Clitoroplasty: Points of Concern

The chapter details a balanced, patient-centric approach to the management of Disorders of Sexual Differentiation (DSD) with clitoral hypertrophy through feminizing genitoplasty (clitoroplasty, labioplasty, and vaginoplasty), stressing the need for surgical precision, legal awareness, ethical sensitivity, and the adaptability to evolving practices and guidelines. Amidst growing debates fueled by concerns over Gender Identity Disorder (GID) in children with DSD and emergence of human rights activists, the practice faces significant ethical, legal, and medical scrutiny. The situation demands a multidisciplinary approach to decision-making, involving experts across pediatric surgery, endocrinology, psychology, and other relevant fields, to individualize treatment and minimize legal and ethical risks. Emphasizing informed consent as a cornerstone, the chapter outlines the necessity of thorough communication regarding the diagnosis, potential outcomes, fertility, gender identity implications, and the details of proposed surgical interventions. This includes specific consent protocols for minors, tailored to age-appropriate comprehension levels. Surgically, the chapter advances toward techniques that prioritize anatomical and sensory preservation, marking a shift from historical practices toward less invasive methods like clitoral recession and subtunical reduction. It underscores the critical understanding of clitoral anatomy, particularly the dorsal nerve, to ensure sensory preservation. The application of hyaluronidase for minimizing surgical trauma is discussed as a technique to enhance dissection efficiency and reduce complications.