There are several reasons why a clitoris may be removed – clitoral hypertrophy (an oversized clitoris possibly caused by CAH, drugs or other interference), female genital mutilation, or possibly another disease or accident. This article covers clitoral hypertrophy only, but if the clitoris needed to be surgically removed for another reason, the surgical procedure would be the same.
Surgery on an oversized clitoris
The decision to remove part of the clitoris is not one taken lightly by either the owner of the clitoris, or her caregivers – parents and doctors, if the clitoris belongs to a young girl. The ability to orgasm shouldn’t be impeded for the sake of looking normal, but it sometimes is in favour of losing the appendage.
Outcomes of surgery
Loss of sensation and neurological damage cannot be ruled out, however while the clitoris is a very delicate part of our anatomy, and after surgery the external and visible part of the clitoris may be missing, thankfully in most women orgasm can still be achieved. This must be absolutely carefully evaluated on a case-by-case basis.
The focus of this surgery is for the patient to have a normal life, including a normal sex life. This means her vagina looks and behaves like a normal vagina, or as much like one as possible, without pain on sexual activity.
The operation has been revised several times over the years however the loss of sensation is very real. Burying the glans is also problematic, since the trapped tissue causes pain when stimulated (engorged), however with the removal of the clitoris (or at least 50 per cent of it), good sensation and function have been observed. The older one is when this operation is undertaken, the worse the outcomes.
With a macroclitoris, the operation is relatively simple to actually cut it off, but complications can include excessive bleeding from the veins at the base of the clitoris and nerve damage. The surgeon is responsible for ensuring the blood supply and nerves remains intact, and that if ruptured, bleeding is controlled. Nerve damage can be a little harder to predict.
Using the example shown (a 5cm hypertrophied clitoris), the end of the clitoris is clamped to hold it steady, and a scalpel is used to cut the clitoris off. The cut is in a wedge-shape, so there is a small V. This allows the labia to be stitched up to cover the gap.
Cutting the clitoris off is a delicate procedure that involves very careful manipulation of the blood supply to avoid extensive bleeding.
Once stitched up, the vagina looks pretty normal, and because a lot of the clitoral tissue (which is extensive beyond what we can actually see and directly touch) still remains.
Hormone replacement therapy (HRT) and surgical reduction is indicated when hormonal problems have been identified. The surgery is only for psychological and aesthetic reasons, which means it is not functionally necessary and in some cases can definitely be considered avoidable. The goal of any treatment is to offer the greatest chance of retaining sensitivity, and caring for the emotional needs of the person.
There are several ways documented to deal with a macroclitoris.
- Amputation (the complete removal) of the clitoris
- Bending the clitoris over and attaching it to the pubic bone
- Removing part of the corpora cavernosa
- Severing the clitoris at the root, then reattaching the glans as a graft
- Shortening and cutting off the corpora cavernosa
Key features of the surgery are to preserve the neurovascular pedicle (a stalk-like structure) to maintain sensitivity of the glans clitoris, since nobody wants to live without orgasms their whole entire life.