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Jun 22, 2023

Clitoral Enlargement Surgery Is Growing

While still quite uncommon, women are seeking doctors who will help them grow

While still quite uncommon, women are seeking doctors who will help them grow their clitorises for both aesthetic and sexual reasons.

BuzzFeed News Contributor

Ana (who requested a pseudonym to protect her privacy), a medical assistant who lives in Florida, started taking synthetic testosterone and estrogen to improve her energy levels and libido in her 30s around 2005. In 2016, a patient at the facility Ana worked at told her a secret: the hormones the patient was taking had caused her clitoris to grow. The patient's lover was thrilled. Sex was great. Ana decided she wanted a bigger clitoris as well.

"Mine was a good noticeable size," she said. But she wanted to enlarge it to increase her pleasure and because she liked the look. She asked her doctor if more testosterone would do that for her. He said yes and upped her dose. Soon, her clitoris grew by "a substantial amount." She loved it. "Oral sex was more intense," she said. And her clit was easier to find. "Your partner just goes down there and is not like, ‘where is it?’"

Ana, who is now 56, learned from a coworker that clitoral enlargement surgery could make her clitoris even bigger. "I feel this way with this [clit], so how would I feel with the big[ger] one?" she asked herself. "I wanted to know how [the clit felt] when I was having an orgasm."

She told her husband and he found her a doctor: Miami-based plastic surgeon Dr. Christopher Salgado, who specializes in gender-affirming surgery. Salgado had never performed this surgery before, but he thought he might be able to produce results similar to the ones he gives some trans men for metoidioplasty, a type of "bottom surgery." The surgery involves cutting the suspensory ligament connecting the clitoris to the pubic bone, which lengthens the visible part of the clitoris.

Before deciding whether to operate, Salgado studied the literature to find out if a larger clitoris led to increased sexual pleasure. He found a 2014 study in the Journal of Sexual Medicine that showed a correlation between women with larger clitorises and the ability to orgasm. But the study was small, with only 30 participants, and it did not prove that a large clitoris could cause women to orgasm.

Other more recent studies also showed little consensus. A 2020 study in the Turkish Journal of Obstetrics and Gynecology found that clitoral size was not correlated with greater orgasm, while a 2020 study in the Journal of Surgery and Medicine found that surgeries "to increase clitoral glans visibility can facilitate sexual satisfaction and/or increase orgasm intensity [and that] clitoral glans visibility is more important than clitoral size for sexual stimulation." Leah Millheiser, an OB-GYN and clinical professor at Stanford University who specializes in sexual health, told BuzzFeed News that "enlarging your clitoris has never been shown to increase sensitivity in women who have a normal size clitoris."

Salgado told Ana he’d never done this surgery before and that she could possibly lose sensitivity in the area. Ana was worried about the possibility, but she hoped the surgery would bring her stronger orgasms. "I wanted the surgery as soon as possible," she said. But Salgado was booked for three months, and he also required her to have a psychological evaluation before the surgery, where they asked her about her gender identity (she is cisgender) and whether her husband was coercing her to get the surgery (she said he wasn't).

She passed the evaluation and underwent surgery in August 2018. It took about three hours and went smoothly. Her insurance didn't cover the surgery, which Salgado says usually costs between $6,000 and $15,000.

After Ana healed, her clitoral glans (the visible part of the clitoris) grew a half inch to a length of 2 inches, nearly double the size of an average woman's clit. And it became even larger when aroused. She noticed a difference in sexual response immediately; her orgasms were more intense. "The sensation is different," she said. "It's not like multiorgasms. It keeps going, keeps going, keeps going. It's nonstop." She said during oral sex, "my husband has to keep his mouth [on my clit] until my soul comes back to my body." But her inner labia were covering much of her clit, and she wanted more of it exposed. "I told [Salgado] I want to do something with my small labia. So he wrapped the labia [minora] around the clitoris, so that it looks like a small penis without circumcision."

"I don't know why all women haven't done this," Salgado recalled her telling him.

One day, while her husband was performing oral sex, she said she had an orgasm that lasted eight minutes (her husband timed it). "It really changed my life," she said. Her orgasms went on to become even more intense. In 2020, she had one that was "so strong that it completely locked my muscle on my back," she said. Her physician said it was the first time he’d seen an orgasm cause back issues.

