible. In response to recent reports and debates that challenge clitoral surgery on minors, HPs had revised some of their opinions. However, they struggled to reconcile their new knowledge with the incumbent norms in favour of intervention as they counsel care users with variable reactions and expectations. The flexible approach taken may reflect compromise, but the interviewees were often trapped by the contradictory values and assumptions.ConclusionsIf the pathology-based vocabularies and narratives about genital diversity could be modified, and normative assumptions are questioned more often, clinicians may be more adept at integrating their new knowledge into a more coherent model of care to address the psychosocial concerns that genital surgery purports to overcome.

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Alter, Gary J. "Labia Minora Reconstruction Using Clitoral Hood Flaps, Wedge Excisions, and YV Advancement Flaps." Plastic and Reconstructive Surgery 127, no. 6 (2011): 2356–63. http://dx.doi.org/10.1097/prs.0b013e318213a0fb.

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32

Wu, Cindy, Lynn Damitz, Kimberly M. Karrat, Alice Mintz, and Denniz Zolnoun. "Clitoral Epidermal Inclusion Cyst Resection With Intraoperative Sensory Nerve Mapping Technique." Female Pelvic Medicine & Reconstructive Surgery 22, no. 3 (2016): e24-e26. http://dx.doi.org/10.1097/spv.0000000000000267.

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Nonomura, Katsuya, Takayuki Kanno, Motoyoshi Tanaka, et al. "A case of neurofibromatosis associated with clitoral enlargement and hypertension." Journal of Pediatric Surgery 27, no. 1 (1992): 110–12. http://dx.doi.org/10.1016/0022-3468(92)90122-n.

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Newman, Kurt, Jodson Randolph, and Shaun Parson. "Functional results in young women having clitoral reconstruction as infants." Journal of Pediatric Surgery 27, no. 2 (1992): 180–84. http://dx.doi.org/10.1016/0022-3468(92)90308-t.

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35

Giordano, R., A. Cianci, S. Rugolo, et al. "T01-O-08 Effects of surgery for stress urinary incontinence on the clitoral blood flow." Sexologies 17 (April 2008): S52. http://dx.doi.org/10.1016/s1158-1360(08)72658-6.

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Sigurjonsson, Hannes, and Malin Jordal. "Addressing Female Genital Mutilation/Cutting (FGM/C) in the Era of Clitoral Reconstruction: Plastic Surgery." Current Sexual Health Reports 10, no. 2 (2018): 50–56. http://dx.doi.org/10.1007/s11930-018-0147-4.

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Elkattah, Rayan, Whitney Trotter-Ross, and Roland Keith Huffaker. "Percutaneous Tibial Nerve Stimulation as an Off-label Treatment of Clitoral Pain." Female Pelvic Medicine & Reconstructive Surgery 20, no. 6 (2014): e1-e4. http://dx.doi.org/10.1097/spv.0000000000000086.

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Opsomer, Dries, Katherine M. Gast, Lisa Ramaut, et al. "Creation of Clitoral Hood and Labia Minora in Penile Inversion Vaginoplasty in Circumcised and Uncircumcised Transwomen." Plastic and Reconstructive Surgery 142, no. 5 (2018): 729e—733e. http://dx.doi.org/10.1097/prs.0000000000004926.

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Placik, Otto J., and John P. Arkins. "A Prospective Evaluation of Female External Genitalia Sensitivity to Pressure following Labia Minora Reduction and Clitoral Hood Reduction." Plastic and Reconstructive Surgery 136, no. 4 (2015): 442e—452e. http://dx.doi.org/10.1097/prs.0000000000001573.

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40

Oranges, Carlo M., René D. Largo, David Garcia Nuñez, and Dirk J. Schaefer. "A Prospective Evaluation of Female External Genitalia Sensitivity to Pressure following Labia Minora Reduction and Clitoral Hood Reduction." Plastic and Reconstructive Surgery 137, no. 4 (2016): 758e. http://dx.doi.org/10.1097/prs.0000000000001994.

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41

Caruso, Salvatore, Salvatore Rugolo, Sebastiano Bandiera, Daniela Mirabella, Antonio Cavallaro, and Antonio Cianci. "Clitoral Blood Flow Changes After Surgery for Stress Urinary Incontinence: Pilot Study on TVT Versus TOT Procedures." Urology 70, no. 3 (2007): 554–57. http://dx.doi.org/10.1016/j.urology.2007.04.045.

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42

Minto, Catherine L., Lih-Mei Liao, Christopher RJ Woodhouse, Phillip G. Ransley, and Sarah M. Creighton. "The effect of clitoral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a cross-sectional study." Lancet 361, no. 9365 (2003): 1252–57. http://dx.doi.org/10.1016/s0140-6736(03)12980-7.

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43

Foote, J., T. Robertson, T. L. Strickland, and D. Bierman. "Poster 15: An Evaluation of Serum Testosterone Levels and Sexual Response Using Clitoral Blood Flow By Color Duplex Ultrasonography." Journal of Pelvic Medicine and Surgery 11, Supplement 1 (2005): S32—S33. http://dx.doi.org/10.1097/01.spv.0000178879.66925.36.

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44

Jordal, Malin, Gabriele Griffin, and Hannes Sigurjonsson. "‘I want what every other woman has’: reasons for wanting clitoral reconstructive surgery after female genital cutting – a qualitative study from Sweden." Culture, Health & Sexuality 21, no. 6 (2018): 701–16. http://dx.doi.org/10.1080/13691058.2018.1510980.

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45

Holcomb, George W. "The anterior sagittal transanorectal approach: A modified approach to 1-stage clitoral vaginoplasty in severely masculinized female pseudohermaphrodites—Preliminary results." Journal of Pediatric Surgery 32, no. 7 (1997): 1130. http://dx.doi.org/10.1016/s0022-3468(97)90428-0.

