Clitoral hood reduction

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Clitoral hood reduction
Clitoral hood reduction in adult caucasian female.jpg
Plastic surgical reduction of the clitoral hood (prepuce) for aesthetic reasons. Left: before, right: after the surgery.
Specialty plastic surgeon

Clitoral hood reduction, also termed clitoral hoodectomy, [1] clitoral unhooding, clitoridotomy, [2] [3] or (partial) hoodectomy, is a plastic surgery procedure (a form of vulvoplasty) for reducing the size and the area of the clitoral hood in order to further expose the glans of the clitoris.

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It is usually performed as an elective cosmetic surgery meant to improve sexual satisfaction and to change the aesthetic appearance of the vulva. The reduction of the clitoral hood usually is done together with a labiaplasty that reduces the labia minora, and occasionally within a vaginoplasty.

Though patient surveys have indicated satisfaction with the outcome of such procedures, the American College of Obstetricians and Gynecologists cautioned in 2007 that for this type of vaginal surgeries, which are not medically indicated, women should be informed about the lack of data on their efficacy and potential complications. [4]

Surgical procedures

Pudendum femininum: The external anatomy of the vulvo-vaginal complex, indicating the clitoris, the clitoral prepuce, the labia majora, and the labia minora. Clitoris outer anatomy.png
Pudendum femininum: The external anatomy of the vulvo-vaginal complex, indicating the clitoris, the clitoral prepuce, the labia majora, and the labia minora.

The procedures for labiaplasty occasionally include a clitoral hood reduction. [5] One technique for reducing the clitoral hood is the bilateral excision (cutting) of the prepuce tissues covering the clitoral glans, with especial attention to maintaining the glans in the midline. [6] Another technique cuts away (excises) the redundant folds of clitoral prepuce tissue, with incisions parallel to the long axis of the clitoris. [7]

Clitoral hood reduction can be included in the extended wedge resection labiaplasty technique, wherein the extension of the exterior wedge sections is applied to reducing the prepuce tissues of the clitoral glans. Yet, occasionally excess prepuce-skin, in the center of the clitoral hood, is removed with separate incisions. [8]

Results

Labiaplasty with clitoral hood reduction and Princess Albertina piercing 1.jpg
Labiaplasty with clitoral hood reduction and Princess Albertina piercing 2.jpg
Result of clitoral unhooding

Studies have reported a high rate of patient satisfaction with the aesthetic changes to the vulvo-vaginal complex after labioplasty, and a low incidence rate of medical complications. [6] [8] [9] [5] The study Aesthetic Labia Minora and Clitoral Hood Reduction using Extended Central Wedge Resection (2008) reported that of a 407-woman cohort, 98 per cent were satisfied with the labial reduction outcomes; that the average patient satisfaction score was 9.2 points on a 10-point scale; that 95 per cent of the women experienced reduced pudendal discomfort; that 93 per cent of the women experienced improved self esteem; that 71 per cent experienced improved sexual functioning; that 0.6 per cent (one woman) reported lessened sexual functioning; and that 4.4 per cent of the women experienced medical complications. [8] The study Expectations and Experience of Labial Reduction: A Qualitative Study (2007) reported that the women who underwent labiaplasty had great expectations for the elimination of pubic discomfort and pain, improved cosmetic appearance of the vulva, and improved sexual functioning. Most of the women experienced improved self esteem; yet the study also reported that formal psychological counselling before the surgical operation about what to expect and what not to expect from a labia minora and clitoral prepuce reduction procedure might better serve the prospective patient by assisting her in establishing realistic expectations for her genital beauty and mental health after such a procedure. [10] [11]

Criticism

Partial or total hoodectomy is classified by the World Health Organization as female genital mutilation (FGM) Type 1A. [12] However, this classification is criticised as being "overly-simplified" and "culturally insensitive" by some. They argue that hoodectomy is no different than male circumcision, which is legally permitted in most countries, and is often less invasive in practice. [13]

