Hoodplasty

(1)

Plastic Surgery, Universidad del Valle Plastic Surgery, Cali, Valle del Cauca, Colombia

Keywords

HoodplastyResection of the clitoris hoodGenital rejuvenationExcessive clitoris hoodFemale penis-like appearanceGenital bad odor

Help them feel more;

take the smell away.

Clitoral hood reduction can be used to remove excess mucosa that just doesn’t look nice, to prevent fluid accumulation, and to reduce smell issues and can be designed to enhance clitoral body exposure, thus improving sexual stimulation.

Although the first choice when planning a hoodplasty must always be a longitudinal resection, the horseshoe option is also important to consider when there is a horizontal excess or a big longitudinal excess that can leave visible scars on labia majora or pubic area.

Excess tissue surrounding the clitoris (when there is a horizontal excess) also reduces sensitivity, hinders sexual function, and appears aesthetically unpleasant. Excess tissue on clitoris hood must always be assessed and identified preoperatively and excised during labia minora resection.

Clitoris hood resections are generally performed through simple mucosa excisions. Large longitudinal excess of clitoris hood or horizontal excess should be treated with a horseshoe resection (this being done by extension on the upper aspects of a lateral resection on each side of clitoris body).

Horseshoe hoodplasty was first introduced by Dr. Rakesh Kalra, an Indian plastic surgeon, who visualized a way of removing excess of clitoris hood and labia minora under one same incision.

Anatomy

The vulva and clitoris comprise the female external genitalia.

The mons pubis, labia majora, labia minora, vaginal vestibule, and bulb of vestibule are part of the vulva.

The clitoris is a sexual organ only present in females. The visible round portion is located near the anterior junction of labia minora, above the opening of the urethra and vagina. It is homologous to male’s penis but without distal urethra. Clitoral body is about 2.5 cm long; it is attached to pubic bone by the suspensory ligament. Final portion of the body is a round mass, the clitoral glans, covered by the hood which is the end point of labia minora.

The clitoris hood is formed by the superior end portion of the labia minora. Labia minora divide on their anterior portion into clitoral hood and frenulum.

An important landmark for the procedure is where clitoris hood joins labia minora. This anatomical point was addressed in the Longitudinal Labiaplasty chapter, and it’s important for the reader to understand the concept, which is key for the correct development of either hoodplasty surgical techniques described in the book.

Assessment: Horseshoe Resection

First:

Ask your patient about the reason for her visit. Try to understand why she wants that procedure. Ideally, these questions should be asked before taking her to the exam room while she’s still wearing her regular clothing ; this will give the patient more confidence to be open to speak with you as her doctor.

What Will the Patient Tell Me?

She is unhappy or uncomfortable with her clitoris hood:

“I look like a man . . . my clitoris looks like a penis.”
“Although my labia minora are not that long, my labia majora doesn’t seem to close in the middle . . . I hate that!”
“It just looks worse than before I had my labiaplasty done.”
“I wish I’d never had labiaplasty, the doctor should have warned me that this extra skin would show more.”

She wants to feel more.

Hygiene, bad smell issues:

“I think this extra skin is causing a bad smell.”
“I’ve been tested to rule out any sort of diseases because of the bad smell, but they don’t seem to find a good explanation for it.”

Second:

Have your patient go to the exam room and take her clothes off; examine her standing up first, then have her lay down in a lithotomy position but always in front of a mirror. While looking on the mirror , have your patient tell you what bothers her before you even examine her.

What to Look for in My Patient?

Important Fact

Good candidate for a horizontal hoodplasty: No showing of clitoris hood + patient’s desire to enjoy more during foreplay or sexual intercourse.

Clitoris hood:

Secretion accumulated under the hood near the frenulum and clitoris gland area
Redundancy
Longitudinal excess or horizontal excess
No showing of clitoris gland

Some clitoris glands can be deeply hidden under clitoris hood excess. This finding during assessment, plus a patient telling you she wants to feel more during foreplay or sexual intercourse, can help you as surgeon to decide whether or not your patient is a good candidate for a horizontal hoodplasty.

What Can Be Achieved with the Longitudinal Hoodplasty Technique?

Advantages

Ideal when there is a large longitudinal excess of clitoris hood.
Easy learning curve.
Best option when clitoris is hidden or buried under redundant clitoris hood.
Best option when the patient wants to feel more during foreplay or sexual intercourse.
When the patient has a way too long clitoris body, this incision helps expose the clitoris gland fascia enabling its plication.
Startup incision used to elongate clitoris hood when clitoris gland is trapped under a tight, phimosed hood due to accumulated secretion.
Startup incision used when we have too much of clitoris gland exposure leading to direct stimulation.

Disadvantages

It leaves a horizontal scar on top of the clitoris body.
- Scar may be visible.
- Scar may be hypertrophic.
- Scar may be painful during sexual intercourse.
Risk to overexposure of clitoris hood.
- May be very difficult to correct
- Overstimulation —even dressed—that can be quite annoying for the patient