The clitoral hood is the hood-like flap of skin at the top of the labia minora that surrounds the glans clitoris. It is also defined as the free edge of the prepuce that extends anteriorly and superiorly to the anterior commissure of the labia. Posteriorly, it extends down to meet labia minora. The length of the hood ranges from 2 to 6 centimeters. The purpose of this flap is not fully known however, it is understood to protect the sensitive clitoral area from constant rubbing and friction.
This flap of skin comes in all shapes, sizes, and colors and varies in each individual. There are multiple surgical procedures performed to manipulate the anatomy of the perineal area which fall under the umbrella of plastic surgery. Clitoral hood reduction, also called cordectomy, is one of the most common cosmetic procedures that is rarely performed as an isolated procedure and is usually performed alongside labiaplasty that is aimed at reducing the size of the clitoral hood by excising the excess or the redundant tissue resulting in exposure of the clitoris glans of the clitoris.
Indications
Aesthetic refinement of the vulva
Improve sexual functioning of the patient
Women with enlarged labia minora and clitoral hood may also complain of discomfort and irritation when exercising which can also cause recurrent infections due to interference with hygiene.
The clitoral hood reduction is also performed as a part of other surgical procedures performed on the clitoris itself. These procedures include clitoropexy, retracting the clitoris, reducing clitoroplasty, reducing the size of the clitoris that has enlarged as a result of congenital adrenal hyperplasia, genital virilism, or female pseudohermaphroditism, and clitoral lysis, to remove adhesions that result from lichen sclerosus.
In general, patients who reach the clinic with manageable expectations and have evidently excess hood tissue are suitable candidates for this procedure. The aim of the genital aesthetics includes a clitoral hood that is not protruding and is short with no extra folds. On the other hand, patients with unrealistic expectations for sexual performance, with evident psychosocial issues interfering with sexual function, and patients with active vulvovaginal infections are strongly discouraged to undergo this surgery.
Procedure
Since there is a wide variety of shape and extent of folds, the excessive tissue is marked prior to surgery according to the anatomy of the individual. After a detailed history of psychological, gynecological, and sexual aspects, an in-depth examination of the clitoral area with special attention to the folds, bulk, symmetry, and commissures the patient is prepared for surgery.
The clitoral hood reduction procedure is performed under local anesthesia with oral sedation or under general anesthesia. Bilateral cutting of the clitoral hood tissue is done while maintaining the position of the glans in the middle. This technique is employed in cases where the patient only requires greater exposure of the clitoris. When performed in conjugation with labiaplasty, the excision can be performed in ‘Y’ shape with the hood excised off the clitoris which is then usually closed with absorbable sutures. Other patients may only require the excision of the excess tissue revealing the hidden clitoris.
In conclusion, it is necessary to only seek attention from a board-certified plastic surgeon who is an expert and fully understands the outcome one is looking for.
Risks and Complications
Like any other surgical intervention, the clitoral hood reduction procedure comes with its own risks and complications. The patient is at risk of developing a hematoma or infection at the surgical site. There is also a risk of bleeding from the site of reduction. Another major complication of undergoing this surgical procedure is the damage to the nerves that travel above the clitoris along the clitoral body. Since the nerves do not grow back, permanent damage to these dorsal nerves can result from hoodectomy and even lead to a complete loss of sensations around the area or sometimes to an over-sensitive vulva. Undergoing this surgery can also lead to painful coitus (dyspareunia), painful post-surgical scars, and tissue adhesions. These adhesions or scarring may even block the urethra leading to urinary retention complaints post-operatively.
After the surgery, the patients are advised to avoid sexual activity and strenuous exercise for almost a month in order for the surgical site to heal fully without complications. The results are immediately visible and permanent however, pregnancy and childbirth may alter the outcomes.
References:
Zeplin PH. Clitoral hood reduction. Aesthetic surgery journal. 2016 Jul 1;36(7):NP231-.
Committee on Gynecologic Practice. Elective female genital cosmetic surgery: ACOG Committee Opinion, Number 795. Obstetrics and Gynecology. 2020 Jan;135(1):e36-42.
Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plastic and reconstructive surgery. 2008 Dec 1;122(6):1780-9.
Hamori CA. Postoperative clitoral hood deformity after labiaplasty. Aesthetic surgery journal. 2013 Sep 1;33(7):1030-6.
Bucknor A, Chen AD, Egeler S, Bletsis P, Johnson AR, Myette K, Lin SJ, Hamori CA. Labiaplasty: indications and predictors of postoperative sequelae in 451 consecutive cases. Aesthetic surgery journal. 2018 May 15;38(6):644-53.