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What is Clitoral Hood Reduction?
Clitoral hood reduction, also known as clitoral unhooding, clitoral hoodectomy, or clitoridotomy is a cosmetic surgical procedure which reduces the excess skin (prepuce) that covers the clitoris. The technique not only
enhances the visual appearance of a woman’s pubic area, but it also serves to improve sexual pleasure by making the clitoris more accessible. As the name implies, the clitoral hood conceals the clitoris nestled inside, similar to an uncircumcised penis where the foreskin sheathes the head in its non-erect state.

What is a Clitoris?
Before launching into a description of the surgery itself, it may be of interest to understand the function, location, and description of the female clitoris.

The clitoris is a woman’s primary and most complex erogenous zone. The head (glans) of this tiny body part is estimated to have more than eight thousand sensory nerve endings twice as many as the glans of a penis. Though its sensitivity and size can differ from female to female, it normally resembles a pea or small pearl. When aroused by oral or manual stimulation, the clitoris becomes engorged much the same way the male penis does, thus enabling a woman to achieve orgasm.

In order to more easily picture the location of the clitoris, simply imagine the nude frontal view of your pubic area. What you are looking at in your lower region is called the vulva. The cushioned ridge you feel beginning halfway down from your navel is the mons veneris. As you continue to move downwards, it separates into two cheek-like mounds that are separated by a vertical opening with lip-like tissue. Those lips are called the labia majora.

By gently pulling apart the labia majora, you will expose two more inner lip-like flaps of tissue on the left and right. These are labia minora. At the base of the labia minora, leading up to the anal opening, there is a small bony ridge called a perineum. At the upper tip of the labia minora, that small tube-like protrusion is the clitoral hood. Peeking out through, or hiding inside the opening of that hood is the tip of the clitoris.

The entire clitoris itself is about 4 inches long, but, as explained earlier, the head or glans, is small, roughly the size of an eraser on the end of a pencil, and it is extremely sensitive to touch.

Clitoral Hood Reduction photoWhy Would a Woman Need a Clitoral Hood Reduction?
Because the size, shape and thickness of the clitoral hood differs from woman to woman, this procedure is not always done for medical reasons alone. It can also be done for aesthetic purposes to give the vulva a neater, trimmer look.

In some cases, the clitoral hood may be extremely large, inhibiting access to the clitoris, thereby preventing the achievement of sexual gratification. A thick or large hood may also cause friction against clothing which can lead to soreness, redness or inflammation.

Often, a woman with an enlarged hood may also have large labial lips that protrude in a manner she may find unsightly. Both the clitoral hood and the labia, if quite prominent, can sometimes create obvious bulges that can be seen outlined against close-fitting outerwear. Women may opt to cosmetically correct prominent labia through a procedure called labiaplasty at the same time as they undergo a clitoral hood reduction.

What Can be Expected During and After the Procedure?
Clitoral hood reduction surgery is normally done as an outpatient procedure under local or general anesthesia. A specialized laser and surgical instruments remove a predetermined amount of superfluous hood tissue, insuring that accessibility and stimulation to the clitoris is no longer restricted. The clitoral head is not modified in any way. Only the hood is altered. At this time, if the patient so chooses, the surgeon may perform additional procedures to the genitalia, such as vaginal tightening, hymenoplasty or vaginoplasty.

Clitoral hood reduction is microsurgery. The procedure, after complete healing, will leave no scars. Tiny, barely visible incisions will be concealed in the folds of tissue around the surgical area.

There will be some numbness experienced after surgery, but this will subside. The numbness is in no way indicative of nerve or any other damage. In fact, after the effect wears off, sensitivity to the clitoris will be heightened due to easier access to it.

The entire procedure will take approximately an hour depending on what needs to be done.

