Corona glans clitoroplasty and urethropreputial vestibuloplasty in male-to-female transsexuals: the vulval aesthetic refinement by the Andalusia Gender Team

Abstract

For more than a decade the pedicled island neurovascular flap of the glans penis has been the standard procedure for clitoroplasty in intersex anomalies and in male-to-female genital sex reassignment surgery. Most authors focusing on genitoperineal reconstructions have used the island neurovascular flap of the dorsal shaft of the penis, including a variable-sized dorsal chip of the glans penis as the distal and functional portion of the flap. Although this dorsal glans clitoroplasty technique for neoclitoral reconstruction is well known, it nevertheless deserves scientific revision, with a view to improving several neglected aesthetic and functional points. The authors describe a new method for reconstruction of the neoclitoris in male-to-female transsexuals, the corona glans clitoroplasty. It is based on a modification of the original pedicled island neurovascular flap of the glans penis. The main difference compared with the dorsal glans clitoroplasty is that, distally, this method includes a bifid dorsolateral coronal flap designed in the shape of an open lotus flower or a bull's horns. Furthermore, a semicircular preputial flap is retained, attached to the bifid coronal flap of the glans, to improve the cosmetic appearance of the vestibulum and avoid growth of hair around the neoclitoris. Finally, a small dorsal flap of the spongiomucosa urethra designed in the shape of a pencil tip is added to improve the cosmetic appearance of the vestibulum between the neoclitoris and the urethral neomeatus. Since October of 1999, the authors have performed more than 30 genital sex reassignment surgeries in male-to-female transsexuals, of whom 16 underwent their technique of corona glans clitoroplasty. The authors describe and discuss the anatomic basis and clinical implications of this technique and its cosmetic and potential functional advantages. They also consider the anatomic differences among four distal designs of the pedicled island neurovascular flap of the glans penis: dorsal, lateral, ventral, and corona glans clitoroplasty in male-to-female transsexuals.