[Clitoromegaly--treatment with the harmonic knife (case description)]

Clitoromegaly, state when clitoris is non-physiologically large, most frequently occurs among patients with endocrine disorders (adrenal-genital syndrome, hormonally active tumors producing androgens, the use of anabolic steroids) or genetic. Less often the clitoromegaly is idiopathic of unknown etiology. There are no fixed standards for the size of organ, but it is assumed that not being in erect clitoris due to sexual arousal has a diameter of no more than 1/2 cm. To assess the size and shape of the clitoris can be used five Prader scale. However, it is most commonly used to assess the genitals of intersex. To the Clinic of Gynecology Oncology and Gynecology reported a 33 year old female patient because of escalating discomfort in sexual life. Patient associated her discomfort with her overly enlarged and painful clitoris preventing its proper coexistence. Gynecological survey found the correct size uterus and appendages. Vestibule of the vagina and the vagina of normal length and width. Larger and smaller labia developed properly. Clitoris increased to approximately 4x2 cm, not swollen, moving, with a uniform consistency. Except clitoromegaly in initial examination no abnormalities were found. Prior to surgery the patient has identified karyotype (46 XX) and has made designation of the levels of sex hormones and sonographic examination. In conducting these studies there was no answer found for the reason of clitoromegaly, there was the idiopathic overgrowth stated. Because of the pain during cohabitation associated with clitoromegaly, the patient was classified for reducing operation of this organ. For fear of the possibility of organ dysfunction, excessive bleeding and the appearance of postoperative adhesions abandoned classical surgical technique. It was decided to use in this operation, the harmonic knife. The use of harmonic knife allows avoiding introperative bleeding and precise, a partial reduction of the clitoris to the considered correct size without damaging of the organ structures. A month after surgery, the patient started having satisfying sex without feeling any pain and preserving proper function of the clitoris.