How I perform clitoroplasty: my technique for clitoral reduction

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By Dr. Walter Zamarian Jr. · Updated: 17/02/2026

What is the clitoris?

The clitoris is a small erectile organ in women located in the vulva, anterior to the urethra and between the labia minora. It is embryologically analogous to the male penis, meaning both originate from the same embryonic tissue. For this reason, the clitoris has elements similar to the penis, but in a smaller size: glans, prepuce, cavernous bodies (which allow for erection). It is one of the most sensitive erogenous zones in women and has lateral extensions to the urethra and vagina, which swell during clitoral stimulation and increase vaginal lubrication.

Clitoromegaly: the enlargement of the clitoris

When the clitoris is enlarged in size, at rest and without any stimulation, it is called clitoromegaly (or clitoral hypertrophy). There are various causes, but generally, it occurs due to greater exposure of the woman to androgens (male hormones) at some stage of her life, before or after birth. Among the most common causes are: genetic factors, congenital adrenal hyperplasia (one of the main congenital causes), polycystic ovary syndrome, androgen-producing tumours, hormonal imbalances, and the use of anabolic steroids. There are cases where the clitoris has been enlarged since childhood, while other patients come to me after having used anabolic steroids. It is worth noting that the enlargement of the clitoris caused by these medications does not fully regress, even after months or years without using them.

Psychological aspects

It is known that some women cope very well with their enlarged clitoris. However, the enlargement of the female clitoris can, in some cases, cause discomfort during sexual intercourse, when wearing tight clothing, or when engaging in physical activities such as cycling. In other situations, this enlargement can lead to embarrassment, shame, and even body dysphoria. In any of these occurrences, the woman may begin to lose sexual interest. This is a determining factor for seeking help from a professional. It is up to me to assess the degree of importance that the enlargement of the clitoris represents for the patient and to weigh with her the necessity of surgery.

Understand the difference between clitoroplasty and clitoropexy

Clitoroplasty involves the reduction of the clitoris. Clitoropexy, on the other hand, involves the fixation of the clitoris to the vulva with stitches, without altering the size of the clitoris. In other words, clitoroplasty actually reduces the clitoris, while clitoropexy merely "tucks" the clitoris into the vulva. Be careful with what you read on the internet, as some professionals refer to clitoropexy as clitoroplasty. This does not mean that clitoropexy should not be performed on anyone, but it happens that women with an enlarged clitoris may become frustrated with the result if only clitoropexy is performed. Generally, clitoropexy can help to disguise cases where the clitoris is slightly enlarged, while for cases where the enlargement is more significant, clitoroplasty may provide a more satisfactory result.

In summary: make sure you are undergoing the appropriate treatment. Seek a specialist with experience in both clitoropexy and clitoroplasty, as they can recommend the best surgery for your case.

Specialisation in the United States

The clitoroplasty as I perform it is not a widely disseminated technique in the Brazilian medical community, whether among plastic surgeons or among gynaecologists and urologists. The vast majority perform clitoropexy due to a lack of knowledge of the technique or fear of complications. For these reasons, I went to learn this technique — and others in intimate surgery — in the United States with the doctors who have the most experience in the world in this surgery: urologist and plastic surgeon Dr. Gary Alter, who also developed the Wedge technique for labiaplasty, and plastic surgeon Dr. Christine A. Hamori. I returned to Londrina with extensive knowledge and have performed clitoroplasty on patients from all over Brazil and abroad. Today I am a reference in this surgery in Brazil, even being invited to give courses on the subject. It is worth highlighting that the clitoris has more than 8,000 nerve endings, which requires an extremely refined technique to fully preserve sensitivity.



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Pre-operative

Important: prerequisite for performing clitoral reduction

If the cause of the patient's clitoromegaly was due to the use of androgenic anabolic steroids, it is necessary to refrain from using them for six months before undergoing surgery. Furthermore, it is essential that the patient understands that they must never use these medications again, as there is a near-certain risk of the clitoris increasing in size again.

The consultation

During the consultation for clitoroplasty, I assess the size, shape, and position of the clitoris and its glans, as well as the other elements of the intimate area, such as the prepuce, labia minora, labia majora, pubic region, and perineum. I conduct a thorough evaluation to recommend the best treatment for your case.