She is now taking testosterone prescribed by a doctor to increase her clitoris size, and she uses a nipple pumping cylinder, which creates a vacuum around the clitoris and enhances blood flow. Ana said it increases the length of her clitoris to 4 inches. When she goes to the beach, sometimes people stare at her crotch, but she's OK with it. "You have to be happy with yourself. [If] you want to explore your body, if you want to feel different, do it," she said.

When she told friends about the surgery, they were skeptical, but she assured them that the improvement in her sex life was worth it.

After Salgado published an academic article on Ana's surgery in 2020, other cis women started reaching out to him. They were looking to improve "not just the function, but also the aesthetic appearance," he said. He has since performed this surgery on four additional women.

Until recently, most clitoral surgeries were designed to decrease its size, not increase it. The clitoris and its extensive network of erectile tissue below the visible glans weren't even fully discovered until 2005, when urological surgeon Helen O’Connell used an MRI machine to examine the organ. "You can think of the clitoral glans as being equivalent to the head of the penis. It's derived from the same tissue," said Dr. Marci Bowers, a gynecologic and reconstructive surgeon who performs clitoral restoration surgeries on women who are victims of female genital cutting.

In part because of the misrepresentations of the clitoris as being smaller than it is in medical textbooks, art, and some pornography, some Western women opt for elective clitoral reduction surgeries. "After always doing reductions for patients that were born with clitoromegaly [enlarged clitorises], I was kind of surprised," Salgado said of enlargement requests like Ana's. "Why would a woman want it larger?"

Surgery is only one of a number of methods cis women can use to enlarge their clits. Plastic surgeons can also inject hyaluronic acid into women's clitoral glans and hood at their offices offices. Like Ana, other women are getting doctor-prescribed or illicit testosterone creams, injections, and pellets, which they sometimes supplement with suction pumps. (Bowers sometimes provides testosterone for cisgender women or nonbinary people who want to grow their clitorises.) In the kink community, a small number of women inject their clitorises and clitoral hoods with saline to provide a temporary puffiness. The subreddit GrowYourClit has 40,000 subscribers, many of whom say they are using testosterone and pumps.

The hormone itself might be the cause for increased sexual pleasure, not the size of the clitoris. "Testosterone has the effect in some women of enhancing libido," said Charles Rardin, a professor of obstetrics and gynecology and director of the division of urogynecology and pelvic surgery at Women and Infants Hospital at Brown University. "But it also increases heart attack risk," Rardin said. Women who use higher levels of testosterone can have a multitude of other side effects, from facial hair growth and pattern baldness to potentially more serious health issues, according to Millheiser. "When levels of testosterone are superphysiologic [more than a premenopausal woman would usually have], it could potentially have effects on the liver, on carbohydrate metabolism. It can cause voice changes and deepening of the voice, which may in certain situations not be reversible. The long-term safety is unknown." Millheiser said.

It's difficult to ascertain how many doctors perform clitoral enlargements and how many patients undergo them. "We don't have specific stats on surgical clitoral enlargement and enhancement," Madison Freeman, a spokesperson from the American Society of Plastic Surgeons, told BuzzFeed News.

Rardin cautions against these clitoral enlargement procedures. "I'm not aware of any peer-reviewed data suggesting that [it] has benefits. My own instinct is that injecting or operating on the clitoris is not usually a good idea. You can get infections, you can get hematomas or bruising, you can get scar tissue," he said.

In 2017, Kelly (name has been changed to protect her privacy), then 22 and living in Europe, decided she wanted to grow her clitoris after looking at photos on Tumblr and bodybuilder porn: "It excited me to imagine those women with such big clits having more powerful and intense orgasms, and thinking of having that for myself was extremely arousing," she said. She’d always thought hers was on the small side, and she’d wondered if she could grow it. "Enlarging my clitoris has always been about exploring a kink. It's a sexual fetish," she said. She began searching Google for more information. "I came across information about female bodybuilders who were experiencing clitoris enlargement as an unwanted (or at least unintended) effect of using steroids," she said.