Aftercare and Recovery
The area will be tender and inflamed, but rest and application of ice will help, along with over-the-counter pain relievers. After about two or three days, the patient will be able to return to work. Complete recovery will take approximately six weeks, and the patient will be cautioned not to engage in sexual intercourse during that time in order to avoid complications. Strenuous activities such as horseback or bicycle riding, running, and heavy lifting should also be avoided during this time. Special care to keep the area clean is important in order to avoid any possibility of infection.

What Are the Complications?
Complications are rare. However, your doctor should be contacted if there are any of the following problems:

  • Intense pain or discomfort
  • Inflammation or numbness after several days
  • Any foul odor or unusual discharge
  • Excessive bleeding.

Interesting Facts Regarding the Clitoris
The size and shape of the full clitoris was not revealed until 1998. Until that time, even though physicians knew of its existence, it was either eliminated from anatomy publications that previously mentioned it briefly, or it was ignored altogether. A 3D sonography image was not available until 2009. Throughout history, the importance of the clitoris to a woman’s sexual pleasure has either been disputed or dismissed altogether. In fact, in the 1500’s, the presence of the clitoris in women was used as irrefutable proof of witchcraft, and was referred to as the ‘devil’s teat’. Perhaps the clitoris snuggled deep within the camouflage of a thick clitoral hood back then saved many a woman from imminent death.

We’re Here to Help
Our highly qualified doctors are here to frankly and openly discuss whether this procedure is right for you. Genital surgery, whether for physical, aesthetic or psychological reasons, is an intimate and important decision. We are here to guide and advise you without judgement, bias or preconception. The more confident and comfortable a woman is with her body, the more pleasurable and satisfying her intimate life will be. We are here to provide the help and advice to make that happen.

To make an appointment with one of our doctors, call 770.720.7733.

cosmetic vs reconstructive surgery photoAt Cherokee Women’s Health Specialists, we offer women the most modern, up-to-date solutions to gynecological problems that were formerly considered almost impossible to treat. Our OB-GYNs, urogynecologists, and Female Pelvic Medicine and Reproductive Surgeons are trained and credentialed to perform the many highly specialized cosmetic and reconstructive procedures that can dramatically change women’s lives and boost their psychological outlook.

Since the beginning of time, women have strived for ultimate beauty, perfect body symmetry and feminine wellness. Similarly, the world of medicine has dedicated itself to studying and repairing human anatomy, and to provide and maintain optimum overall health. It was inevitable that this combination would ultimately lead to a branch of medicine focused solely on women’s unique medical and cosmetic pelvic health issues.

From the time of the misguided, but well-intentioned Hippocrates, who believed in using a pomegranate as a pessary to cure prolapse, doctors have dissected, analyzed, and tried to understand the all-important female reproductive system, not just to insure the future of mankind, but to alleviate and correct those gender-specific disorders.

Eventually, as medical knowledge evolved, specialties such as gynecology, obstetrics, and urogynecology emerged. However, it wasn’t until 2014 that cosmetic and reconstructive surgery combined into a recognized and accredited field called Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This subspecialty satisfied women’s dual concerns of both repair and cosmetically improved genital appearance without the need to see several different doctors for each individual requirement.

Today, complete hysterectomies and other radical surgeries are no longer the all-in-one solution to many of the pelvic health problems women encounter throughout their lifetimes. The days of dangerous, invasive surgeries that resulted in disfiguring scars and months of recuperation and rehabilitation are slowly being left behind in the last century where they belong.

Yet many women, especially older ones, are unaware of the many options available to them today. They suffer needlessly, assuming their disorders are simply something they must learn to live with. They shyly excuse themselves to leave a room to change an adult diaper, or to push back something that might be peeking out from their private areas, not realizing that a simple surgery with minimal scarring and recovery time is available and can easily correct the problem. Others are hesitant to indulge in sexual intimacy because they’re concerned their partner may find a particular irregularity distasteful.

