麻豆传媒

Cosmetic genital surgery is increasingly popular, but new research suggests crucial nerves are at greater risk of injury during vulval surgery than many surgeons may realise.

Textbooks rarely depict or describe the dorsal nerves in the clitoris, and the organ is often depicted as smaller than it is, says Paul Pin at the Baylor University Medical Center in Dallas, Texas.

Basic anatomical research on the clitoris has lagged behind that of the penis, he says. To address this, he and his colleagues dissected the clitoral regions of 10 cadavers of women aged 43 to 88.

They found that the nerves responsible for sensation and orgasm ranged from 2 to 3聽millimetres in diameter, similar in聽size to the nerves running along the shaft of the penis and in the index finger.

These nerves sit millimetres under the surface of the clitoral hood, the fold of skin that protects the pea-sized glans.

Similar measurements were found in a study of 27 cadavers led聽by Marlene Corton at the University of Texas Southwestern Medical Center.

These studies are the first to thoroughly measure the size of the clitoral dorsal nerves, and they聽change the conventional understanding that these nerves are small and situated deep below the surface.

Labiaplasties are cosmetic surgeries designed to reduce the size of the fleshy lips of the vulva, though surgeons sometimes also reduce the size of the clitoral hood.

Pin worries that a lack of聽information on clitoral anatomy means many surgeons performing labiaplasties don鈥檛 realise the nerves are even there. 鈥淏ut they are large, superficial and聽therefore very susceptible to聽injury if you don鈥檛 know what you鈥檙e doing,鈥� he says.

This is concerning in light of聽the聽growing popularity of labiaplasties. Between 2003 and 2013, Australia saw a threefold rise in the procedure, and the UK experienced a fivefold increase. In聽the US, there was a nearly 500聽per cent increase in the surgery between 2011 and 2018.

Pin collaborated on this work with his daughter Jessica Pin, who聽is also at Baylor. She had a labiaplasty and claims that the dorsal nerves of her clitoris were cut during the procedure.

鈥淚n the years following my surgery, I was repeatedly told my loss of clitoral sensation couldn鈥檛 have happened,鈥� she says. 鈥淚 was told by the [doctors] I turned to that I just needed to relax, just needed to fall in love.鈥�

Michael Goodman at California Northstate University says internet forums are full of stories of botched labiaplasties. 鈥淭here are all sorts of ways women have been harmed by well-meaning surgeons who didn鈥檛 know any better,鈥� he says.

Goodman adds that well-trained plastic surgeons or gynaecologists can safely perform the procedure.

Gino Pecoraro at the Royal Australian and New Zealand College of Obstetricians and Gynaecologists says these findings聽show how important it聽is聽to avoid unnecessary surgeries聽in this area. He says a聽true medical聽need is rare, and a聽more detailed understanding shouldn鈥檛 be seen as a green light聽to perform them.