Examinations

For your clitoroplasty with me, I request some examinations. They are:

The anaesthesia

Clitoral reduction is a very delicate procedure, almost a microsurgery, as the vessels and nerves must be isolated and preserved to avoid loss of sensitivity and changes in the vascularisation of the clitoris. For this reason, it is a procedure that should be avoided under local anaesthesia, as it can distort and cause vasoconstriction or compression of the vessels that supply the clitoris. I prefer to perform this surgery under general anaesthesia or, in some cases, with a block (spinal anaesthesia) and sedation.

The clitoroplasty surgery

Beginning

The surgery begins with a circumferential incision at the base of the clitoris, at an oblique angle, to preserve the skin on the dorsal side of the glans and avoid discomfort during erection. Next, the skin is carefully released around the clitoris, fully exposing it. A repair suture is passed through the glans to assist in presentation. Hemostasis must be careful, avoiding injury to the dorsal artery and veins.

Dissection and isolation of the vascular-nervous bundle

The next step consists of two vertical incisions, paramedian, on each side of the ventral side of the clitoris, exposing the two cavernous bodies. Then, the entire dorsal vascular-nervous bundle is isolated with the aid of a number one Penrose drain, to avoid injuries to it.

Reduction of the cavernous bodies

Each cavernous body is then reduced by removing a segment whose length may vary according to each case and with the final goal of reduction. A hemostatic suture is performed on the proximal stumps of the cavernous bodies. Subsequently, I place a stitch with PDS 5-0 thread on each side, bringing the respective proximal stumps to the distal ones. At this point, a clear reduction in the length of the clitoris is already noticeable.

Vasodilator bath to avoid vascular spasm

Before fixation, I usually bathe the vascular-nervous bundle with a vasodilator solution containing lidocaine or papaverine, in order to avoid ischaemia of the vascular pedicle due to spasm.

Fixation of the clitoris (clitoropexy)

Yes, clitoropexy is also one of the stages of clitoroplasty, and it serves to position the clitoris as desired. However, in this case, the risk of recurrence, that is, of the clitoris becoming enlarged again, is minimal due to the reduction of the cavernous bodies, compared to clitoropexy as a standalone procedure. During clitoropexy, extra care must be taken to check the integrity of the vascularisation of the glans.

Suturing and adjustments

At this stage, I resuture the skin covering the clitoris and identify and treat any excess prepuce, labia minora, labia majora, or others that may be necessary. Sometimes, a bit of fat grafting in the labia majora may be indicated to help further disguise the volume of the clitoris.

Reduction of the glans

The final stage of this surgery is the evaluation of the glans and, if necessary, its reduction. It is known that the greatest sensitivity of the glans of the clitoris is at 12 o'clock and 6 o'clock, if we look at it like a clock. For this reason, the reduction of the glans is performed by removing a triangular segment at 3 o'clock and 9 o'clock. In this way, the clitoris is reduced in all its dimensions, taking care to preserve its sensitivity as much as possible.

Post-operative

The recovery from clitoroplasty is quite smooth. There may be slight pain in the clitoris during the first week due to the reduction of the cavernous bodies, but normally common analgesics alleviate this discomfort significantly.

Ointment

I recommend the use of 1% silver sulfadiazine ointment during the first week, as it is a topical antibiotic that is very effective against infections, especially since it is a moist area and the suture is hidden.

Resuming intimacy

The recommendation is to wait six weeks before having sexual intercourse for any intimate surgery, and this includes clitoroplasty. I follow the same recommendation given by my American mentors, Doctors Gary Alter and Christine A. Hamori.

Loss of sensitivity?

All patients ask if there is a risk of loss of sensitivity after clitoroplasty. The answer to this is that the risk always exists, but no patient I have operated on, to date, has shown any loss of sensitivity or even necrosis of the clitoris. I strictly follow the teachings I received, after all, I went to learn this technique and deepen my knowledge in the United States, as mentioned above.

Stitches

All the stitches I use in this surgery are absorbable. I use absorbable threads of vicryl 5-0 colourless and PDS 5-0 and 6-0, each in a specific region. In some cases where the glans is reduced, it may be necessary to remove one or another stitch at the two-month follow-up, if the PDS 6-0 threads from the glans have not fallen out.

Have your clitoroplasty with me

Get in touch with my clinic and book an assessment for clitoroplasty — clitoral reduction surgery — or other available intimate surgery options. I have international specialisation and can recommend the best treatments for your case.

Clitoroplasty is often combined with labiaplasty, clitoral hood reduction, and labia majora fat grafting. Also learn about labia majora reduction, pubic liposuction, perineoplasty, and vaginoplasty. Find out more about pricing and online consultation.

