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Genital surgery
Published in James Barrett, Transsexual and Other Disorders of Gender Identity, 2017
Creation of a sensate clitoris was first described in 19804 but the original technique, using blood supply through the urethra, has been superseded by techniques using the neurovascular bundle on the dorsum of the penis.5 Earlier, some surgeons produced a small skin fold in an attempt to improve the cosmetic appearance, but this had no true sensation, and is not particularly realistic. The sensate clitoris uses parts of the glans penis, which can be isolated on its neurovascular pedicle. These nerves and vessels lie in the tissue between Buck’s fascia and the tunica albuginea which surrounds the corpora cavernosa, and runs along the dorsum of the penis. The commonest part of the glans to use is the dorsum, which is immediately adjacent to the vessels, although some surgeons prefer to use the tissue from the ventral part of the penis, which is usually more sensitive. After the tissue is freed on its pedicle, the pedicle may be folded under the suprapubic skin, and the neoclitoris is sutured to the skin. Normally, a clitoral hood is made out of the surrounding skin. The long folded pedicle is at risk of occluding the vessel, with subsequent loss of the neoclitoris, but the author’s experience is that over 95% survive and are sensitive. Despite this, only some 75% of patients are able to reach orgasm.
Women and health care in a multicultural society
Published in Karen Holland, Cultural Awareness in Nursing and Health Care, 2017
One cultural practice that has had a major impact on women's health in some societies is that of female genital mutilation (FGM) (sometimes called female circumcision). According to Schott and Henley (1996) there are three types of FGM: Removal of the clitoral hood – this is the only type that can correctly be called circumcision.Excision of the clitoris and part or all of the labia minora (clitoridectomy).Infibulation – the most extensive form of FGM in which the clitoris and the labia minora are removed and the labia majora are reduced and then stitched together, leaving a small opening so that urine and menstrual fluid can escape. Occasionally infibulation is performed over an intact clitoris.(Schott and Henley, 1996, p. 213)
Classification of the labia minora
Published in Miranda A. Farage, Howard I. Maibach, The Vulva, 2017
Cindy Wu, Lynn A. Damitz, Denniz A. Zolnoun
If a patient has a class I labia minora variant, labiaplasty may result in tethering of the clitoral hood, causing discomfort and pain. The class II labia minora variant seems to be the aesthetic ideal. In the class III variant, in which the labia minora are circumferential, the surgeon must counsel the patient that obtaining a result similar to a class II type is more difficult given the redundant tissue. This is especially true if sensory mapping prohibits large resection areas. Patient education and expectation management is critical to patient satisfaction.
Lichen sclerosus of the vulva
Published in Climacteric, 2021
Lichen sclerosus of the vulva (LSV) is seen frequently enough in general gynecological practice to warrant knowledge about diagnosis and treatment. It is a chronic, progressive, inflammatory epithelial disease that affects the inner aspects of the labia majora, labia minora, perineum, perianal area and clitoris, manifesting as glistening white or hypopigmented thin areas of the skin of the sites, which can be isolated or confluent, leading to skin atrophy. Alternatively, the skin may appear thickened and parch-like or leathery in appearance. Invariably, there are associated multiple ecchymoses, fissuring of posterior commissure and adhesions of the vaginal labia or clitoral hood. LSV rarely affects the vagina, but it can affect the urethral orifice. In about 15% of the women, extragenital sites may be affected, including the thighs, buttocks, anal cleft, upper trunk or axilla. Previously known as lichen sclerosus et atrophicus, vulval dystrophy, kraurosis or leukoplakia, in 1976 the International Society for the Study of Vulvovaginal Diseases decided to call the disease lichen sclerosus and it has remained as such ever since [1–3].
Phantom Penis: Extrapolating Neuroscience and Employing Imagination for Trans Male Sexual Embodiment
Published in Studies in Gender and Sexuality, 2020
Original anatomy with or without testosterone nurturance, and metoidioplasties are the most sensorially rigorous of neo-penises. This is despite the fact that metoidioplasties do entail significant cutting of suspensory ligaments and surface tissues of the clitoral hood. In a March 30, 2019, conversation with me, at the Psychotherapy Center for Gender and Sexuality (PCGS) conference in New York City, Dr. Loren Schechter stated that even when the clitoris and its neural structures remain intact, a phalloplasty is probably slightly less sensorially rigorous than the testosterone-nurtured neo-penis or the metoidioplasty because current phalloplasty procedure embeds the clitoris beneath an extra layer of skin. Van de Grift et al. (2019) confirmed decreased orgasmic capacity in a significant minority of 38 trans men in a clinical follow-up to phalloplasty, “possibly because genital stimulation is more difficult with a buried clitoris” (p. 203). In a systematic review of 11 articles on radial forearm flap phalloplasty (RFFP) and 7 on metoidioplasty, Frey et al. (2016) found that 69% of RFFP patients had erogenous sensation, compared to 100% of metoidioplasty patients (p. 3). Nevertheless, we must also consider that metoidioplasties are vulnerable to a normative critical gaze due to their lesser size. Such a critical gaze can challenge embodiment even of one’s own tissue, causing what phenomenologists term excorporation. Can the phantom penis produce an attitude to confront the critical gaze?
Sexual well-being after menopause: An International Menopause Society White Paper
Published in Climacteric, 2018
J. A. Simon, S. R. Davis, S. E. Althof, P. Chedraui, A. H. Clayton, S. A. Kingsberg, R. E. Nappi, S. J. Parish, W. Wolfman
The physical examination starts with a general inspection of the patient and her vital signs, palpation of the thyroid, breasts and abdomen, and presence and distribution of pubic hair. The most anxious patient is reassured by inspection of the vulva without a speculum as the initial part of the examination. The characteristics of the clitoris including any adhesions or abnormalities under the clitoral hood, labia minora, majora and anus are evaluated. Vulvar skin conditions that produce adhesions, erythema, ulcers, leukoplakia or pustules, papules and nodules may be confirmed. Gentle separation of the labia minora is performed to evaluate the urethra, hymenal area, vestibule, and posterior fourchette. If the patient has vulvar pain or painful intercourse, the Q-tip test is then useful in mapping out tender areas, especially of the vestibule65.