What is the Difference Between Pelvic Cosmetic and Pelvic Reconstructive Surgery?
Cosmetic surgery is usually an elective procedure to correct physical flaws, irregularities or deformities, and is not typically done out of necessity, but more to improve appearance and elevate self-confidence. It can also reverse many physical age-related effects, providing a more youthful rejuvenation to the area.

Reconstructive surgery is done for medical, and sometimes life threatening issues. It corrects damage to the pelvic area, and usually restores function, stability, sensation, and position, reverting the reproductive system to its pre-trauma state.

Can Pelvic Reconstructive Surgery Also be Cosmetically Beneficial?
It certainly can! While repairing damage that requires necessary tightening or trimming, reconstructive surgery can also automatically provide a more visually appealing and youthful look. Also, in many cases, as reconstructive surgery is being performed, an elective cosmetic procedure can be done simultaneously as well.

What are the Different Cosmetic Surgeries and Reconstructive Procedures you Offer?
There are a number of different procedures available to you for both physical wellness and aesthetic benefits.

Reconstructive Surgeries include:

  • Midurethral slings: This procedure quickly, easily and effectively corrects the problem of stress urinary incontinence, which is involuntary urine leakage when you cough, sneeze or laugh. Urinary incontinence may also occur during different activities. This is an outpatient procedure that can be completed in approximately 30 minutes.
  • Colposuspension: Used to treat stress urinary incontinence as well, colposuspension is a surgical procedure that requires restoring the shifted or fallen vagina to its original location. This can either be done by laparoscopic technique or via abdominal incision.
  • Posterior/anterior colporrhaphy: This vaginal wall defect repair corrects any protrusion of the bladder into the vagina (cystocele) or the rectum into the anus (rectocele). Both these problems are known as pelvic organ prolapse (POP), meaning organs are drooping from their regular place in the pelvic vault. POP can cause pelvic pain and pressure, vaginal bleeding, painful intercourse, back pain, bowel movement problems and incontinence.

Cosmetic Surgeries include:

  • Vaginal rejuvenation (Vaginoplasty): Vaginoplasty is a blanket term that encompasses several different procedures, both reconstructive and cosmetic. Cosmetically speaking, however, one of the procedures of vaginoplasty is vaginal rejuvenation which tightens, modifies, and/or reforms the shape of the vaginal tissue to achieve a younger appearance and ‘feel’. It can be described as a face lift of sorts for a woman’s genitals.
  • Labiaplasty: Labiaplasty reduces the size of the labia—usually the labia minora. If you have large or saggy labia, or are uncomfortable with any bulging that may show through tighter clothing, labiaplasty can give that area a trimmer appearance.

Cosmetic and Reconstructive Surgeries
ThermiVa: ThermiVa is a completely non-invasive, nonsurgical, drug and hormone- free vaginal rejuvenation treatment that restores vaginal health in many beneficial ways. Though it cannot actually be classified as ‘reconstructive’ in a surgical sense, temperature controlled heat administered via radio frequency energy rejuvenates interior and exterior vaginal tissue by stimulating new collagen growth. This process revitalizes the vagina to much of its former condition by reducing discomfort, providing lubrication, and eliminating laxity. ThermiVa can also correct incontinence and deliver support to the bladder, correcting many disorders caused by natural aging and childbirth, with added aesthetic advantages.

  • Perineoplasty: Though usually considered a reconstructive procedure, perineoplasty can also be cosmetic in the case of a deformed perineum. Perineoplasty corrects damage and defect in the perineum, the triangular section located between the anus and vagina, and serves an important role as a structural support for several reproductive organs. Typically, it can become impaired through childbirth, episiotomy, obesity or excess weight loss. Perineoplasty can correct issues such as scarring, excess skin, reduction in sexual pleasure, and can restore support to internal organs.
  • Hymenoplasty: Though this usually involves cosmetic restoration or creation of the ‘virginal’ tissue that may have been non-existent from birth, lost through trauma, sexual intercourse or other forms of rupture, hymenoplasty can also correct conditions such as imperforate, septate or microperforate hymen that can make intercourse, menstruation or tampon insertion difficult or impossible without surgical intervention.
  • Monsplasty (pubic lift): Reduces, tightens or lifts the pubic mound located just under your abdomen for a more feminine look.
  • Clitoral hood reduction: A thick or prominent clitoral hood may inhibit sensation and diminish sexual pleasure. A clitoral hood reduction can alleviate extreme discomfort, redness or irritation that can possibly lead to infection from constant chafing against clothing. Often, this procedure is accompanied by labiaplasty to shorten the vagina.
  • G-shot: G-shot is a treatment to enhance sexual pleasure, thus making it beneficial physically. G-shot can be administered by our pelvic health care providers.