The American College of Obstetricians and Gynecologists (ACOG) published Committee Opinion No. 378: Vaginal "Rejuvenation" and Cosmetic Vaginal Procedures (2007), the college's formal policy statement of opposition to the commercial misrepresentations of labiaplasty, and associated vaginoplastic procedures, as medically "accepted and routine surgical practices". The ACOG doubts the medical safety and the therapeutic efficacy of the surgical techniques and procedures for performing vaginoplastic operations such as labiaplasty, vaginal rejuvenation, the designer vagina, revirgination, and G-spot amplification, and recommends that women seeking such genitoplastic surgeries must be fully informed, with the available surgical-safety statistics, of the potential health risks of surgical-wound infection, of pudendal nerve damage (resulting in either an insensitive or an over-sensitive vulva), of dyspareunia (painful coitus), of tissue adhesions (epidermoid cysts), and of painful scars. [4]

Risks

The dorsal nerves of the clitoris travel above the clitoris along the clitoral body. Permanent injury to these nerves can occur with clitoral hood reductions. [14]

See also

Related Research Articles

<span class="mw-page-title-main">Clitoris</span> Erectile female sexual organ

In many animals, the clitoris is a female sex organ. In humans, it is the vulva's most erogenous area and generally the primary anatomical source of female sexual pleasure. The clitoris is a complex structure, and its size and sensitivity can vary. The visible portion, the glans, of the clitoris is roughly the size and shape of a pea and is estimated to have at least 8,000 sensory nerve endings.

Clitoridectomy or clitorectomy is the surgical removal, reduction, or partial removal of the clitoris. It is rarely used as a therapeutic medical procedure, such as when cancer has developed in or spread to the clitoris. It is often performed on intersex newborns. Commonly, non-medical removal of the clitoris is performed during female genital mutilation.

<span class="mw-page-title-main">Female genital mutilation</span> Ritual cutting or removal of some or all of the vulva

Female genital mutilation (FGM) is the ritual cutting or removal of some or all of the vulva. The practice is found in some countries of Africa, Asia and the Middle East, and within their respective diasporas. As of 2023, UNICEF estimates that "at least 200 million girls... in 31 countries"—including Indonesia, Iraq, Yemen, and 27 African countries including Egypt—had been subjected to one or more types of FGM.

<span class="mw-page-title-main">Labia minora</span> Flaps of skin on either side of the vaginal opening in the vulva

The labia minora, also known as the inner labia, inner lips, or nymphae, are two flaps of skin that are part of the primate vulva, extending outwards from the vaginal and urethral openings to encompass the vestibule. The labia minora are situated between the labia majora and together form the labia. They vary widely in size, color and shape from individual to individual.

<span class="mw-page-title-main">Genital modification and mutilation</span> Permanent or temporary changes to human sex organs

Genital modifications are forms of body modifications applied to the human sexual organs, such as piercings, circumcision, or labiaplasty.

<span class="mw-page-title-main">Clitoral hood</span> Part of the vulva that covers and protects the glans of the clitoris

In female humans and other mammals, the clitoral hood is a fold of skin that surrounds and protects the glans of the clitoris; it also covers the external clitoral shaft, develops as part of the labia minora and is homologous with the foreskin in the male reproductive system. The clitoral hood is composed of mucocutaneous tissues; these tissues are between the mucous membrane and the skin, and they may have immunological importance because they may be a point of entry of mucosal vaccines.

<span class="mw-page-title-main">Genital piercing</span> Form of body piercing on a part of the genitalia

Genital piercing is a form of body piercing that involves piercing a part of the genitalia, thus creating a suitable place for wearing different types of jewellery. Nevertheless, the term may also be used pars pro toto to indicate all body piercings in the area of the anus, perineum, penis, scrotum, and vulva, including piercings such as anal, guiche, and pubic that do not involve perforation of genitalia. Genital piercings can be done regardless of sex, with various forms of piercings available. The main motive is beautification and individualization; in addition, some piercings enhance sexual pleasure by increasing stimulation. Pre-modern genital piercings is most culturally widespread in Southeast Asia, where it has been part of traditional practice since ancient times. Records of genital piercing are found in the Kama Sutra.

<span class="mw-page-title-main">Female reproductive system</span> Reproductive system of human females

The female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The human female reproductive system is immature at birth and develops to maturity at puberty to be able to produce gametes, and to carry a fetus to full term. The internal sex organs are the vagina, uterus, fallopian tubes, and ovaries. The female reproductive tract includes the vagina, uterus, and fallopian tubes and is prone to infections. The vagina allows for sexual intercourse and childbirth, and is connected to the uterus at the cervix. The uterus or womb accommodates the embryo, which develops into the fetus. The uterus also produces secretions, which help the transit of sperm to the fallopian tubes, where sperm fertilize ova produced by the ovaries. The external sex organs are also known as the genitals and these are the organs of the vulva including the labia, clitoris, and vaginal opening.

