Labiaplasty with Clitoral Unhooding

Labiaplasty is a controversial cosmetic surgery procedure on the female external genitalia, which many have equated with the oft-condemned female genital mutilation (FGM) that has been made a criminal offence in most developed countries.

It is noteworthy that both procedures have almost identical verbal descriptions and thus their essential similarity is undisputed.

The aim of labiaplasty is to alter the look of the labia minora, which tend to become somewhat larger and plumper with sexual maturity and stages of life such as pregnancy, though still quite small and thin as compared to the labia majora.

They may also become pigmented. Labia naturally exist in an extensive array of sizes and shapes, so that it is impossible to label any one variant as the only ‘perfect’ or ‘normal’ structure.

However, this is what is occurring in the world of medical fashion, where the surgeon is a dictator as to the ‘right’ way a woman’s genitalia should look!

The indication for labiaplasty is nothing more than a woman’s desire, often prompted and fueled by intense and highly misleading advertisements, which attribute several functional problems to the size of the labia. In addition, this type of advertisement seeks to project the look of a pre-pubescent vulva as the norm that all women should have.

It is subtly insinuated that large or flappy labia are not desirable, flying in the teeth of male opinion in many other parts of the world which finds such structures intensely exciting and a stimulus to pleasurable foreplay.

Labiaplasty is the removal of part of the labia minora so that they hardly show beyond the edges of the overlying labia majora. This is achieved by one of several approaches, including:

  • Edge resection or direct excision, which simply takes off the longitudinal edge of both labia to a level thought to be acceptable.
  • Wedge resection in which a wedge of tissue is removed from the middle of the labia followed by approximation of the edges. This has several variants such as central wedge excision, posterior wedge excision, Z-plasty, W-plasty and the like.

In some cases, the trimming of the edge of the labia leads to clitoral hood overhang, usually due to excessive reduction of labial size. This may make the clitoris look larger instead of smaller, which may make the woman feel as if she has a tiny penis and lead to dissatisfaction with the surgery.

To avoid this complication, the technique of composite reduction was evolved.

Composite Reduction

Composite reduction uses central wedge resection with the external incision (made on the lateral side of the labia) extended upwards to include the lateral clitoral hood tissue, which is removed with minimal loss of central tissue. This reduces the prominence of the hood and makes the hood tighter, referred to as unhooding. The technique is also called a Y-to-V technique after the shape of the incision.

It is claimed that this allows the clitoris to be repositioned if needed, and results in greater sexual satisfaction.

The risks of this type of surgery include over-zealous removal of too much of the clitoral hood can result in hypersensitivity of the clitoris, which makes intercourse and even normal friction with underclothing very uncomfortable. In addition, it could make the clitoris protrude excessively.


Further Reading

Last Updated: Feb 26, 2019

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.


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