PMC6348164_01
The clitoral frenulum and the infrafrenulum fascial bundle are presented. A. The case asymmetrical clitoral frenulum is presented. The right clitoral frenulum is much longer and thicker than left and is fused with the inner labium minus surface (black arrows indicate the superficial layer of the both clitoral frenula). B. The clitoral frenulum superficial stratum was removed and the clitoral infrafrenulum fascial bundle is depicted (clitoral frenulum deep stratum). Black dot-lines indicate the excision of the superficial stratum and emerging deep stratum (the clitoral infrafrenulum fascial bundle) are presented. The predetermined reduction of both strata of clitoral frenula is carried-out (black dot-lines).
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fig3
She pointed out that the most troubling appearance was the upper left labium minus, the clitoris being bulking, and did not look right, Fig. 3A. On physical examination, the right side of the clitoral frenulum was longer, much thinner, and unnaturally fused with the upper part of the right labium minus surface, Fig. 3A. The left clitoral frenulum was shorter and appreciably thicker than the right side, Fig. 3A.
PMC6348164_02
Clitoral frenuloreduction type I is displayed. A. Two-sutures ware placed laterally and superficially on the skin of the clitoral prepuce for retraction (yellow arrows). The incision was made on the labium minus to get access to Fusion between the right distal clitoral frenulum and labium minus as well as to create de novo the labium minus bifurcation. B. A tong depressor was used to protect surrounding tissues from inadvertent surgical injury. Separation of the right clitoral frenulum from the labium minus unnatural fusion is executed and followed by the length and thickness reductions. The black arrow points to the reduced length and thickness of the right clitoral frenulum. The partially resected superficial layer (the skin) and deep stratum (the infrafrenulum fascial bundle of the clitoris) were done. The length of the right clitoral frenulum was reduced to match the length of the left clitoral frenulum.
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She presented with hypertrophic clitoral frenula and the absence labium minus bifurcation causes bilateral inner folding of the labia minora upper edges, Figs. 4A and 5A. The upper fragment of the labium minus migrates into the clitoral hood and fuses laterally to the distal clitoral glans, Figs. 4A, 5A.
The external genitalia before and after the surgery are exhibited. A. The external genitalia appearance before surgery. B. The same subject is depicted after surgery. Clitoral frenuloplasty, clitoral preputial reconstruction, and labioreduction of the labia minora were executed. To minimize the male scrotum-like appearance of the labia minora, fenestration labioreduction was performed without preserving the original labial contour. The new counter was established and the natural edges were preserved.
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She presented with hypertrophic clitoral frenula and the absence labium minus bifurcation causes bilateral inner folding of the labia minora upper edges, Figs. 4A and 5A. The upper fragment of the labium minus migrates into the clitoral hood and fuses laterally to the distal clitoral glans, Figs. 4A, 5A. The right frenulum is much longer and thicker than the left one, Fig. 5A. The posterior surface of the right clitoral frenulum has a brownish color and texture similar to the labium majus when compared the left clitoral frenulum, Fig. 5A. The clitoral frenula were uneven in thickness and created an unnatural groove with the labia minora, Fig. 5A. The frenulum and the distal part of the labia minora were covered by the unnaturally elongated clitoral prepuce, Fig. 5A. There are also identifiable anatomical aberrations of the external genitalia such as the clitoral prepuce presents unnatural cord-like three-structures and clitoral hood banded, Fig. 5A; the hypertrophic, asymmetrical, and the upper part of the labia minora are folded. The general tissue texture of the labia minora resembles the male scrotum and they are unnaturally suspended to the clitoral hood and the clitoral glans, Fig. 5A.
PMC6348164_03
Clitoral frenuloreduction (type II) is performed in two-surgical phases. A. Phase I, separation of the right clitoral frenulum from the clitoral prepuce band-like skin (the red arrow) and the upper part of the labium minus (the red arrow). B. Phase II, the resection process of the right clitoral frenulum is demonstrated (the red arrow). A white plastic plate from a surgical package was used to protect surrounding anatomical structures from inadvertent injury. The black arrow shows the fragment of the clitoral prepuce and the part of the labium minus.
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fig7
Her chief complaint was the absence of interest in sexual activities with any partner due to external genital anatomic aberrations and very offensive odors of the external genitalia, Fig. 7A and B. She also was troubled by the fact that her labia minora were aesthetically unattractive, asymmetric, and had a pocket in which she noticed small, solid cast structures and the area was tender to her touch, underwear, and caused discomfort during bathing, Fig. 7B. The physical examinations revealed that the right clitoral frenulum being fused with the labia minora and with the clitoral redundant preputial cord-like tissues, Fig. 7A and B. All these structures created a pocket, which was permanently fused with and suspended to unnatural clitoral redundant preputial cord-like tissues, Fig. 7A. Upon stretching the margin-free pocket's edge, "stalagmite-like" multiple small cast structures, white in color, were noted, Fig. 7B. The pocket was filled with small casts structures, which emanated offensive odors. "Stalagmite-like" multiple structures loosely adhered to the inner tissue of the pocket, Fig. 7B; upon removing "stalagmite-like" materials, the area appeared as reactive inflammation within the pocket. Additionally, an unnatural appearance of the reverse triangular-shaped deformity was created by the base of the pocket, Fig. 7A and B.