What effects does it have?

What is it?

Surgical creation of a clitoris.

How long does it last?

The effects are permanent and cannot be reversed.

More information

Clitoroplasty involves surgically constructing a neoclitoris (artificially created clitoris), normally out of tissue taken from the dorsal (top) side of the glans penis (head of the penis). This organ is able to provide sexual sensation and in many cases the ability to orgasm. The penis is completely destroyed in the process of creating the clitoris.

Clitoroplasty only creates the clitoris (the small organ that acts as a focus of sexual sensation). The rest of the vulva (external part of the genitalia) is created by labiaplasty, and the internal vaginal canal by vaginoplasty. These operations are usually carried out together, though some people choose not to have a vaginoplasty.

The most common technique for clitoroplasty is to use a small triangular piece of the dorsum (top side) of the glans penis, near to the corona (raised ring at the base of the glans). This is moved to the new position along with the neurovascular bundle (connecting tube of nerves and blood vessels) to supply it that would originally have run down the top edge of the penis.

A variety of different variations on this basic technique exist, such as neourethroclitoroplasty (utilising urethral tissue as part of building the clitoris) 1, moving the remainder of the glans to between the urethra and neoclitoris for additional sensation 2, and corona glans Clitoroplasty 3. There is no clear medical evidence about which techniques are most effective. You may wish to discuss the advantages and disadvantages of these techniques with your surgeon.

Historically, alternative techniques such as a free graft of the tip of the penis 4, retention of the entire glans, or use of the ventral (bottom) side of the glans 5 have also been used, but these are now much less common.

Creation of a neoclitoris is a delicate surgery and is not without risk. It is common for there to be no sensation in the clitoris for many months after surgery. Around 2-5% of people who have a clitoroplasty do not gain sensation in the clitoris at all 5,2, and around 15-25% are unable to reach orgasm after clitoroplasty, though findings have varied significantly between medical studies on this topic 6.

A more dramatic complication is for the blood supply to the clitoris not to survive the surgery. This causes necrosis of the clitoris (the tissue dies from lack of blood supply). In this situation, some sensation may remain from the nerves leading to the area 5. This affects around 1% of patients who have a clitoroplasty.

Cost and funding

A operation in the UK to perform labiaplasty and clitoroplasty costs around £11-12000.

If you have a formal diagnosis, the NHS will usually provide funding for labiaplasty and penectomy, orchidectomy, clitoroplasty and/or vaginoplasty. You will normally need to meet the following conditions:

  • persistent and well-documented gender dysphoria
  • capacity to make fully informed decisions and to consent to treatment
  • if significant medical or mental health concerns are present, they must be reasonably well controlled
  • two medical opinions, usually at least one from a gender clinic, that surgery is appropriate
  • 12 months’ continuous endocrine treatment as appropriate to the patient’s goals (unless the patient has medical contraindications or is otherwise unable to take hormones)
  • at least 12 months’ living continuously in a gender role that is congruent with the gender identity 7.

References

  1. 1 Trombetta, Carlo, Colombo, Fulvio, Umari, Paolo, Liguori, Giovanni, et al. (2015) “Technical Suggestions for Better and Lasting Functional and Aesthetic Outcomes in Creating the Neoclitoris,” in Management of Gender Dysphoria, Springer, pp. 125–133.
  2. 2 Selvaggi, Gennaro and Bellringer, James (2011) “Gender reassignment surgery: an overview.” Nature reviews. Urology, 8(5), p. 274.
  3. 3 Giraldo, Francisco, Esteva, Isabel, Bergero, Trinidad, Cano, Guadalupe, et al. (2004) “Corona glans clitoroplasty and urethropreputial vestibuloplasty in male-to-female transsexuals: the vulval aesthetic refinement by the Andalusia Gender Team.” Plastic and reconstructive surgery, 114(6), pp. 1543–1550.
  4. 4 Hage, J Joris, Karim, Refaat B, Bloem, Joannes JAM, Suliman, Harold M and Alphen, Marcel van (1994) “Sculpturing the neoclitoris in vaginoplasty for male-to-female transsexuals.” Plastic and reconstructive surgery, 93(2), p. 558.
  5. 5 Bellringer, James (2007) “Genital surgery,” in Barrett, J. (ed.), Transsexual and other disorders of gender identity: A practical guide to management, Radcliffe Publishing, pp. 209–219.
  6. 6 Wylie, Kevan, Wootton, Edward and Carlson, Sophie (2016) “Sexual Function in the Transgender Population,” in Ettner, R., Monstrey, S., and Coleman, E. (eds.), Principles of Transgender Medicine and Surgery, Second Edition, Routledge, pp. 159–164.
  7. 7 Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” [online] Available from: www.rcpsych.ac.uk/usefulresources/publications/collegereports/cr/cr181.aspx

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Page last updated: December 2017