Clitoral hood reduction

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Plastic surgical reduction of the clitoral hood (prepuce) for aesthetic reasons. Left: before, right: after the surgery.

Clitoral hood reduction, also termed clitoral hoodectomy,[1] clitoral unhooding,[2] clitoridotomy,[3][4][5] or (partial) hoodectomy,[6] is a plastic surgery procedure for reducing the size and the area of the clitoral hood (prepuce) in order to further expose the clitoral glans of the clitoris.

It is sometimes done as a form of elective surgery where the therapeutic goal is to improve the sexual functioning of the woman, and the aesthetic refinement of her vulva. It is a form of hoodplasty. The reduction of the clitoral prepuce tissues usually is a sub-ordinate surgery within a labiaplasty procedure for reducing the labia minora; and occasionally within a vaginoplasty procedure.

Surgical procedures[edit]

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.[7] 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.[8] Another technique cuts away (excises) the redundant folds of clitoral prepuce tissue, with incisions parallel to the long axis of the clitoris.[9]

Clitoral hood reduction is included to the 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.[10]

Results[edit]

The functional corrections and perceived aesthetic improvements to the vulvo-vaginal complex indicate that labiaplasty procedures have a high-rate of patient satisfaction with the surgical outcome, and a low incidence-rate of medical complications.[8][10][11][12] 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.[10]

Moreover, regarding the woman’s satisfaction with the plastic surgical outcome, 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 a clitoral prepuce reduction procedure, might better serve the woman (as the patient) by assisting her in establishing realistic (feasible) goals for her genital beauty and mental health, which might be derived from a genitoplastic procedure.[13][14]

Criticism[edit]

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.[15]

To determine whether or not women truly seek labiaplasty solely to have "more socially acceptable genitalia" the International Society for the Study of Women’s Sexual Health (ISSWSH) considered the practices of elective plastic surgery of the vulva and of FGC (female genital cutting) in the Third World. The report, Is Elective Vulvar Plastic Surgery ever Warranted and What Screening Should be Done Preoperatively? (2007) indicated that physical variations in the external appearance of the vulvo-vaginal complex are statistically normal, but that labiaplasty — like access to all types of medical treatment — is a woman’s human right. Nonetheless, the ISSWSH report concluded that vaginoplastic surgery might be medically warranted only after the woman undergoes a pre-operative psychological screening, and only if the woman afterwards remains so decided — yet also recommended that the vaginal surgery can be performed if the surgeon deems it medically necessary for her health.[16]

See also[edit]

References[edit]

  1. ^ Gynecological cosmetic surgery: Expert Rev. Obstet. Gynecol. 4(2), 101-104 (2009): "The procedures described under female esthetic genital suergery are reduction labiaplasty, vaginaplasty, liposuction to mons pubis, fat injections to labia majora or mons, clitoral hoodectomy, hymenorrhaphy, 'G-spot amplication', and the use of a surgical laser in 'vaginal rejuvenation'."
  2. ^ Clitorolabial Reconstruction in Circumcised Females with Clitoral Inclusion Cyst: "It is very clear from the Prophet’s instruction to perform partial hoodectomy. This hoodectomy or clitoral unhooding is currently considered in the aesthetic literature as cosmetic procedure of the female genitalia."
  3. ^ Obiajulu Nnamuchi (2012). "Circumcision or Mutilation-Voluntary or Forced Excision-Extricating the Ethical and Legal Issues in Female Genital Ritual.". JL & Health (25): 85. "The appropriate medical nomenclature for FC is "clitoridotomy" or hoodectomy" 
  4. ^ 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" 
  5. ^ Maria Caterinala Barbera (2009). Revisiting the anti-Female Genital Mutilation Discourse. "Circumcision (also called as 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 the prophet Muhammad). This kind of cutting can be equated to male circumcision." 
  6. ^ New Approach to Clitoral Phimosis: Hoodplasty Giovanni Alei, Cristiano Monarca, Maria I. Rizzo, Piero Letizia, Lavinia Alei, and Nicolò Scuderi. Journal of Gynecologic Surgery. March 2011, 27(1): 25-28. doi:10.1089/gyn.2009.0093. Published in Volume: 27 Issue 1: March 18, 2011: "Clitoral phimosis is seldom reported. It is treated by hoodectomy or dorsal slit."
  7. ^ Mirzabeigi MN, Moore JH Jr, Mericli AF, Bucciarelli P, Jandali S, Valerio IL, Stofman GM. Current Trends in Vaginal Labioplasty: A Survey of Plastic Surgeons. Annals of Plastic Surgery. 2011 PMID 21346521
  8. ^ a b Felicio Y. Labial Surgery. Aesthetic Surgery Journal. 2007. 27:3;322–328.
  9. ^ Hunter JG. Considerations in Female External Genital Aesthetic Surgery Techniques. Aesthetic Surgery Journal. 2008. 28:1;106–107.
  10. ^ a b c Alter GJ. Aesthetic Labia Minora and Clitoral Hood Reduction Using Extended Central Wedge Resection. Plastic and Reconstructive Surgery. 2008. 122:6; 1780–1789.
  11. ^ Scholten E. Female Genital Cosmetic Surgery — The Future. Journal of Plastic, Reconstructive & Aesthetic Surgery. doi:10.1016/j.bps.2009.01.002.
  12. ^ Mirzabeigi MN, Moore JH, Mericli AF, Bucciarelli P, Jandali S, Valerio IL, Stofman GM. Current Trends in Vaginal Labioplasty: A Survey of Plastic Surgeons. Annals of Plastic Surgery. 2011. PMID 21346521
  13. ^ Bramwell R, Morland C, Garden AS. Expectations and Experience of Labial Reduction: A Qualitative Study. British Journal of Obstetrics and Gynaecology. 2007. 114(12);1493–1499.
  14. ^ Di Saia JP. An Unusual Staged Labial Rejuvenation. Journal of Sexual Medicine. 2008:5;1263–1267.
  15. ^ American College of Obstetricians and Gynecologists (2007). Vaginal "Rejuvenation" and Cosmetic Vaginal Procedures (PDF). p. 2. 
  16. ^ Goodman MP, Bachmann G, Johnson C, Fourcroyo JL, Goldstein A, Goldstein G, Sklar S. Is Elective Vulvar Plastic Surgery ever Warranted and What Screening Should be Done Preoperatively? Journal of Sexual Medicine 2007;4:269–276

External resources[edit]