Is a cut frenulum responsible for loss of pleasure?

I see many reconstructions since I invented the wedge labiaplasty over 25 years ago. A trimming labiaplasty often leaves the frenulum hanging, I have had a theory that the lack of pulling by on the clitoris by the cut frenulum decreases sensation. I can suggest reattachment of the frenulum to the upper labium and see if that helps. The reconstruction is much more difficult than a primary labiaplasty and should be done by a plastic surgeon with extensive experience in labia reconstruction. I published the first and most extensive paper on labia reconstruction in the prestigious journal "Plastic and Reconstructive Surgery" about 11 years ago. Approximately 40% of the surgeries I perform are revisions of other surgeons’ labiaplasties. You only get one good chance to reconstruct you, so be patient and ask a lot of questions.

Gary J. Alter, M.D.
Beverly Hills, CA - Manhattan, NY

Thank you for your questionA surgeon can perform surgery several times a week and continue to do a poor job over and over again. The frenulum holds down the clitoris to increase pressure contact during intercourse. Cutting the frenulum can reduce the contact and pressure. I cannot fully evaluate your frenulum from the photo to see if this is the case with you. I can see that your prepuce( the upper pair of labia that forms the hood and enters into the lower pair) was not addressed with your surgery which makes me question the skills of your surgeon for this procedure.

If I had seen your old photos, I could have given a better comment. As far as I can see, the junction of the labia frenulum is very short and this has caused loss of sensation. It would be appropriate to perform genital prp to reanimate in this way, re-surgery would not be correct. Some feelings may come back over time.

Nerves associated with clitoral orgasm are located inside the clitoris. These nerves are not interfered with in labiaplasty surgeries. I see that there was no intervention in your surgery. I think this problem will go away over time. I do 1 or 2 labiaplasty surgeries every day. I've never encountered the problem you're having.

Q: Can anything even be done about it?

A: Yes, there is hope to restore your diminished sensation. From your narratives, you selected the surgeon who has been doing two daily cases. It is important to remember the number of cases performed by a surgeon is not crucial in decision making, but how well the surgery was done with satisfactory outcomes.

The attached middle picture best illustrates the causes of your suffering. The two masses-like structures on the right side of the clitoral prepuce stretch the right clitoral frenulum and suspend the clitoral hood, making it less flexible; therefore, it contributes to stretching the clitoral frenulum. Additionally, the labia minora bifurcation was surgically extended, which also added to stretching the right frenulum. Furthermore, the clitoral orifice wall was surgically extended, causing the clitoral prepuce mucosa to prolapse partially and contribute to clitoral stretching.

Bering in mind these anatomical distortions following surgery, repairing these defects will release compression on the clitoral frenulum nerve endings should help you. Please familiarize yourself with my clinical research on fernuloreduction by clicking on the link doi:10.1016/j.heliyon.2018.e01098 to get access to this publication.

With regards,
Prof. Dr. Adam Ostrzenski
US Gynecologic Surgeon