Clitoral hood reduction surgery: where to have it, identifying the cause and choosing a clinic to reduce revision surgery

The basic approach to choosing where to have clitoral hood reduction surgery is to select a clinic that can identify the underlying cause of the hooding.[1][2]When the hood is adhered due to skin disease or post-menopausal changes, treatment addressing the cause may take priority.[1]In addition, confirm whether the clinic discusses whether to reshape the labia minora at the same time and whether there is an explanation of complications and revision surgery.[3][4].

Can the cause of the hood be examined?

Clitoral hood conditions fall into two main types: one where the hood is thick and excess, and one where the hood is adhered and the clitoris is buried.[2]In the former, excess hood tissue is reduced; in the latter, the hood is separated so the clitoris becomes visible.[2].

When the hood is adhered, causes may include chronic skin inflammation, thinning of skin after menopause, or scarring from childbirth.[1]Depending on the cause, medication treatment may be available, and surgery is considered when scarring becomes permanent.[1]If you have persistent itching or pain, please mention it at the start.

How do you decide whether to reshape the labia minora at the same time?

Clitoral hood reduction is often performed together with labia minora surgery.[5][6]This is because reducing only the labia minora can make the hood appear disproportionately large.[6].

In fact, failure to address the hood during labia minora surgery is cited as one of the common reasons for revision surgery.[4]On the other hand, combining labia minora and hood reduction in one procedure yields good results but has been associated with the highest rates of complications and revision surgery at 17.4%.[4]Since the benefits and burden change depending on how much tissue is removed, listen carefully to the explanation of the extent of the procedure.

What explanation should be given about complications and revision surgery?

Complications you should ask about include pain, bleeding, infection, scarring, adhesion, sensation changes, pain during intercourse, and revision surgery.[3]Hood surgery has also been reported to cause scar sensitivity and fluid accumulation.[4].

In 68 patients who underwent a two-stage approach to labia minora and hood reduction, complication rate was 7.4% and revision surgery rate was 1.5%.[7]Rates vary by facility and method, so it is reassuring to ask how that particular facility handles these issues.

How much is known about effects on sensation and sexual function?

Honestly, a definitive answer is not yet available. Before having cosmetic vulvovaginal surgery, you should be informed that there are few high-quality studies demonstrating outcomes.[3].

Reports that hood reduction improves sexual function are based on personal perception and have not been measured by a standardized scale.[5]It is important to align expectations and limitations, including the possibility that sensation may change.[3].

Before the procedure, what should be confirmed regarding physical and emotional well-being?

For people with strong cosmetic concerns, it is recommended to also assess whether there are any sexual concerns, mood disturbance, or anxiety.[3]When body dysmorphic disorder is suspected, coordination with a mental health specialist may occur.[3].

Smoking is also an important point to confirm. All three patients who had wound opening after labia minora surgery were smokers.[8].

Where should I have it done? Guidelines when undecided

In consultation, ask about the following points:

Identifying the cause: Will the clinic assess whether there is underlying skin disease or post-menopausal change?[1]

Extent of surgery: Will the clinic explain the benefits and burdens of whether to reshape the labia minora at the same time?[4][6]

Complications: Will the clinic discuss sensation changes and revision surgery?[3][4]

Physical and emotional assessment: Will the clinic ask about the severity of concern and smoking habits?[3][8]

Follow-up care: Can you be seen if swelling or wound opening occurs afterward?[7]

Whether your hood is excess tissue, adherent, or whether the labia minora should be reshaped cannot be determined from an article alone. During examination, discuss the shape of your hood and labia minora, skin condition, and your concerns, and decide together on the extent of tissue to be removed.