What is hoodectomy (clitoral hood reduction)?
Clitoral unhooding is a surgical procedure that involves reducing the redundant tissue that surrounds the clitoris on the upper area and on both sides. It’s purpose is to protect the clitoris from unwanted stimulation. If the prepuce wasn’t present, the clitoris would be exposed to constant rubbing by clothing.
Due to the protective function and visual similarity of this tissue, the prepuce is referred to as a "hood." The hood can look differently in every woman and it is quite common that it varies in size. However, some women have too much skin around the clitoris to such an extent that it interferes with the woman's daily functioning.
Who is a suitable patient for clitoral hood reduction?
The average age of patients seeking this type of surgery is between 20 and 30 years old. However, older patients, whose children have already grown up, also seek solutions to this problem. Because of that we can see that the pregnancy itself and natural childbirth is not the main cause or trigger of these changes. A suitable patient is any woman who feels that the prepuce of her clitoris prevents normal intimate and daily functioning.
Some women develop the so-called hypertrophy – skin and tissue excess that start to overhang, which occurs not only in the entire hood of the clitoris, but also in the area below the clitoris and that proceeds longitudinally forming the small paws and anchors in various levels (the so-called paralabial algae) on their outer sides. As a rule, women with a genetic predisposition suffer from an enlargement of the inner labia, and nothing else can be done with the progression of this condition other than a slightly invasive reduction operation.
What causes labial hypertrophy or enlargement of the inner labia?
This problem is 99% associated with hypertrophy (enlargement) the inner labia which commonly has congenital and hormonal origin. The enlargement may be apparent from birth, but mostly manifests itself fully in puberty.
The most common cause of the hypertrophy of clitoral hood, except from hormonal causes (exogenous androgenic hormones), is a chronic irritation of this area, which also contributes greatly to enlargement.
Last but not least, hormonal changes during pregnancy can be important in this case, also changes related to age cannot be ignored. Labial hypertrophy can affect one or both sides of the labia and often doesn’t require diagnosis beyond the expert's opinion.
Which problems can be solved thanks to hoodectomy?
Redundant skin in and under the clitoris area causes problems not only in everyday life (discomfort and friction when walking, in tight clothing, underwear) but also in other activities such as sports (running, cycling, etc.) and during using sauna. The increased risk of infection is also not negligible, similarly to men who undergo circumcision for hygienic reasons.
In particular, in the case of a large excess of skin, the accumulated smegma in poor hygiene can cause itching, scabies and secondary infections and subsequent pseudophimosis, and it is the surgical reduction of clitorial hood that can help in prevention and provide proper hygiene.
The sexual aspect is equally important: the clitoris is immersed (literally hidden) in the excessive skin and very difficult to access, which prevents the woman from reaching arousal and orgasm. This kind of problem in the intimate area can lead to anxiety, frustration and ultimately dissatisfaction with the sexual experiences and, last but not least, to insecurity related to the appearance of external genitalia. Therefore, this operation will help to improve the possibility and the duration of orgasms. Many women claim that after the proceudre their sex lives have improved along with their general self-confidence.
The problem with the excess of skin in that area is that it can hide or even cover the head of the clitoris. The clitoris contains many nerve endings which are crucial to achieve clitoral orgasm, whether during sexual intercourse or masturbation, with the clitoris becoming more congested and enlarged; if the skin of the hood is overhanging it can inhibit the ability to feel sexual arousal or pleasure and reach orgasm.
Effects of the clitoral unhooding
The result of the operation is not only the rejuvenation of the external genitalia, but especially better access to the clitoris (but not it’s complete exposure) and thus more pronounced arousal and improved sexual satisfaction of the woman. Clitoral unhooding is a frequently performed procedure and, in ideal conditions, it is performed simultaneously with the labiaplasty of inner labia, as it is a single morphological-functional unit that should not be operated separately. The procedure should be combined not only beacause of an anatomical point of view, but especially beacuse of an aesthetic point of view.
Hoodectomy combined with labiaplasty
If the patient has a problem with skin excess under the clitoris, it is ideal to solve this problem during the labiaplasty, as the surgeon chooses the incision exactly according to the anatomical constitution of each patient strictly individually. Of course, it is always possible to reduce the hood of the clitoris and skin folds even after a labiaplasty, if this has been done in the past, but it should be noted that the resulting effect will never be as optimal as in the labiaplasty.
Labiaplasty with clitoral hood reduction is a safe surgical procedure that can help patients achieve a much better level of comfort, a more beautiful aesthetic appearance of the entire external genital area and, last but not least, permanently increase the patient's self-confidence.
Surgical reduction of the hood of clitoris
The operation should be performed by a very experienced and specialized plastic surgeon. The procedure is relatively uncomplicated in this area, and is usually performed under local anesthesia.
During the procedure, the overhanging skin of the hood is reduced so that the clitoris remains accessible but not completely exposed. During the surgery the anatomy of every patient should be taken into consideration as there are large anatomical differences between women. At the same time, hypertrophied longitudinal paralabial algae are removed so that the transition between the prepuce and the inner labia is smooth and without extra skin.
During the operation, the clitoris itself remains intact, and if it is operated on in the right layer, there is no damage to the sensitive innervation. Because the clitoral nerves are not disturbed, patients did not find any decrease in sensitivity or ability to achieve arousal; on the contrary: the results of the available study included that an average patient satisfaction after the procedure is 9.2 out of 10, with 95% of patients increasing comfort, 93% of patients experienceing an improvement in self-esteem, and 71% experiencing an improvement in sex life.
The procedure lasts at least 1 hour and is performed on an outpatient basis. If it is combined with labiaplasty, it is limited in time to 2.5 hours, including preparation.
Potential risks and complications of clitoral reduction
As with any surgical procedure, this operation carries a degree of risk and sometimes complications such as bleeding, hematoma, swelling and, in the worst case, infection, which are also manageable and aesthetically they will not affect the result if it is detected and treated in time. There is no risk of nerve injury unless the complication is deeper.
Scar healing is very individual but in general the scars in this area are very inconspicuous. Changes in sensitivity in both directions (hypo- and hyper-sensitivity) adjust spontaneously within 8 weeks.
Postoperative care after clitoral reduction
Patients can expect mild bleeding, swelling and discomfort immediately after surgery and for several days after. After the surgery the recommendation is to rest 3-7 days, especially if the hoodectomy is combined with labiaplasty.
Heavy physical exercise and sports are not recommended for about 6-8 weeks, sexual intercourse should be avoided for about 5 weeks. Sauna and solarium are not allowed for at least the first 3 months. Stitches do not have to be removed as they are normally absorbable. Strict individual recommendation will be provided to you by your plastic surgeon.