<span class="mw-page-title-main">Labia</span> Parts of the vulva

The labia are the major externally visible portions of the vulva. In humans and other primates, there are two pairs of labia: the labia majora are large and thick folds of skin that cover the vulva's other parts while the labia minora are the inner folds of skin between the outer labia that surround and protect the urethral and vaginal openings.

<span class="mw-page-title-main">Clitoris piercing</span> Type of body piercing

A clitoris piercing is a genital piercing placed directly through the head (glans) of the clitoris itself. It is a relatively uncommon piercing by choice because of the potential for nerve damage, and because many may find it too stimulating to allow the constant wearing of a small ring or barbell. Most piercing studios will refuse to do a clitoral piercing. It is often confused with the more common clitoral hood piercing, which pierces only the hood covering the clitoral glans, allowing the jewelry to make only occasional contact with the most sensitive area.

<span class="mw-page-title-main">Labiaplasty</span> Plastic surgery procedure for altering the labia minora

Labiaplasty is a plastic surgery procedure for creating or altering the labia minora and the labia majora, the folds of skin of the human vulva. It is a type of vulvoplasty. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their vulvas because they believe they do not fall within a normal range.

Nymphotomy is the surgical procedure of incision into the labia minora. Surgical removal of the labia minora is called nymphectomy. In plastic surgery, the term labiaplasty, which describes plastic surgery of the labia is now more commonly used.

<span class="mw-page-title-main">Perineoplasty</span>

Perineoplasty denotes the plastic surgery procedures used to correct clinical conditions of the vagina and the anus. Among the vagino-anal conditions resolved by perineoplasty are vaginal looseness, vaginal itching, damaged perineum, fecal incontinence, genital warts, dyspareunia, vaginal stenosis, vaginismus, vulvar vestibulitis, and decreased sexual sensation. Depending upon the vagino-anal condition to be treated, there are two variants of the perineoplasty procedure: the first, to tighten the perineal muscles and the vagina; the second, to loosen the perineal muscles.

<span class="mw-page-title-main">Vulva</span> External genitalia of the female mammal

In mammals, the vulva consists of the external female genitalia. The human vulva includes the mons pubis, labia majora, labia minora, clitoris, vulval vestibule, urinary meatus, the vaginal opening, hymen, and Bartholin's and Skene's vestibular glands. The urinary meatus is also included as it opens into the vulval vestibule. The vulva includes the entrance to the vagina, which leads to the uterus, and provides a double layer of protection for this by the folds of the outer and inner labia. Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support.

Clitoral photoplethysmography uses light to measure clitoral blood volume (CBV).

<span class="mw-page-title-main">Vulva activism</span> A feminist movement

Vulva activism is the promotion of a raised awareness of the appearance of female genitalia and the breaking of taboos surrounding the vulva, as carried out by feminist movements and advocacy groups. Other names for this advocacy movement are labia pride, labia liberation, vulvaversity, viva la vulva, pussy positivity and similar. It is supported by several independent feminist groups and based on diverse channels of communication such as cyberfeminism, protest marches and advocating boycotts against physicians and clinics that make use of deceptive advertising.

Female genital mutilation in Sierra Leone is the common practice of removing all or part of the female's genitalia for cultural and religious initiation purposes, or as a custom to prepare them for marriage. Sierra Leone is one of 28 countries in Africa where female genital mutilation (FGM) is known to be practiced and one of few that has not banned it. It is widespread in part due to it being an initiation rite into the "Bondo," though initiation rite-related FGM was criminalised in 2019. The type most commonly practised in Sierra Leone is Type IIb, removal of part or all of the clitoris and the labia minora. As of 2013, it had a prevalence of 89.6%.

Nigeria has the highest rate of female genital mutilation (FGM) in the world in total numbers. It is usually experienced by girls aged 0 to 15 years old. It involves either partial or complete removal of the vulva or other injury to the female genital organs and has no medical benefit.

<i>Woman, Why Do You Weep?</i> 1982 book by Asma El Dareer

Woman, Why Do You Weep? Circumcision and Its Consequences (1982) is a book by Sudanese physician Asma El Dareer about female genital mutilation in Sudan. Published in London by Zed Press in association with the Babiker Bedri Scientific Association for Women's Studies, the book summarizes research El Dareer conducted on female genital mutilation (FGM) for the medical faculty of the University of Khartoum.