Surgery Methods

  • Robotic surgery: This is a minimally invasive surgery that implements the use of a robotic arm to perform corrective surgery for such problems as pelvic cancerous tumors, fibroids, obstructions and masses. It is also used to ease pelvic pain and bleeding, and to rectify pelvic, rectal, vaginal vault and uterine prolapse. Today’s robotic surgery, under the practiced guidance of a specialist, can perform hysterectomies and endometrial excisions and resections. Due to its precision, robotic surgery offers wonderful benefits such as almost insignificant scarring, minimal discomfort or pain, rapid recovery, and less danger of infection.
  • Laparoscopic and single incision laparoscopic surgery: Apart from being a wonderful diagnostic tool, laparoscopy can correct many pelvic problems. A thin tube that is equipped with a light can be inserted into the body to probe for the cause of various problems within the reproductive system. It can also remove cysts, tumors, scarring (adhesions) and fibroids, as well as perform hysterectomies and tubal ligations. Laparoscopic surgery and can correct disorders such as incontinence and pelvic organ prolapse, leaves insignificant scarring, and allows for a much shorter recovery time with less risk of infection.

What is the Recovery Time for Most of These Surgeries You’ve Described?
Because of the less invasive methods we use today, like robotic and laser surgery, the recovery time is far shorter than most women may imagine. Some procedures only require one to three weeks of recuperation, others a little longer. Generally the longest recovery time is about three months. Your doctor will always provide you with aftercare instructions and any special precautions you may need to take.

The days of heavy handed scalpel wielding are becoming a thing of the past, giving way to treatments that were beyond our scope of imagination even 20 years ago. By today’s standards, yesterday’s methods seem almost barbaric in comparison. Yet many woman are still convinced that they are destined to endure the discomfort and changes Mother Nature sends their way, convinced that it is their destiny, or just a result of passing years.

In this day and age of open, frank, and honest dialogue, the word “vagina’ does not have to be whispered. Sex is no longer a marital ‘duty’ explained on the night prior to your wedding, but is a pleasurable experience you have every right to participate in and enjoy without discomfort or embarrassment. Nor is it a taboo subject to consider a lift, tuck, tightening or trim to an intimate zone if that change can allow you more self-confidence, less inhibition and additional ‘feel-good’ sensation.

We offer the physical, psychological, aesthetic and therapeutic means for you to achieve and maintain optimum pelvic health and confidence. At Cherokee Women’s Health Specialists, we not only listen and guide you in confidential privacy, but also communicate vital information regarding genital heath in public forums like Real Self, so that you can always be informed and make knowledgeable choices regarding your body.

The procedures covered in this article are only a partial and generalized list of the many various services we offer. The pelvic structure is a complicated myriad of bone, tissue, fiber, blood, organs, and cartilage, and the possible problems that can affect your wellness are equally complex. That is why we treat each person who comes to us with the individual attention their personal issues deserve.

If you have additional questions on cosmetic or reconstructive surgery, or to book an appointment, call 770.720.7733.

woman with low sex drive photoEvery week women ask me why their sex drive is so low. “Fix me so I can enjoy sex more and want it more often,” they say. Then they ask me to check their hormones and to give them a physical examination.

