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Clitoroplasty

What is clitoroplasty?

Surgical creation of a clitoris.

What does clitoroplasty do?

Who can have clitoroplasty?

  • You must have had 12 continuous months living as your gender identity

  • You must have had 12 continuous months of HRT, unless you’re unable to

  • You must have capacity to consent for this treatment

  • If you have significant medical conditions, these need to be “reasonably well-controlled”

  • You need to be at least 16 in Scotland, but at least 17 in other parts of the UK

  • You typically need a BMI of less than 30

How long does clitoroplasty last?

The effects are permanent and cannot be reversed.

What should I be aware of?

Creation of a clitoris 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 1, p.214;2, and around 15-25% are unable to reach orgasm after clitoroplasty, though findings have varied significantly between medical studies on this topic 3.

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 1, p.215. This affects around 1% of patients who have a clitoroplasty.

Why might I want clitoroplasty?

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.

How do I get clitoroplasty?

NGICNS maintains a list of NHS surgery providers providing various gender-related surgeries. At the moment, all of these surgeons are based in England, so you will have to travel if you live in another part of the UK.

In order to be eligible for clitoroplasty, 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 4.

What kinds are there?

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) 5, moving the remainder of the glans to between the urethra and neoclitoris for additional sensation 2, and corona glans clitoroplasty 6. 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 7, retention of the entire glans, or use of the ventral (bottom) side of the glans 1, p.213 have also been used, but these are now much less common.

How do I get ready for surgery?

Doing some preparation in advance can help make sure everything goes smoothly during your hospital stay and recovery. To help you avoid forgetting to do or buy something we have created a Getting ready for gender surgeries page.

How much will it cost?

A operation in the UK to perform labiaplasty and clitoroplasty costs around £15000.

If you have a formal diagnosis, the NHS will usually provide funding for labiaplasty and penectomy, orchidectomy, clitoroplasty and/or vaginoplasty.

If you're receiving certain benefits, or are on a low income, you may be able to get help with the cost of travel for NHS treatment. Further information about help with travel costs can be found:

What else might I want?

Normally clitoroplasty is carried out as part of labiaplasty. Some people also undergo vaginoplasty (surgical creation of a vagina), while other people opt to avoid vaginoplasty because they do not want a vagina or to reduce the risk of complications, reduce recovery time, or avoid the need to dilate 8, p.268.

References

  1. 1.
    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. Link
  2. 2.
    Selvaggi, Gennaro and Bellringer, James (2011) “Gender reassignment surgery: an overview.” Nature reviews. Urology, 8(5), p. 274. Link
  3. 3.
    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. Link
  4. 4.
    Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link
  5. 5.
    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. Link
  6. 6.
    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. Link
  7. 7.
    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. Link
  8. 8.
    Selvaggi, Gennaro and Andreasson, My (2017) “Genital Reconstructive Surgery for Transgender Women,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 265–275. Link

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