Why do doctors all seem to disagree on whether clitoral hood reduction is actually safe or not? (photos)

I had a labiaplasty 1 mo ago. I'm frustrated at how unnatural the results look with my enlarged clitoral hood. My doctor doesn't perform hood reductions because of the risk of nerve damage. I have read online extensively, and still have no idea how high the actual risk of damage from a hood reduction is, as doctors all seem to disagree! Can anyone tell me how safe this procedure is considered in the medical community? How common is it for doctors to offer labiaplasties but not hood reductions?

Doctor Answers 6

Clitoral hood reduction is safe

Sorry that you chose a surgeon who is either misinformed or inexperienced regarding aesthetic vulvar surgery. If you knew you wanted the hood reduced as well why did you settle with a surgeon that didn't know how to combine a clitoral hood reduction with a labia reduction? There isn't any additional risk of nerve injury when performing a clitoral hood reduction.  Not all surgeons are trained or experienced equally and therefore you will see differences of what they're capable of doing. Since your surgeon doesn't know how to perform a proper hood reduction he/she told you that it's not done because it is risky. This simply isn't true.  I perform labia reductions in the office under local anesthesia. Every woman is shaped differently and requires her own unique cosmetic correction.  What is often overlooked by most surgeons is the prepuce, or clitoral hood, which may require reduction and even lifting to achieve the optimal youthful appearance and enhanced sensation for ultimate pleasure. In my practice over 80% of patients have a clitoral hood reduction at the time of a Labiaplasty in order to ensure a natural appearance that all women want. You will need to search for an experienced surgeon when you decide to have your Labiaplasty revision with clitoral hood reduction. See link below for advice on choosing the best surgeon and see examples of hood reductions combined with Labiaplasty in the photo gallery.  Best of luck,

Denver Urogynecologist
5.0 out of 5 stars 21 reviews

Clitoral hood reduction is safe in experienced hands and dangerous in inexperienced hands

There is no risk of nerve damage with a properly conducted clitoral hood reduction. The sensory nerves of the clitoris are not in the clitoral hood, but rather in the clitoral shaft and underneath it. There is no reason to operate in the territory of the clitoral sensory nerves when conducting a clitoral hood reduction. An expert knows exactly where these nerves lie and how to operate safely away from them. A non-expert will feed you all sorts of excuses for not doing a clitoral hood reduction because (1) they don't know how to do it, (2) they can't admit they don't know how to do it, and (3) they want your money and are hoping that you'll believe their bogus story.

Safety of clitoral hood reduction

This is a very safe procedure, when performed by a surgeon experienced with clitoral hood reduction. The clitoral hood is excess skin, just like the labia. Clitoral hood reduction does not involve the nerves of the clitoris, so stimulation is not negatively impacted by this procedure. Often, with reduction of the clitoral hood, stimulation is enhanced, due to better exposure to the clitoris. 

Why do doctors all seem to disagree on whether clitoral hood reduction is actually safe or not?

Thank you for sharing your question and I am sorry to hear about your frustrations with the current appearance of your clitoral hood after labiaplasty surgery.  Most patients that see a labiaplasty surgeon for correction benefit from some degree of clitoral hood reduction and the risk of any sensory changes to the clitoris or remaining tissues is very small.  Reevaluate your results in 2 more months and if still unhappy see a surgeon with extensive labiaplasty and clitoral hood work for a revision.  Best wishes. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 38 reviews

Safety of Clitoral Hood Reduction

Clitoral Hood Reduction can be safe if done conservatively. I do many labiaplasties without them as not all women are concerned about the hood. My usual wedge labiaplasty tightens the hood a small bit without specific hood work.
Best Regards,
John Di Saia MD

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 25 reviews

Untrained, unskilled surgeons are the only ones who say "hood reduction not safe!"

Thank you sincerely for your question. This is a situation I am passionate about. As a cosmetic gynecologist who has performed > 650 labiaplasties w/hood reduction, and as the Editor of the only medical textbook on Genital Plastic/Cosmetic surgery, I can say UNEQUIVOCALLY that the careful, mindful reduction of excess clitoral tissue is SAFE and SUCCESSFUL in the hands of an experienced surgeon who is aware of the "rules" in how to reduce the hood successfully.
UNFORTUNATELY, your surgeon, and any surgeon who states that "...it is not safe..." or that "...you will lose sensation" is simply NOT SAVVY and has not been specifically and adequately trained in the procedure of aesthetic labiaplasty and hood reduction. For you specifically, if you are satisfied with your results, then no problem. However, the reality is that your surgeon left half the job undone, and lied to you about your hood because he or she didn't know how to do it & either didn't want to lose the surgical fee or didn't want to refer you to an appropriate surgeon and admit that he/she simply didn't know how to do it. Only a hacker not trained in the fineries of hood surgery will experience nerve damage! I agree entirely with my colleagues, Drs. Aguirre and Pelosi. Between us, we have performed well > 2000 LPs with hood reduction. We see NO "...nerve damage..." You may wish a careful hood reduction, and the lie your surgeon told you may be actionable!
With Regards,
Michael P Goodman, MD
Davis, CA, USA

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.