A distinction to be made at the outset: clitoral hood reduction is not a procedure performed on the clitoris, and it has nothing whatsoever to do with female genital cutting, infibulation, cultural or ceremonial practices, or genital piercing. The sources make this distinction explicitly.
Why is it rarely done on its own?
The wording of the source text is clear:
- Hood reduction is rarely performed as a separate procedure; most often it is done together with inner lip reduction.
- Its functional results are not fully known and its effect on sexual function has not been established.
- For this reason it is regarded as predominantly a procedure to do with appearance.
The function of the hood is also not known for certain; it is thought to protect the clitoris and the glands in the area. This uncertainty means the decision needs to be made carefully.
Its relation to labiaplasty
There is a two-way connection:
- Aesthetic balance: if the excess hood is not corrected while the inner lips are being reduced, the clitoral area may look disproportionately prominent. The sources use a specific term for this appearance. For this reason the two procedures are often combined in the same session.
- A result that depends on the trim method: when the edge-trim method is used in inner lip reduction, this disproportion may arise because the lips are shortened while the hood stays the same.
For details on inner lip reduction you can see the Labiaplasty page.
When the clitoris remains buried
In some people the clitoris is completely covered by a hood that is excessively thick, drooping or folded. This can prevent the clitoris from receiving adequate stimulation.
There is an important order here: in such a situation procedures performed inside the vagina alone will not solve the problem — the excess hood tissue needs to be corrected first.
Who benefits and who does not?
The sources set out a detailed selection framework on this. Who will not benefit is as important as who will.
Those expected to be content with the result
- Those whose orgasm is slow or weak — in the source this is the group expected to be most content with the result.
- Those who are able to reach orgasm but need additional stimulation — they may expect an increase in sensitivity, but the need for additional stimulation will most likely continue.
- Those who have had inner lip reduction — in terms of a more balanced appearance.
Those not expected to be content with the result
This list is written in order to prevent disappointment:
- Those expecting orgasm only in a particular position or with no other stimulation at all.
- Those who are currently content and have no findings — if the examination findings do not support it, surgery is avoided.
- Those with reduced sexual desire: if the cause is psychological or hormonal, surgery does not help — the underlying condition must be treated first.
- Those with pain in the clitoris: the pain may resolve when an ongoing infection or adhesion is treated.
- Those seeking multiple orgasms: such a result cannot be promised, and surgery is avoided in these people.
- Those with adhesions due to menopause: if the hormonal situation is not corrected, the problem recurs.
- Those with scar tissue due to lichen sclerosus: this condition recurs within a few months almost every time.
Situations in which it should not be performed
- Unrealistic expectations
- Untreated psychosexual problems
- Active infection or inflammatory disease of the external genital area
- A clotting disorder
- Smoking
ACOG recommends that in people who present with a complaint of sexual dissatisfaction, the psychosexual situation and the context of the relationship be carefully assessed before moving to surgery.
What is looked at in the assessment?
- It is recommended that the excess of the hood be assessed standing.
- Tissue thickness, excess folds and symmetry are examined.
- Previous genital surgery — particularly inner lip reduction done with the edge-trim method — is always asked about.
- The clitoris is examined by hand and its size assessed.
- Adhesions, narrowing, scarring, piercing, trauma and pain are recorded; lichen sclerosus is ruled out.
The appearance of the hood varies a great deal from person to person; it may be flat or folded, and it is mostly not symmetrical. For this reason there is no definition of an "ideal" appearance.
Protecting the nerves
The clitoris is the most sensitive area, containing about 8,000 sensory nerves. The under-surface of the hood is also rich in nerves, and the sources do not recommend surgery on these tissues unless there is a medical necessity.
For this reason surgery does not go down to the deep plane; the dissection is kept in the superficial layer so that the nerve carrying sensation is protected. Aggressive incisions can lead to lasting loss of sensation or to pain during intercourse.
With any surgical procedure, results vary from person to person. You are advised to discuss the procedure with your doctor in detail beforehand.
