Why is it permissible to remove the mucous membrane, which plays an important role in immunity?

Thank you for your appropriate and thoughtful question. There is much confusion when it comes to discussion of the "...Clitoral Hood." I'll try to clarify. Think of the hood as the foreskin of the clitoris, the same as a man has (at birth) a foreskin over the glans (the "head") of his penis. As the foreskin is a structure separate from the head (or "glans") of the penis, the hood is an attached but separate structure from the clitoris (which is made up of "glans" (head), shaft (or "body"), "knee" (where it takes a right angle to go under the pubic bone (like a mans penis takes an angle to "root" into the testicles.) The "root" of the clitoris consists of the "crurae" and "bulb," erectile structures that occupy, along with nerves from the autonomic nervous system, Grafenberg's area, colloquially known as the "G-Spot. The hood consists of different areas, the central hood (the little "hoodie" that covers the clitoral glans); the lateral portions of the central hood which; the folds from the underside of the clitoral glans (called the "frenular folds") and the prepucial fold (or prepuce), variable folds more laterally placed on the hood, which frequently "anchor" in to the lateral (or outer) portion of the labia. These variable folds continue "downward" to make up the labia, and are frequently reduced during a labiaplasty( labial reduction.) While "connected," the labia and clitoral hood are considered anatomically to be separate structures. NOW-- to answer your question: The hood proper is covered not by mucosa, but by a "squamous epithelium." This is the "covering" that is reduced during hood reduction. The human body has different tissue types that "cover" underlying tissue. Most common externally is the somewhat thickened, cornified covering known as "squamous epithelium." This is the external covering of your clitoral hood, most of your vulva, etc. -- what most persons call "...skin..." Mucosal epithelium is that pinkish tissue found in your mouth, your vagina, your vulvar vestibule, and- yes- on the underside of the central clitoral hood directly over your clitoral glans. The "correct" way to reduce what some women feel is "excessive" epithelium (redundancy) of the clitoral hood is to, in a variety of ways (that's why you want to go to an experienced surgeon!) excise kayak-shaped ellipses of epithelium only (very superficially, so as not to injure nerves that travel deep) from each side of the hood, sort of like smoothing out the center of the bedsheet by tucking in the sheets on either side. You do not want to operate on the central hood, removing tissue directly over the clitoral glans, as that can cause scarring, exteriorization of the glans, and- often- pain. Regarding "immunological importance because they may be a point of entry of mucosal vaccines..," this does not make sense to me. Bottom line: 1. The clitoral hood is not the clitoris; 2. It can be safely reduced if its redundancy is causing functional or significant aesthetic issues; 3. "...If it ain't broke, don't fix it. No reason to reduce the hood if not part of your aesthetic or functional issues. If you do have it worked on: ONLY by a well-experienced surgeon.. Hope this helps...

Best Regards,

Michael P Goodman, MD, FACOG, IF, AAACS
International Surgeon
Davis and Sacramento, CA, USA