There are several reasons why a clitoris may be removed in an operation called a clitoridectomy.
These causes include clitoral hypertrophy (an oversized clitoris possibly caused by congenital adrenal hyperplasia (CAH), drugs or other interference), female genital mutilation, or possibly another disease or accident.
A normal clitoris and clitoral hood
Surgery to remove part or all of the clitoris – the clitoridectomy
The decision to remove part of the clitoris is not one taken lightly by surgeons, the owner of the clitoris, or her caregivers if the clitoris belongs to a young girl.
The ability to orgasm shouldn’t be impeded for the sake of looking ‘normal’, but sometimes the circumstances favour losing the appendage.
Outcomes of clitoridectomy surgery
Loss of sensation and neurological damage cannot be ruled out after a clitoridectomy. While the clitoris is a very delicate part of our anatomy, after surgery the external and visible part of the clitoris may be missing partially or fully, thankfully in most women orgasm can still be achieved. This will be very carefully evaluated on a case-by-case basis.
The focus of a clitoridectomy is for the patient to have a normal life, including a normal sex life. This means the vagina and vulva looks and behaves like a normal vagina, or as much like one as possible, without pain on sexual activity.
The clitoridectomy operation has been revised several times over the years, however the loss of sensation is a very real risk. Burying the glans is also problematic, since the trapped tissue causes pain when stimulated (engorged), however with the removal of the clitoris (or at least 50 per cent of it), good sensation and function have been observed. The younger one is when this operation is undertaken, the better the outcomes.
With a macroclitoris (an enlarged clitoris), the operation is relatively simple to actually remove excess tissue, but complications can include excessive bleeding from the veins at the base of the clitoris and nerve damage. The surgeon is responsible for ensuring the blood supply and nerves remains intact, and that if ruptured, bleeding is controlled. Nerve damage can be a little harder to predict, so a very experienced surgeon should be sought.
The clitoridectomy operation
- An example of a 5 cm hypertrophied clitoris – the end of the clitoris is clamped to hold it steady, and a scalpel is used to cut the end of the clitoris off. The cut is in a wedge-shape, so there is a small V. This allows the labia to be stitched up to cover the gap.
- Cutting the clitoris off is a delicate procedure that involves very careful manipulation of the blood supply to avoid extensive bleeding.
- Once stitched up, the vagina looks pretty normal, and because a lot of the clitoral tissue (which is extensive beyond what we can actually see and directly touch) still remains.
Other treatments that may be included with a clitoridectomy
Hormone therapy (HT) and surgical reduction is indicated when hormonal problems have been identified as the cause of an abnormal clitoris. The surgery is only for psychological and aesthetic reasons, which means it is not functionally necessary and in some cases can definitely be considered avoidable.
The goal of any treatment is to offer the greatest chance of retaining sensitivity, and caring for the emotional needs of the person.
Techniques for clitoridectomy
There are several documented methods to remove part or all of the clitoris
- Amputation (the complete removal) of the clitoris
- Bending the clitoris over and attaching it to the pubic bone
- Removing part of the corpora cavernosa
- Severing the clitoris at the root, then reattaching the glans as a graft
- Shortening and cutting off the corpora cavernosa
Key features of the surgery are to preserve the neurovascular pedicle (a stalk-like structure) to maintain sensitivity of the glans clitoris, since nobody wants to live without orgasms their whole entire life!
Sex after a clitoridectomy
Every clitoris has its own story to tell, with the technique used in the surgery – including female genital mutilation techniques – largely determining what happens with sexual pleasure, arousal and orgasm. Whether you are on your own or with a partner, the scar tissue and rearrangement of tissues will be unique to you.
Also unique is what turns you on, and what areas of your body are sensitive. While it seems incredible, some women (lucky things!) can orgasm from nipple stimulation alone, but this is not the norm. This means that most of us require a set of psychological cues plus the physical stimulation to be aroused and reach orgasm.
It’s important to note that the clitoris has legs and arms, and is actually quite a big structure inside the pelvis, compared with the outer portion (glans). The inside of your vagina therefore provides access to these arms and legs of the clitoris, which become erect upon arousal, just like a penis.
If you have never had an orgasm, and your clitoris has been cut, there isn’t anything to compare it to. This means you’re on your own in terms of figuring out what you like and what you don’t. Most women can find sexual pleasure and orgasm, since luckily our physiology means that’s possible. This, however, takes a partner who cares about your sexual pleasure, and is willing to put in the time. Or, a lot of time on your own practising masturbation techniques that work for you.
Having part of a clitoris or no clitoris does not mean no orgasm. It can mean no orgasm for a small percentage of women depending on the damage, and a bit or a lot more work for many of you. Some of you, however, will have absolutely no issue with orgasm after a clitoridectomy. Modern surgical techniques are a far cry from female genital mutilation.
You will need a sex therapist experienced in this field, who can guide you on how to find sexual satisfaction if you are finding it challenging. Find support groups, talk to others who are in the same position, and find strategies that work for you.