Dysgenesis of the external genitalia is a common clinical sign in disorders of abnormal sex development, usually an enlargement of the clitoris with fusion of the labial sac. As the confusion of the vulva has a huge psychological impact on the patients and they are unable to live a normal life in the society, they need to be reconstructed and changed into a female vulva or reconstructed into a male, depending on the situation. However, in this article, we will focus on the surgical alteration of a dysplastic vulva to a female vulva. For enlarged clitoris, the traditional procedure is simple clitoridectomy. Since the clitoris is an important organ related to the quality of sexual life, the excision brings a great impact on the patient’s quality of life. In order to change the disadvantages of this procedure, Spence and Allen proposed clitoral reduction with preservation of neurovascularity in 1973 [1], and Lang Jinghe et al. detailed the key points of this procedure in 2003.2 We have improved this procedure and it has become a conventional procedure for the treatment of enlarged clitoris. The procedure is safe, aesthetically pleasing, and more anatomical and physiological. First, the type of vulvar malformation and anatomical characteristics of vulvar sex confusion is most common in patients with congenital adrenocortical hyperplasia, Prader will varying degrees of vulvar masculinization is divided into five types [4]. type I clitoris is slightly larger, type II clitoris is larger, type III clitoris is significantly enlarged, the vaginal and urethral orifices open in a common urogenital sinus, type IV clitoris enlarged like the penis, the penis base for the urogenital sinus opening, similar to the suburethral sinus opening. Type IV has an enlarged penis-like clitoris with a urogenital sinus opening at the base of the penis, resembling a hypospadias, and the genital bulge is mostly fused. type V is the manifestation of a completely male vulva. When the clitoris is significantly enlarged, its internal structure is similar to that of the male penis, with the two penile corpus cavernosum separated on both sides of the posterior pubic arch, each attached to the anteromedial aspect of the left and right sciatic branches of the pubic bone. The enlarged clitoris is quite rich in blood, lymph and nerves. The distribution of blood vessels is divided into superficial and deep groups, with the superficial group mainly consisting of the dorsal clitoral artery located at the back of the clitoral body, and the deep group coming from the vaginal artery. The main afferent nerve is the dorsal clitoral nerve at the back of the clitoris, and the nerves seem to be distributed in the whole clitoral body in a fan shape, but the head and the back of the clitoris are the most dense, which is conducive to the conduction of sexual stimulation [5]. The sexually sensitive area is located in the head of the clitoris. Based on the above anatomical features, the basic aims of surgery for patients who require vulvoplasty for women should be: ① excision of the clitoral body with preservation of the vascular nerves; ② preservation and reduction of the head of the clitoris; ③ establishment of normal labial structure; ④ ensuring sufficient vaginal length and sufficiently large vaginal opening; and ⑤ separation of the urethra and the vagina to prevent urinary tract complications [6]. The basic principle of surgery is to try to restore the normal anatomical structure and try to retain the original sexual function. II.HISTORICAL REVIEW There are various surgical approaches to clitoridoplasty. The earliest, in 1930 by the United States Hugh Hampton Young proposed [7]. 60’s, the main operation for the clitoral head retained, the clitoral body buried in the subcutaneous clitoral buried method or clitoral shortening buried method [1], but this surgery often causes severe local pain, when the local bulge obvious congestion, affecting the aesthetics. Therefore, it is only suitable for patients with mild to moderate masculinization of the vulva.In the late 70’s, the conventional surgical procedure has been identified as clitoridectomy [7]. That is, from the root of the clitoris to remove all the clitoris, the operation is simple, but the loss of normal anatomical structure and aesthetics, sexual function is affected. It has been reported that 78% of patients who underwent clitoridectomy at an early age lacked sexual desire in adulthood, and 39% were unable to achieve orgasm [7]. In 1973, Spence and Allen proposed clitoral reduction with preservation of neurovascularity [1]. The procedure not only preserves the nerves and blood vessels, but also preserves part of the clitoral head, and the preserved prepuce forms the labia minora, which make the vulva more in line with normal anatomy and physiology, and preserve the sexual function as much as possible. We in the application of the operation, before cutting the skin on the back of the clitoral body, with saline in the whole subcutaneous injection to form a water cushion, easy to separate, less bleeding, to avoid the vascular nerve damage. Third, the indications for surgery: congenital adrenocortical hyperplasia, incomplete androgen insensitivity syndrome, testicular degeneration, true hermaphroditism and so on. When the patient’s vulva has signs of clitoral enlargement or lip sac fusion, the vulva needs to perform plastic surgery. Surgical steps Firstly, saline is widely injected into the subcutaneous superficial fascia of the back of the enlarged clitoris, so that a water cushion is formed under the skin of the entire clitoris (for patients without hypertension, 4 drops of norepinephrine can be added to 100ml of saline), a tissue clamp is clamped in the middle of the root of the prepuce of the clitoris at the dorsal side of the pubis as a sign, and a longitudinal incision is made between the sign and the coronal groove of the clitoris, with a depth of only up to the subcutaneous area. After incision of the skin, the skin and superficial subcutaneous fascia on both sides of the incision are sharply separated, taking care not to damage the skin. The lateral aspect of the clitoral corpus cavernosum is separated to fully expose the corpus cavernosum. The dorsal supraclitoral arteries and nerves and their surrounding tissues are bluntly detached from the middle of the lateral aspect of the cavernous corpus cavernosum. The subclitoral arteries and nerves and surrounding tissues on the ventral side of the corpus cavernosum are separated in the same way, up to the bifurcation of the corpus cavernosum and down to the coronal sulcus. It is important not to damage the vessels and to preserve as many nerves as possible. Remove the corpus cavernosum between the proximal aspect of the coronal sulcus and the root of the clitoris, removing the root in close proximity to the two descending branches of the pubic arch, and suturing the wound to stop bleeding. One suture was left in place on each side of the clitoral head with a central line, which was utilized to secure the clitoral head to the subpubic root. The dorsal median skin of the head of the clitoris was sutured together with the median incision marked at the beginning of the operation with a No. 4 silk thread, and the rest of the retained clitoral skin was pulled down along the dorsal incision margins to form the labia minora on both sides, and the cut edges of the skin were closed with interrupted silk sutures. A rubber sheet is placed for drainage. If the clitoral head is too large, a wedge-shaped incision can be made to remove part of the clitoral head tissue and suture the wound. In 1999, we reported 16 patients with congenital adrenocortical hyperplasia who underwent vascular-preserving clitoral reduction and restoration [3]. Twelve of them were married, five were pregnant, and four gave birth. Eight cases were followed up with satisfactory clitoral sensitization. The surgical technique is now mature, the average operation time is 60 minutes, and the bleeding is 10-20 ml. There is no case of intraoperative and postoperative complications such as hematoma. Short-term follow-up, the appearance of the vulva is good and beautiful, and the patients are basically satisfied. In carrying out this surgery so far, the surgical method has been improved, the steps have become clearer, and the operation time has been significantly shortened, from about 3 hours at the beginning to 1 hour at present. Since 2000, more than 60 cases have been completed, with good postoperative follow-up and patient satisfaction.