Clitoral hood/labia reduction and anal tags - what are my options? (photos)

Question

During my 2nd pregnancy 13 years ago I developed hemorrhoids and vulvar varicosities. I had a c-section with both pregnancy's but I'm not happy with he way I look down there. My husband loves the way I look and says my vagina is a bit tight but otherwise never complains. I am self conscious because it looks like it's stretched out skin to me on the exterior and my clitoral area protrudes when I'm standing and looks very prominent to me. What are options and suggestions?

Nelson Castillo, MD · Answer

Thank you for your question and photograph. Though your labia fall well within "normal," your appearance is common for those women desiring an improved aesthetic, reduced discomfort, and increased self-esteem with a labiaplasty. Combined with a clitoral hood reduction you will see a proportional reduction to all of the tissues affording a superior result. See a labiaplasty specialist in consultation for an in-person evaluation.

Gary J. Alter, MD · Answer

Your labia minora and clitoral hood are very enlarged. Your clitoris may be enlarged which will change the procedures. If you have clitoris enlargement, it would protrude a lot longer when you are aroused.  A labiaplasty with a clitoral hood reduction can reduce your size. However, it must be performed by a surgeon with experience. One of the two most common labiaplasty techniques is the central wedge technique, which I invented in 1995 and published in the plastic surgery textbooks. It is also known as the "V" or wedge technique. Gynecologists and most plastic surgeons perform a labioplasty very differently. They essentially trim the labia minora (inner vaginal lips) and leave a long suture line instead of the normal labial edge. Their technique is the same whether a scalpel or a laser is used. This often causes asymmetry, scallops, and a wide suture line. In contrast, the central wedge removes triangles of tissue and bring the normal edges together. Thus, the normal labial edges, normal color, and normal anatomy are preserved, but the darkest labial tissue is usually removed. If you have extra tissue on your clitoral hood, it can be reduced at the same time.

Your clitoral hood is thick, wide, and protuberant.  It can be decreased somewhat by reducing the sides.  I pioneered a clitoropexy with clitoral hood reduction in which the clitoris is pushed closer to the pubic bone and the width, thickness, length, and protuberance of the clitoral hood can be drastically decreased. I have done it over 350 times with excellent results.  I have not published this technique, so no one does it like me. However, if you have clitoris reduction, this procedure will not be successful as the sutures would not hold.  Very few surgeons perform a clitoris reduction, since it is technically challenging and is rarely taught. It is an intricate procedure, since the sensory nerves have to be carefully preserved.  I have done over 70 reductions without any loss of sensation or orgasmic ability. The clitoral reduction reduces the glans or head and also removes the erectile tissue in the shaft. After surgery, the clitoris will not stick out much or increase with arousal. The surgery is not very uncomfortable.  It takes up to 3 1/2 hours and includes clitoral hood reduction.  A labia minora reduction and/or labia majora reduction can be done at the same time.

Your anal tags can be addressed at the same time.

No matter the technique, an inexperienced or unskilled surgeon can lead to a high rate of complications, chronic scar discomfort, labial deformities, and further surgery.  About 40% of my labia cases are reconstructions of other surgeons' labiaplasties.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY

Burcak Tok, MD · Answer

Hello, when I commented looking at your picture, we achieve a much younger appearance aesthetically with clitoral hoodoplasty + labiaplasty and labia filling. If your vaginal stenosis is good, there is no need for a procedure there.However, all the procedures we perform are for your self-confidence and a better sexual relationship. I don't think it necessarily needs to be done if you are happy with your sexual relationship with your husband.

Michelle Jones Singer, MD · Answer

I certainly understand that you feel self conscious about the appearance of your vulva after child birth. But I want to assure you that you appear normal. That being said. You would benefit most from a Labiaplasty and a Clitoral hood reduction. Be certain to see an experienced cosmetic gynecologist and not a general OB/GYN. Ask plenty of questions and see a lot of before and after photos.

Leila Kasrai, MD, FRCSC · Answer

If you are concerned about your appearance, labiaplasty can surgically reduce the bulkiness and prominence of your labia minora. A clitoral hood reduction can be performed at the same time.

Michael P. Goodman, MD, FACOG · Answer

Of course your husband loves you! We guys are just happy to BE THERE, and we love every part of our partners because it is attched to them and therefore sexy. But this is about YOU. Your comfort with how you look directly influences your comfort with sex and your overall sexual experiences and sexual health. It is evidence-based that a woman's comfort with the appearance of her vulva, breasts, butt, belly directly influences her overall sexual enjoyment. So... having said that, what about you personally? Yes, you could have a "sleeker" look with a labial reduction labiaplasty ("LP") and clitoral hood reduction ("CHR"), performed by an experienced surgeon who knows the anatomy and is versed in both linear (separate labiaplasty and hood reduction or "straight shot" linear labiaplasty ) and wedge-type LP so as to CHOOSE the best tchnique to fit your personal anatomy. From your photos,  I think you would do well with a linear type LP and CHR, but after a hands-on 3-D evaluation, the "straight shot" technique may be just right. The goal, with your input of course, would be to reduce size so all you would see protruding from your "genital cleft" would be a small edge, or nothing at all. An experienced surgeon used to working with all types of anatomy and "designing" her or his surgery to fit your individual anatomy is best. Check training; check experience! You should see at least 2 dozen B&A photos on her or his website that show different techniques and different anatomy. (It may be worth it to travel to get th right surgeon...) Best wishes,  Michael P Goodman, MD, FACOG, IF, AAACS. Davis, CA, USA