After doing some more research, she decided that one of the best ways to increase the size of her clitoris was to use a hormone called dihydrotestosterone (DHT), which helps produce sexual characteristics such as a deeper voice, facial hair, and Adam's apples. She found someone selling DHT online and ordered herself a vial, which she now believes was tap water. It was "absolutely useless, but it gave me the start I needed to solidify the fantasy in my mind and actually try to find a safe and effective version of the hormones," she said. She bought a cream containing androgens and anabolic steroids online that she applied directly to her clitoris.

"Within a few weeks, I could already see that my clitoris was growing larger. It was an incredible surprise," she said. "I began to really enjoy sharing photos and videos of my growing clitoris." (Millheiser, the OB-GYN, does not think this was wise. "A mix of testosterone and anabolic steroids can be dangerous … We don't know what the safety or efficacy of this is … because there's no data to support its use," she said.)

Kelly was drawn to the subreddit r/BigClit, where people post pictures of their large clitorises and typically receive an abundance of praise. Soon after posting her own photos, she became a moderator. When another Reddit user proposed they start a clit-growing subreddit, she was all in. "[I] agreed to help support a community that would provide support and safe, legal resources for other women to grow their clitorises," she said.

r/GrowYourClit went live on Oct. 1, 2019. Since then, Kelly has seen thousands of women ask questions about the best hormones to use, proper dosage levels, where to find doctors willing to prescribe testosterone for clit growth, and what to say. Most of the women in the subreddit are interested in growing their clits to experience more sexual pleasure.

"A lot [of women] have confided that low sex drive, body issues, inability to achieve satisfactory orgasm are the reasons they want to explore clitoris enlargement," she said. "[It] started to look like a very real and potentially misunderstood, dismissed, or misdiagnosed problem that a lot of women were facing." But many fear that doctors are going to judge them, she said. "A great piece of advice I see commonly offered on the subreddit is simply to be honest… You have no reason to be ashamed of wanting to increase your own sexual pleasure."

Kelly has seen a number of benefits to enlarging her clitoris. "My orgasms are certainly better, and it's often much easier for me to achieve orgasm — but I can't say for sure if that's due to physical changes to my clitoris, or if it's because I’m just that much more excited about having a huge clit and showing it off," she said. (Rardin, the Brown professor of gynecology, said that while "testosterone is demonstrated to have a libido effect, [taking large doses] is not without systemic cardiovascular risks.")

Dr. John Anastastos, who does clitoral enhancement in Beverly Hills, California, on Feb. 17, 2023.

Dr. John Anastasatos, a plastic surgeon in Beverly Hills, who does both clitoral enlargement and reduction procedures, said that clitoral reduction procedures are much more common than enlargement ones. Yet, in the past five years, the number of women requesting clitoral hood enlargement treatments has been increasing, he said.

He injects women's clitoral hoods with hyaluronic acid fillers, which last about six months. Anastasatos charges between $3,500 and $4,500 for the procedure, which insurance does not cover. "I also perform all such treatments in an operating room to ensure the highest safety and sterility standards," he said. Operating rooms, facility fees, and anesthesia contribute to the total costs." Some women desire the procedures because they want the area to be smoother, plumper, and more youthful-looking. "There's always some wrinkling at the level of the hood…that gets even more wrinkly with advancing age," he said. Others want the injections to increase sexual sensation. "[Filler] gives it a little bit more volume," he said, possibly leading to the "stimulation of the clitoris during intercourse or masturbation [that] can make it more pleasurable."

Anastasatos traces the increase in genital plastic surgery to the rise in popularity of pubic hair removal. "When there was hair there, I can tell you, there wasn't much interest," he said.

Anastasatos began doing the procedures after one of his patients suggested clitoral hood fillers. "She was very empowered by her positive experience afterwards," he said.

Dr. Daniel Moghadam, a plastic surgeon in Santa Monica, California, also started injecting hyaluronic acid fillers after a patient requested them. "I don't really advertise for it, honestly. All my patients are from word of mouth," Moghadam said.

He has seen an uptick in requests for both clitorial and penis enlargement. "During the pandemic, I feel like everyone was stuck at home for three months and just watching porn nonstop…and my business exploded," he said. "If you had told me 20 years ago people would be getting fillers in their clitoris, I would have said, ‘No way.’"

