Clitoris Anatomy Applied to Aesthetic, Reconstructive and Transgender Surgery: A Narrative Review.

This review aims to provide a comprehensive analysis of the anatomy of the clitoris, focusing on its complex internal structure, topographic relationships, and neurovascular supply highlighting its morphological features and clinical implications in aesthetic, reconstructive and transgender surgery. We analyzed papers published in the past 70 years in the databases of Pubmed, Embase and Scielo. We excluded case reports, editorials and opinions of specialists. Studies were excluded if they lacked clear anatomical descriptions of the clitoris, if full-text access was unavailable, or if they were published in languages other than Portuguese, English, or Spanish. Long overshadowed by other anatomical studies, the clitoris is now understood as a multi-planar organ with significant depth and extensive innervation with several applications and surgical techniques, such as clitoral hood reduction (hoodectomy) or labiaplasty. The clitoris is a very important structure to female physiology, specially orgasm. Knowledge of clitoris anatomy is a fundamental step in aesthetic surgery and in reconstruction. In aesthetic and reconstructive clitoroplasty, Buck's fascia is a critical anatomical landmark. The neurovascular bundle resides just beneath this fascia on the dorsal aspect of the clitoris. By staying superficial to or carefully dissecting within this layer, surgeons can ensure that the blood supply and sensory fibers remain intact, preventing glans necrosis and desensitization. This narrative review addresses the anatomical integration, surgical techniques, and functional importance of the clitoral complex in the transgender population and transgender surgery.