Remove only the prepuce, or reshape together with the labia minora? Methods and how to choose for prepuce removal

Prepuce removal has two approaches: removing only the prepuce (the excess fold next to the skin wrapping the clitoris) or reshaping it together with labia minora reduction. When both the labia minora and prepuce are enlarged, reducing only the labia minora can throw off the balance and leave dissatisfaction; for this reason, methods to reshape them together are being researched[1]. Which suits you depends on the size of your labia minora and what concerns you.

What is the difference between removing only the prepuce and reshaping together with the labia minora?

The biggest difference is the range of tissue removed. The method of removing only the prepuce focuses the incision on the fold beside the clitoris. The method of reshaping at the same time cuts the prepuce and labia minora bulges in sequence to align the shape[1][2].

For example, in a Chinese report, a 'three-stage' method was used: first the prepuce is cut, then the labia minora bulge is cut in a wedge shape, and finally the two junction points are refined[1]. In another report, a 'two-stage' method was used, cutting the prepuce first and then the edge of the labia minora[2].

Why does the balance shift when only the labia minora are reduced?

It has been noted that when both the labia minora and prepuce are enlarged, the prepuce is easily overlooked during surgery[1]. If the prepuce remains enlarged, only the upper portion can appear swollen, sometimes throwing off the overall proportions[3].

In fact, failure to reshape the prepuce during labia minora surgery is cited as one of the common reasons for revision surgery[4]. If the labia minora also concern you, having both examined together allows the proportions to be considered as a whole.

Do complications increase if surgery is done at the same time?

Even with the simultaneous reshaping method, complication reports are not numerous. With the three-stage method, complications occurred in 4.4% (about 4 per 100 people) of 136 patients, with revision surgery in 5 patients[1]. With the two-stage method, complications occurred in 7.4% of 68 patients, with revision surgery in 1.5%[2].

However, when looking at 'combined resection' as a whole—cutting the prepuce and labia minora together—one summary noted that the complication and revision surgery rate was 17.4%, the highest among the reports[4]. The wider the surgical area, the more preparation is needed for swelling and wound complications.

All these figures are reports compiled by the facilities that performed the surgeries on their own outcomes. This is not research comparing the method of removing only the prepuce and the method of simultaneous reshaping under the same conditions.

What problems occur if too much is removed?

The prepuce and labia minora cannot easily be restored if removed excessively. In cases where too much tissue was removed during labia minora edge surgery, reports describe distress from the inner mucosa protruding outward, causing dryness and persistent discomfort, as well as recurrent urinary and vaginal infections[5].

In revision surgery, one method uses remaining prepuce tissue to fill in the missing part of the labia minora[5]. This method can be used when prepuce remains from the initial surgery[5]. Additionally, in prepuce surgery, scarring or hypersensitivity to touch can occur[4].

What determines which method is right for you?

There are three guidelines: whether the labia minora are also enlarged, how much the prepuce bulges, and whether your concern is appearance, chafing, or hygiene.

In the two-stage method report, the reasons for having surgery were physical discomfort in 82.4%, appearance in 61.8%, and hygiene in 32.4%[2]. Concerns such as friction from underwear or difficulty cleaning are also important factors to discuss.

If only the prepuce bulge concerns you and the labia minora do not, the method of removing only the prepuce has gained attention. If the labia minora are also enlarged, consider whether to reshape them at the same time. In either case, selecting the method to match that person's anatomy is considered essential[6].

What is checked during the consultation?

The method for prepuce removal cannot be decided from an article alone. The size of the labia minora and prepuce, asymmetry, and how much to preserve cannot be determined without a direct examination.

During consultation, confirm with your physician what range will be incised, how much will be preserved, and how any complications will be managed.