This is a popular topic among women and it’s everywhere in the media. Patients ask me about the latest fads they’d seen touted as the latest, greatest best thing. They ask about bioidentical hormones. Vaginal rejuvenation. Sexual vitamins. Gspot enhancement. clitoral hood reduction. The list goes on. Treatments of all sorts are advertised to women of all ages to solve a low sex drive. And it’s true that some solutions, when chosen for the right person, can transform a woman’s sexual responsiveness.

However, most of the time treatment is unnecessary or unhelpful.

Sometimes a woman’s sex drive is low for a good reason. But something that’s not broken can’t be fixed. Other times there is something that can be done. Asking the right questions is the key to understanding how to help them.

Five Key Questions for Women With a Low Sex Drive

1) Has your sex drive dropped or has it stayed more or less the same?
Many women are convinced they have a low sex drive because they compare their desire for sexual contact with their male partner’s. However, men and women typically have vastly different desires for sexual intercourse. The typical woman’s sexual desire usually ranges from once or twice a week to once or twice a month. The typical man’s is once or twice a day. This discrepancy accounts for the feeling many women have that there is something wrong with them.

That said, if a woman’s sex drive has suddenly dropped, a woman should consult with her doctor to determine the reason. If it’s always been low, then chances are that’s the way you are.

2) What is your childbearing history?
There is a myth that women reach their sexual peak in their forties. This is the idea that women in this age range finally becoming sexually liberated from natural inhibitions. The idea is that the forty year old woman now has a sexual desire and ability to orgasm that has reached new heights. There are specific circumstances in which this occurs but it is the exception rather than the rule.

Women in their forties who have not yet had children can have a very high sex drive. But oftentimes, there’s a reason for this. Women who have small children will often see their sex drive plummet. When toddlers and grade school children require constant mothering, there is often little left for the woman’s partner.

And women who are breastfeeding often have the lowest sex drive of all women. After all, she has a baby feeding off her body all day long and when she puts her head on her pillow at night, the last thing she wants is for more physical contact. Men will often say, “You used to want to have sex, I think there is something wrong with you.” It’s at this point that she’ll seek my help. Or, her partner will send her in to see me.

3) Does sex hurt or do you have pain with your cycles?
There are two main reasons why sex hurts. One has to do with vaginal dryness. This is pain with entry, which commonly occurs with menopause. The ovaries stop producing estrogen which leads to thinning of the vaginal lining, which exposes nerves and decreases lubrication. There is more pain and less pleasure and a reduced desire for sex. This can be treated with topical estrogen cream or even more advanced office procedures such as ThermiVa.

Other women commonly hurt with sex because they experience pelvic pain with their cycles. This is painful sex from the actual thrusting motion. If a woman missed school during her adolescence because of discomfort during her cycle or if her mother needed a hysterectomy for pelvic pain, it’s very likely she has endometriosis or internal scarring of her internal reproductive anatomy. This patient needs a gynecological evaluation, particularly if she has not had children, is experiencing infertility or if she experiences pain more than a couple of days a month.
Women with back pain during their cycles often have a tilted uterus that can be corrected by an experienced surgeon during an outpatient laparoscopy.

4) How is your general health?
In the same way that a person’s appetite for food drops when they’re not feeling well so does their appetite for sex. When you are in bed with the flu you don’t want to eat and you don’t want to be sexually active. But if you are chronically unhealthy, your desire for sex will be low as well.

The most common reason for poor health in America is lifestyle. As a society, we are sedentary and we eat addictive, poorly nutritious food. Patients with cancer and heart disease don’t come to my office complaining of low sex drives. But overweight patients who munch on pizza and don’t exercise often complain of a lack of sexual desire. Exercise and nutritious plant based diets raise testosterone levels and other important hormones responsible for not only sex drive but also an overall sense of youth and vigor.

