Subtotal de-epithelialization and partial concealment of the glans clitoris: a modification to improve the cosmetic results of feminizing genitoplasty.

An unsatisfactory appearance of the external genitalia after otherwise successful genitoplasty may result from failure to reduce the size of a hypertrophied glans clitoris and change its appearance from a large bulbous structure to a small conical cap. A more pleasing cosmetic result can be achieved by modifying a technique for glansplasty originally described by Lattimer: subtotal glans de-epithelialization and partial glans concealment. Six patients with virilized external genitalia (3 with congenital adrenal hyperplasia, 2 with gonadal dysgenesis and 1 true hermaphrodite) underwent feminizing genitoplasty using this modified technique at ages 3 to 13 months. All patients have achieved pleasing cosmetic results that are vastly superior to our experience with other methods for clitoral reduction.