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46

Iqbal, Shazia, Khalid Akkour, Bushra Bano, et al. "Awareness about Vulvovaginal Aesthetics Procedures among Medical Students and Health Professionals in Saudi Arabia." Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics 43, no. 03 (2021): 178–84. http://dx.doi.org/10.1055/s-0041-1725050.

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Abstract Objective The present study aimed to explore the opinion and ethical consideration of vulvovaginal aesthetics procedures (VVAPs) among health professionals and medical students in Saudi Arabia. Methods This is a cross-sectional study performed between January 2020 and April 2020. Data was collected through electronic media, WhatsApp, and emails. The results were analyzed by applying the Students t-test, and correlations were considered significant if they presented a p-value < 0.05. Results There is significant demand to educate doctors, health professionals, medical students, and gynecologists for the VVAPs to have a solid foundation, justified indications, and knowledge about various aesthetic options. Although female doctors, medical students, young doctors, and gynecologists have more knowledge about VVAPs, all health professionals ought to be aware of recent trends in vulvovaginal aesthetics (VVA). The present analysis determined that VVA should be under the domain of gynecologists, rather than under that of plastic surgeons, general surgeons, and cosmetologists. The majority of the participants considered that vaginal rejuvenation, “G-spot” augmentation, clitoral surgery, and hymenoplasty are not justifiable on medical grounds. Conclusion The decision to opt for different techniques for vaginal tightening and revitalization should be taken very carefully, utilizing the shared decision-making approach. Ethical aspects and moral considerations are important key factors before embarking in the VVAPs purely for cosmetic reasons. Further research is required to determine the sexual, psychological, and body image outcomes for women who underwent elective VVAPs. Moreover, medical educators must consider VVAPs as part of the undergraduate and postgraduate medical curriculum.

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Werker, Paul M. N., and Moshe Kon. "A Pilonidal Sinus of the Clitoris?" Annals of Plastic Surgery 25, no. 1 (1990): 63–64. http://dx.doi.org/10.1097/00000637-199007000-00014.

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Foldes, Pierre. "Surgical Techniques: Reconstructive Surgery of the Clitoris after Ritual Excision." Journal of Sexual Medicine 3, no. 6 (2006): 1091–94. http://dx.doi.org/10.1111/j.1743-6109.2006.00335.x.

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Alba, Eva L., Kruti K. Patel, and Alice C. Levine. "Ectopic Adrenal Tumor in a Patient With Untreated Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency." Journal of the Endocrine Society 5, Supplement_1 (2021): A128—A129. http://dx.doi.org/10.1210/jendso/bvab048.259.

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Abstract Case Presentation: A 43 year-old female was diagnosed at birth with non-salt wasting congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency and underwent clitoral reduction surgery. She was treated with hydrocortisone and had menarche at age 7 with irregular and heavy menses. At age 15 she had a D&C with removal of “something in her ovaries.” She stopped hydrocortisone at age 30 except for stress doses during illness. At age 35 she stopped oral contraceptives and thereafter has been amenorrheic. She presented with abdominal distention and constipation. On exam she had short stature, marked frontal and temporal balding, hirsutism, increased musculature and a large distended abdomen. Labs showed AM cortisol 3.1 mcg/dL (nl 10–20), ACTH 440 pg/ml (nl <46), 17-OH Progesterone 11000 ng/dL (nl <206), DHEAS 362 mcg/dl (nl <430), FSH 0.2 mIU/ml, LH 2.7 mIU/ml, testosterone 618 ng/dl (nl 10–75), and estradiol 162 pg/ml (nl post menopause <41). MRI showed a massive fibroid (30 cm), bilateral adrenal hyperplasia and a left paraaortic, retroperitoneal mass (5.9 cm). She underwent hysterectomy with removal of a 9.5 kg uterus containing degenerated fibroids, left adrenalectomy and removal of the left paraaortic mass that was initially read as oncocytic adrenal cortical neoplasm, metastatic. A similar oncocytic neoplasm was noted in the left adrenal gland and on further review with pathology the revised report read paraaortic mass, probable adrenal rest tumor. Discussion: Excess androgens and chronically elevated ACTH levels in untreated CAH can lead to adverse effects beyond adrenal insufficiency and virilization. We present a woman with untreated classic CAH who developed a large fibroid and paraaortic adrenal cortical tumor. Fibroids have been described in CAH patients, a potential consequence of elevated androgens that are converted by aromatase in the endometrium to estrogens driving growth of fibroid tumors. Chronic ACTH can further act as a growth factor, leading to adrenal hyperplasia, adrenal tumors and ectopic adrenal rest tissue. Intra-adrenal tumors in untreated CAH are generally benign with rare cases of adrenal cortical carcinoma reported. Ectopic adrenal rest tissue in untreated CAH is most commonly reported in testes. There have been rare case reports of ectopic adrenal rest tumors in the adnexa, broad ligament, and perirenal area. Our patient presents as an unusual case of ectopic adrenal rest tumor in the paraaortic region. Based on the atypical location and incomplete history available to the pathologist, it was initially read as metastatic adrenocortical carcinoma. Upon further review given the clinical information, the diagnosis was revised to indicate a pararenal adrenal rest tumor. This case highlights the importance of glucocorticoid compliance in CAH and the necessity to provide a clinical context for the pathologist in cases of extra-adrenal tumors in untreated CAH.

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Quilichini, J., B. Burin Des Roziers, G. Daoud, and S. Cartier. "Chirurgie réparatrice du clitoris après excision rituelle." Annales de Chirurgie Plastique Esthétique 56, no. 1 (2011): 74–79. http://dx.doi.org/10.1016/j.anplas.2010.04.001.

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