Frequently Asked Questions
Is clitoral hood reduction female genital cutting?
No, it is definitely not. The sources make this distinction explicitly: clitoral hood reduction has nothing whatsoever to do with female genital cutting, infibulation, cultural or ceremonial practices, or genital piercing. Nor is it a procedure performed on the clitoris — only the excess of the hood skin covering it is reduced.
Can I have it on its own?
It can be done, but that is uncommon. According to the sources, hood reduction is rarely performed as a separate procedure; it is most often planned together with inner lip reduction. One reason is aesthetic balance: if the hood is not corrected while the inner lips are reduced, the clitoral area may look disproportionately prominent.
Will it improve my sexual function?
It is necessary to be honest here: according to the sources its functional results are not fully known and its effect on sexual function has not been established. For this reason it is regarded as predominantly a procedure to do with appearance. One exception: if the clitoris is completely covered by an excessively thick hood, this can prevent it from receiving adequate stimulation.
Who is not expected to be content with the result?
The source gives this list plainly: those expecting orgasm only in a particular position or with no other stimulation at all; those who are currently content and have no examination findings; those with reduced sexual desire (if the cause is psychological or hormonal, surgery does not help); those with pain in the clitoris; those seeking multiple orgasms — such a result cannot be promised.
I am in menopause, or I have lichen sclerosus — is it suitable?
In these two situations the likelihood of the problem recurring is high. With adhesions due to menopause, the problem recurs if the hormonal situation is not corrected. With scar tissue due to lichen sclerosus, the condition recurs within a few months almost every time. For this reason the underlying condition needs to be addressed first.
Is there a risk of losing sensation?
This is the most important technical concern of the procedure. The clitoris contains about 8,000 sensory nerves and the under-surface of the hood is also rich in nerves. For this reason surgery does not go down to the deep plane; the dissection is kept in the superficial layer. Aggressive incisions can lead to lasting loss of sensation or to pain during intercourse.
Who is it not performed on?
Those with unrealistic expectations, those with untreated psychosexual problems, those with an active infection or inflammatory disease of the external genital area, those with a clotting disorder, and those who smoke. ACOG also recommends that in people presenting with a complaint of sexual dissatisfaction, the psychosexual situation be assessed before surgery.
What happens at the examination?
It is recommended that the excess of the hood be assessed standing. Tissue thickness, excess folds and symmetry are examined; the clitoris is examined by hand and its size assessed; adhesions, narrowing, scarring and pain are recorded. Previous genital surgery is always asked about. The appearance of the hood varies a great deal from person to person and is mostly not symmetrical — for this reason there is no definition of an "ideal" appearance.
Sources
- Clitoral Hood Reduction Techniques. In: Hamori CA, Banwell PE, Alinsod R (Ed.), Female Cosmetic Genital Surgery: Concepts, Classification, and Techniques. Thieme, 2017, Chapter 7. Anatomy, the uncertainty in the reasons for the procedure, the patient selection framework, situations in which it should not be performed, and assessment.
- Benson R — Clitoral hood reduction (patient selection criteria).
- Aesthetic gynaecology sources — joint assessment of the clitoral, urethral and vaginal structures, protection of the sensory nerve, and planning together with labiaplasty.
- American College of Obstetricians and Gynecologists (ACOG) — recommendation for psychosexual assessment before surgery.
The information on this page is based on the national and international guidelines listed above. The page is reviewed whenever those guidelines are updated.
Practice and Contact Details
The information on this page is general. Please speak to your doctor about your own situation.
- DoctorOp. Dr. Murat Alpay — Specialist in Obstetrics and Gynaecology
- AddressOp. Dr. Murat Alpay Practice, Tekelioğlu Cd. No:51 B Kat:2, Filo Apt., 07160 Muratpaşa / Antalya
- Telephone0505 351 77 88
- HoursMonday – Saturday 09:00 – 18:00 · Closed on Sunday