Monghadam does about five or six clitoral hyaluronic acid procedures a month, which cost $1,500 a pop. He always asks women why they want it and clarifies the limitations. "If it's strictly cosmetic and they just want a bigger clitoris, it's fine," he said. "But sometimes people are under the impression that [they’ll] be more stimulated, and it doesn't really work that way. If anything, there's a risk of actually losing a little bit of sensitivity because it's filler… it's just padding between the nerve ending and the tissue." In fact, Salgado, the doctor who did Ana's surgery, said some doctors are injecting cis men's penises with hyaluronic acid to to prevent premature ejaculation.

When injecting the clitoral hood with hyaluronic acid, Anastasatos said he always starts with small amounts of filler: "It's critical to maintain the natural architecture that someone has." About 70% of women return to get follow-up clitoral hood injections. "The majority of patients…find that there is an increase in sexual satisfaction. Now, how do you define sexual satisfaction? The treatment itself doesn't do anything to make the nerves more sensitive…but sexual satisfaction to a large degree is mental too," he said.

He doesn't advertise clitoral hood procedures, either. Many women requesting them do so when undergoing "mommy makeovers," which usually involve breast lifts and enlargements and tummy tucks.

Plastic surgeon Landon Pryor of Pryor Health in Rockford, Illinois, injects hyaluronic acid into the clitoral glans. Most of the patients requesting these procedures are women between 35 and 45 years old with kids, he said.

He recommends hyaluronic acid fillers to patients who tell him that their clitoris "is the most sensitive area for [them] sexually, and [that they’re] having problems deriving maximum pleasure," he said. Unlike Moghadam and Salgado, he said fillers could improve sexual response. "If something's bigger, it's more exposed to external forces, it potentially is going to be more pleasurable for somebody during sexual intimacy," he said. Pryor said that patients have reported better orgasms. "To me, augmenting the clitoris isn't any different than augmenting the breasts: It makes women feel more sexually attractive," he said. "The benefits of hyaluronic acid are it's safe, it's effective. It's not long-lasting and it's easily reversible."

For women who want a more temporary clit enlargement, there's saline, which lasts less than 24 hours. Saline clitoral injections are do-it-yourself treatments that are not administered by doctors but rather members of the medical fetish community. "I think it is potentially dangerous, particularly if done by a provider who is not very familiar with the anatomy," Salgado said.

Electrasexual (the pseudonym she uses online), a self-described medical fetishist and masochist, began enlarging her clit with saline recently, which she says is "the most painful form of saline injection for my body … The throbbing continues for several hours." The pain is part of what draws her to the practice. "Physical pain turns me on if it's in the right setting," she said.

She already had a large clit thanks to the testosterone she's been on for a decade. "My doctor found that my testosterone level was zero. This is abnormal even for a cis female, so we started testosterone pellets every three months," she said. Her large clit began to arouse her, so she sought a way to make it even bigger. "When it increases in size [with saline], it emerges from underneath its hood, and when it rubs against things while exposed, it is incredibly sensitive," she said. "I’ve started getting turned on by the fact that my clit is kind of a tiny penis, and can be sucked and massaged in ways that are similar to a cock."

She began sharing videos of herself injecting her clit on Twitter and ManyVids. "Others seem to enjoy watching me inflict pain on myself, so I’ve started making a little money doing this," she said. "I do it because of the sensation, the appeal to my followers, and because on a purely psychological basis, it turns me on with its genderqueer nature."

Despite the growing number of women like Electrasexual who are enlarging their clitorises to increase sexual sensation or improve the look of their clitorises, doctors remain wary. "I can understand the enthusiasm and hoping [enlargement] will help," Rardin said. "But these [procedures] are not scientifically established. [Clitoral surgery] is a complicated and fraught procedure. Obviously the clitoris has incredible amounts of nerve endings and complex vascularity… even just injecting materials [in the clitoris] is going to have some possibility of decreased function down the road." ●

Correction:

An earlier version of this story misstated where Landon Pryor's practice is located.

BuzzFeed News Contributor

Hallie Lieberman is a historian and journalist. She's the author of Buzz: A Stimulating History of the Sex Toy.

Contact Hallie Lieberman at [email protected].

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