Book your consultation for clitoroplasty, the plastic surgery for clitoral reduction, with Dr. Walter Zamarian Jr. in Londrina

+55 43 99192-2221


Dr. Walter Zamarian Jr.

Plastic Surgeon in Londrina - Brazil

Rua Engenheiro Omar Rupp, 186
Londrina - Brazil
ZIP 86015-360
Brazil



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Frequently asked questions about clitoroplasty

What causes clitoral enlargement?

In my clinical experience, the most common causes of clitoromegaly are the use of anabolic steroids, congenital adrenal hyperplasia, polycystic ovary syndrome, and genetic factors. In some cases, androgen-producing tumours may also be responsible. I always investigate the cause before recommending any treatment, as this directly influences surgical planning and postoperative care. It is important to highlight that enlargement caused by anabolic steroids does not completely regress even after years without use.

What is the difference between clitoroplasty and clitoropexy?

I frequently explain this difference to my patients, as there is a lot of confusion on the internet. Clitoroplasty is the surgery that effectively reduces the size of the clitoris, including the corpora cavernosa and, when necessary, the glans. Clitoropexy, on the other hand, merely repositions the clitoris in the vulva with fixation stitches, without reducing its volume. In my practice, I recommend clitoropexy for discreet cases and clitoroplasty for more significant hypertrophies, where simple fixation would not yield the desired result.

Does clitoroplasty preserve sensitivity?

This is the question I receive most often, and I can affirm that preserving sensitivity is my absolute priority in this surgery. I carefully isolate the entire dorsal neurovascular bundle during the procedure and use a vasodilator solution bath to prevent vascular spasms. To date, none of my patients have experienced loss of sensitivity or necrosis of the clitoris. The technique I learned in the United States from Dr. Gary Alter and Dr. Christine Hamori is extremely refined and safe in this aspect.

What is the recovery like after clitoroplasty?

In my experience, recovery is quite smooth. There may be slight discomfort in the first week, which is well controlled with common painkillers. I recommend using 1% silver sulfadiazine ointment during the first few days to prevent infections. Most of my patients resume light activities within a few days, and all the stitches I use are absorbable, eliminating the need for removal in most cases.

When can I have sexual relations after the surgery?

I recommend waiting at least six weeks before resuming sexual activity, following the same guidance from my American mentors. This period is crucial for the complete healing of the tissues and to ensure that the final result is preserved. In my practice, this recommendation applies to all intimate surgeries I perform, and it is essential that the patient strictly follows this guidance.

Why did Dr. Zamarian specialise in this surgery in the United States?

I noticed that clitoroplasty was not a widely practiced technique in the Brazilian medical community, as most colleagues only performed clitoropexy due to ignorance or fear of complications. For this reason, I sought training directly with the world's leading specialists in this surgery: Dr. Gary Alter and Dr. Christine A. Hamori. I returned to Brazil with in-depth knowledge and today I am a national reference in this surgery, even being invited to teach courses on the subject.

What type of anaesthesia is used in clitoroplasty?

I prefer to perform clitoroplasty under general anaesthesia or, in some cases, with spinal anaesthesia and sedation. In my assessment, local anaesthesia should be avoided in this procedure because it can distort anatomy and cause vasoconstriction of the vessels that supply the clitoris. As this is an almost microscopic surgery, with extremely delicate vessels and nerves, appropriate anaesthesia is essential for safety and the best possible outcome.

Is it necessary to stop using anabolic steroids before the surgery?

Yes, I require a minimum period of six months without the use of anabolic steroids before performing clitoroplasty. Furthermore, I make it clear that the patient will not be able to use these medications ever again after the surgery, as the risk of recurrence — that is, the clitoris enlarging again — is almost certain if use is resumed. This guidance is non-negotiable in my practice.

Can clitoroplasty be combined with other intimate surgeries?

Yes, in my practice it is quite common to combine clitoroplasty with other procedures, such as labiaplasty (reduction of the labia minora), prepuce reduction, or even fat grafting to the labia majora. During the consultation, I assess the entire intimate area comprehensively and recommend treatments that can be performed together for a harmonious result. Each case is individualised according to the needs and desires of the patient.

Is there a risk of the clitoris enlarging again after clitoroplasty?

In my technique, the risk of recurrence is extremely low, as I perform effective reduction of the corpora cavernosa, unlike isolated clitoropexy. Clitoropexy as a complementary step helps to position the clitoris correctly, but it is the reduction of the corpora cavernosa that ensures the stability of the result. The real risk of recurrence only exists if the patient resumes using anabolic steroids after the surgery, which is why I prohibit this use permanently.