All About Labiaplasty: A Primer for Patients. Part 2: Clitoral Hood Reduction

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Symmetry, balance and comfort are the most common reasons why my clientele request labiaplasty. Clitoral hood reduction is frequently needed to achieve these goals. A wide clitoral hood can push the labia majora aside creating a wide labial cleft (camel toe) which some women find unappealing. Sometimes the color of the edges of the labia minora have become much darker (hyperpigmentation) than the surrounding vulva or the tissues have become enlarged (labial hypertrophy). In other instances, the labia majora have become deflated from weight loss or aging or they sag after massive weight loss.

It is not uncommon for women to experience damage to the labia during childbirth or from surgery or disease. These situations too, may lead to the desire for labiaplasty and clitoral hood contouring.

Cosmetic surgery of the this area is focused on reshaping these delicate structures carefully and precisely. Reshaping of the labia minora is commonly referred to as reduction labiaplasty, labia minoraplasty or simply labiaplasty. Reshaping of the clitoral hood is sometimes called contouring or reduction. 

The clitoral hood, also known as the prepuce is layer of loose skin which envelops and protects the clitoral shaft and the head, or glans, of the clitoris from constant and unwanted friction.

Sometimes redundant folds of loose skin unrelated to the body of the clitoris (shaft and glans) develop alongside the lateral borders of the clitoris. This lax tissue may occur on either or both sides of the midline, may fuse with the labia minora and may exceed the clitoral hood in size.

Clitoral hood reduction procedures focus on these lateral folds of loose tissue. The glans clitoridis, the head of the clitoris, is not exposed by this type of surgery. Meticulous superficial dissection and precise incisions which avoid the course of the clitoral nerve supply protect the sensitive nerves which supply this region.

Clitoral hood reduction is usually performed in conjunction with labia minora reduction procedures (reduction labiaplasty, reduction labia minoraplasty, laser reduction labiaplasty). Since both structures are intimately fused, combined treatment of both structures yields better cosmetic flow than isolated treatment of either structure alone.

Clitoral hood procedures are sometimes confused with clitoroplasty - a therapeutic surgery typically done to reduce the size of the clitoral shaft and/or glans. Enlargement of these structures has nothing to do with the skin of the clitoral hood, but rather the clitoris itself. Women with these issues usually have hormonal issues related to excess levels of testosterone and other masculinizing hormones.

Clitoral hood reduction is conducted with great caution to prevent damage to the nerves that provide sensation during sex.


ANATOMY OF THE CLITORAL REGION

The clitoris receives its nerve and blood supply from the pudendal nerves and vessels.

These structures emerge from behind bony structures known as the ischial tuberosities - in lay terms, they are called the "sit bones".

The pudendal nerves and vessels then course along the muscles beneath the labia majora (the bulbocavernosus muscles) and emerge from the deep tissues within the superfical layers of the clitoral shaft. 


The skin of the clitoral hood (top arrow) is formed from the skin of the labia minora. This skin is also know as the prepuce.

The clitoral hood covers the entire shaft and head (glans of the clitoris; bottom arrow).

A cross-section view of the clitoris (inset) shows how the nerves (yellow) which provide sensation to the clitoris are not actually in the skin layer, but much deeper in the shaft of the clitoris itself.

The structure of the clitoris is identical to that of the penis except for the absence of the urethra.
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Jersey City OB/GYN