A simple and step-wise dissection of the dorsal nerve of the clitoris

Objective

Dissection of the dorsal nerves of the clitoris (DNC) is an important step in most gender-affirming phalloplasty techniques. Understanding DNC anatomy also facilitates safe vulvar and clitoral surgery. However, the surgical anatomy of the DNC has only recently been thoroughly described in the literature, and dissection of the DNC has not traditionally been a routine part of genitourinary surgical education.^1,2 With procedures involving the DNC (e.g. gender-affirming phalloplasty) increasing in frequency, surgical resources are needed to better illustrate and teach this critical dissection. In this video, we demonstrate a safe, efficient and reliable approach to dissection of the DNC.

Patients and surgical procedure

This video is a demonstration of an approach to dissection of the dorsal nerve of the clitoris in a gender-affirming phalloplasty procedure.

Results

The DNC is a critical structure for erogenous and sexual function and its dissection should always be approached cautiously to avoid injury. The DNC is formed from branches of the pudendal nerve and travels below the inferior public ramus along the posterior edge of the clitoral crus [3]. Inferior to the pubic symphysis, at the angle of the clitoral body, the dorsal clitoral nerves enter the deep component of the suspensory ligament of the clitoris.^1,2 At the base of the clitoral body the dorsal nerves are superiorly suspended away from the clitoris before they descend inferiorly along the clitoral body. At this level, the DNC are large, approximately 2–3.2 mm, traveling at 10-11 and 1-2 o'clock positions along the clitoral body. We approach the DNC at this level by releasing the suspensory ligament of the clitoris and dissecting through the clitoral fascia.

Conclusions

Dissection of the dorsal nerve of the clitoris (DNC) is a critical step in many gender-affirming phalloplasty procedures. A thorough understanding of its surgical anatomy is also necessary for safe vulvar surgery. In this video, we demonstrate a safe, efficient and reliable approach to dissection of the DNC.