Surgical Treatment for a Small Clitoris: Clitoral Unhooding (Hoodectomy)

Overview

The clitoris is a female sex organ present in mammals and in humans, it is described as a button-like structure located above the urethra (opening of the bladder) at the front junction of the labia minora (inner lips of the vagina).

The best analogy to use to describe the clitoris is that it is a structure equivalent to the male penis which, to a point, can become erect with sexual stimulation. The clitoris is covered with a tissue known as the prepuce, which covers the area like a hood in the same way the foreskin in a male covers the head of the penis.

Therefore, just as the male foreskin varies in shape and size and in the way it covers the head of the penis, so does the prepuce of the clitoris. If the prepuce covers the clitoris to a great degree then it can seem like the clitoris is not present. This may affect sexual functioning in a female as they may have complaints of decreased sexual gratification due to not being able to achieve an orgasm. In turn, this can cause increased frustration and anxiety which can have long-term negative consequences regarding the affected women's sexual health.

Clitoral unhooding

Also known as clitoral hood reduction, clitoral hoodectomy, or clitoridotomy, clitoral unhooding is a plastic surgery procedure for reducing the size and the area of the clitoral prepuce in order to allow exposure of the clitoris.

This procedure is usually performed if the cause of the woman's sexual dysfunction is assessed to be due to a poorly exposed clitoris due to the genitalia being covered with the prepuce.

The procedure of removing part of the prepuce that covers the clitoris can be thought of as performing a circumcision in men where the part of the foreskin that covers the head of the penis is removed.

One technique that is used for reducing the clitoral hood is by cutting the prepuce tissue on either side of the clitoris and maintaining the midline of the structure. Another technique involves cutting away redundant folds of the prepuce tissue by making incisions parallel to the long axis of the clitoris. There is also a technique that involves performing a wedge-excision of the hood tissue to expose the clitoris.

Warning

The American College of Obstetricians and Gynecologists (ACOG) has opposed the commercial misrepresentation of procedures such as labioplasty and other vaginoplastic procedures for alleged medical reasons. The reason why labial-modifying surgery is mentioned here is that some plastic surgery specialists may suggest that patients perform these procedures for aesthetic purposes together with a clitoral hood reduction.

The ACOG doubts that vaginoplastic surgeries have been researched enough to allow them to say that these procedures are medically safe and therapeutic, and they may pose potential health risks and leads to complications such as wound infection, pudendal nerve damage leading to sensation changes of the vulva, painful scar formation, and experiencing painful intercourse.

It is very important that doctors, who are going to perform any surgery on or around the vagina, fully inform their patients regarding the way the procedures are performed and what possible side-effects and complications can be faced. This is done so that the patient can give proper informed consent for the surgery.