References

  1. ↑ Renganathan, Arasee; Cartwright, Rufus; Cardozo, Linda (2009). "Gynecological cosmetic surgery". Expert Rev. Obstet. Gynecol. 4(2). Vol. 4. p. 102. doi:10.1586/17474108.4.2.101. The procedures described under female esthetic genital surgery are reduction labiaplasty, vaginaplasty, liposuction to mons pubis, fat injections to labia majora or mons, clitoral hoodectomy, hymenorrhaphy, 'G-spot amplification', and the use of a surgical laser in 'vaginal rejuvenation'.{{cite book}}: |journal= ignored (help) (originally located at http://www.expert-reviews.com/doi/pdfplus/10.1586/17474108.4.2.101)
  2. ↑ Carol Downer (1980). "Self-help for sex". Women's Sexual Development. Springer US. pp. 255–279. Some therapists refer women for female circumcision (clitoridotomy) to have their clitoral hoods removed so that they can be more sensitive to the thrusts of the penis
  3. ↑ Maria Caterinala Barbera (2009). "Revisiting the anti-Female Genital Mutilation Discourse" (PDF). Circumcision (also called clitoridotomy, τομία, Greek for "cut", "incision") is the mildest form of genital cutting. This involves the clitoral hood removal, but it preserves the clitoris and the posterior larger parts of the labia minora. In Islamic culture, circumcision is known as sunna (tradition), because it is mentioned in some ahadith (the sayings of Muhammad). This kind of cutting can be equated to male circumcision.{{cite journal}}: Cite journal requires |journal= (help)
  4. 1 2 American College of Obstetricians and Gynecologists (2007). "Vaginal "Rejuvenation" and Cosmetic Vaginal Procedures" (PDF): 2. Archived from the original (PDF) on December 30, 2008.{{cite journal}}: Cite journal requires |journal= (help)
  5. 1 2 Mirzabeigi MN, Moore JH, Mericli AF; et al. (February 2012). "Current trends in vaginal labioplasty: a survey of plastic surgeons". Ann Plast Surg. 68 (2): 125–34. doi:10.1097/SAP.0b013e31820d6867. PMID   21346521. S2CID   36163955.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. 1 2 Felicio Y. Labial Surgery. Aesthetic Surgery Journal. 2007. 27:3;322–328.
  7. ↑ Hunter JG. Considerations in Female External Genital Aesthetic Surgery Techniques. Aesthetic Surgery Journal. 2008. 28:1;106–107.
  8. 1 2 3 Alter GJ. Aesthetic Labia Minora and Clitoral Hood Reduction Using Extended Central Wedge Resection. Plastic and Reconstructive Surgery. 2008. 122:6; 1780–1789.
  9. ↑ Scholten E. Female Genital Cosmetic Surgery — The Future. Journal of Plastic, Reconstructive & Aesthetic Surgery. doi : 10.1016/j.bps.2009.01.002.
  10. ↑ Bramwell R, Morland C, Garden AS (2007). "Expectations and Experience of Labial Reduction: A Qualitative Study". British Journal of Obstetrics and Gynaecology. 114 (12): 1493–1499. doi:10.1111/j.1471-0528.2007.01509.x. PMID   17877771. S2CID   71948922.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  11. ↑ Di Saia JP. "An Unusual Staged Labial Rejuvenation". Journal of Sexual Medicine. 2008 (5): 1263–1267.
  12. ↑ "Sexual and reproductive health: Classification of female genital mutilation". World Health Organization. Archived from the original on January 14, 2014. Retrieved 2018-05-08.
  13. ↑ Zakir, Mohammed (2016). "WHO's stance and the criminalization of female circumcision: The protection of or violation of human rights?" (PDF). Dawoodi Bohra Women for Religious Freedom. Archived from the original (PDF) on December 4, 2023.
  14. ↑ Ginger, Van Anh T.; Cold, Christopher J.; Yang, Claire C. (2011-02-04). "Surgical anatomy of the dorsal nerve of the clitoris". Neurourology and Urodynamics. 30 (3): 412–416. doi:10.1002/nau.20996. ISSN   0733-2467. PMID   21298720. S2CID   22501531.
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