56805 Clitoroplasty for intersex state

Name of the Procedure:

Clitoroplasty for Intersex State

Summary

Clitoroplasty is a surgical procedure aiming to reshape or reduce the size of the clitoris. It is often performed on individuals with intersex conditions where the genitalia may not fit typical definitions of male or female. The procedure strives to create genitalia that aligns with the individual’s identified gender or to address functional or cosmetic concerns.

Purpose

The purpose of clitoroplasty is to address atypical clitoral size and appearance in individuals with intersex conditions. The goals include enhancing genital appearance, improving sexual function, and aligning the genitalia with the individual's gender identity.

Indications

Indications for clitoroplasty include:

• Congenital adrenal hyperplasia (CAH)
• Ambiguous genitalia
• Intersex conditions where the individual desires or requires genital reconstruction
• Patients seeking cosmetic or functional improvements to the clitoral region

Preparation

• Patients may need to undergo psychological counseling to ensure informed consent.
• Preoperative blood tests and imaging studies (e.g., pelvic ultrasound) to assess anatomy.
• Fasting for at least 8 hours before surgery.
• Adjustment or cessation of certain medications as directed by the physician.

Procedure Description

1. Administration of general anesthesia.
2. An incision is made to access the clitoral tissue.
3. The clitoris is carefully sculpted to achieve the desired size and shape.
4. Repositioning and anchoring of the clitoral tissue, if necessary.
5. The incision is closed with sutures.
6. A sterile dressing is applied.

Tools and Equipment:

• Scalpel
• Scissors
• Sutures
• Electrocautery device
• Sterile drapes and instruments

Duration

The procedure typically takes around 1 to 2 hours.

Setting

Clitoroplasty is usually performed in a hospital or surgical center.

Personnel

• Pediatric or urological surgeon
• Anesthesiologist
• Surgical nurses
• Scrub technician

Risks and Complications

• Common: Swelling, pain, infection, and bleeding.
• Rare: Reduced clitoral sensitivity, scarring, dissatisfaction with cosmetic results, and need for additional surgeries.

Benefits

• Improved genital appearance.
• Enhanced sexual function and sensitivity.
• Psychological benefits from alignment of genital appearance with gender identity.
• Benefits can often be realized several weeks to months post-surgery.

Recovery

• Initial recovery may involve a hospital stay of 1-2 days.
• Pain management with prescribed medications.
• Instructions for wound care and hygiene.
• Avoidance of strenuous activities and sexual activity for several weeks.
• Follow-up appointments to monitor healing and address any concerns.

Alternatives

• Watchful waiting and psychological support without surgical intervention.
• Non-surgical cosmetic treatments to address appearance.
• Hormone therapy in certain conditions.
• Each alternative has its own set of pros and cons, such as no surgical risks but potentially less satisfactory cosmetic results.

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel pain.
• Postoperatively, patients may experience pain, swelling, and discomfort managed with medications and comfort measures.
• Gradual improvement in symptoms and overall satisfaction with the outcomes over time.