5) Do you have orgasms?
Many women cannot have orgasms with sexual intercourse. Clitoral stimulation is the main way for a woman to achieve sexual climax. Unlike a man’s sex drive that ends with ejaculation, many women don’t focus on the biological climax but rather the emotional and physical intimacy. But a woman who does not orgasm can see her sex drive eventually plummet. It’s important to understand your body and to know how you achieve physical gratification from sexual activity.

Many women need vibrators applied directly to their clitoral region to achieve climax. The first step is masturbation alone when you can discover for yourself what gets you there. This can then be incorporated into sexual activity with your partner. Good communication is necessary to have a healthy sexual life. Some husbands will be uncomfortable with this kind of change. I tell my patients who indicate this to me to blame me (their doctor). “My doctor told me I have to do this so I can continue to be sexually active because having children and getting older has changed my body.” Hey, if it means a woman will have more intimacy and a better sex life, I’ll take one for the team!

Cosmetic GYN

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Our Female Pelvic Medicine and Reconstructive Surgery specialists address both the internal and external changes to the vagina due to age or childbirth.

We provide the following cosmetic and reconstructive services:

  • Vaginoplasty
  • Labiaplasty
  • ThermiVa
  • Vaginal Lengthening
  • Hymenoplasty
  • Clitoral Hood Reduction
  • G-Shot
  • Perineoplasty

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Vaginoplasty – A procedure aimed at tightening lax muscles to achieve a narrower and tighter vaginal canal and smaller opening.

Labiaplasty – An aesthetic procedure that corrects enlarged or asymmetrical labia.

ThermiVa – An in-office, non-surgical procedure for labia and vaginal tightening.

Vaginal Lengthening – Non-invasive and surgical options are available to repair a shortened vagina, a condition that occurs as a result of gynecological surgery, cervical cancer or radiation therapy.

Hymenoplasty – The cosmetic repair or restoration of a woman’s hymen, also known as revirginization.

Clitoral Hood Reduction – A cosmetic surgical procedure which reduces the excess skin (prepuce) that covers the clitoris.

G-Shot – A procedure that treats G-spot atrophy or diminished G-spot sensation, often coupled with ThermiVa for enhanced vaginal sensation.

Perineoplasty – A procedure for tightening the vaginal opening and improving its appearance, or for enlarging a vaginal opening that is too small.

 

Q&A with Dr. Litrel on RealSelf

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Dr. Litrel Explains Cosmetic and GYN Glossary Terms in Plain English

dr-litrel photoVaginoplasty: Tightening of the entire vaginal canal from the opening to the cervix (or the apex of the vagina, if hysterectomy was performed).

Hymenoplasty: Restoration of the hymen to create virginal anatomic state, which can be done at the time of vaginoplasty, if patient desires.

Cosmetic Surgery on the External Genitalia

Labiaplasty: Reshaping the labia minora or inner lips for improvement in appearance and to diminish labial irritation with clothing and during sex.

Clitoral Hoodectomy: Removal of excess skin covering the clitoris to create a better appearance and to help with clitoral orgasm.

Perineoplasty: Reshaping the external opening to the vagina for a smaller, more youthful appearance. This is performed during vaginoplasty or can be done without vaginoplasty, if vaginal tightening is not desired.

Labia Majora Reduction: Reshaping the labia majora or outer lips for a better appearance.

Female Reconstructive And Reparative Surgery (Usually Covered By Medical Insurance)

Anterior Repair: Repair of cystocele or bulging of bladder using natural tissue or biological graft or synthetic material.

Posterior Repair: Repair of rectocele or bulging of rectum using natural tissue or biological graft.

Enterocele Repair: Repair of enterocele or the sagging of the top of the vagina using natural tissue or biological graft or synthetic material.

Incontinence Repair: Repair of leakage of urine using native tissue, biological graft or synthetic material.

Endometrial Ablation: Outpatient or in-office procedure to diminish or eliminate menstrual bleeding without changing hormone status.

Hysterectomy: Removal of uterus to stop periods and pelvic pain associated with menses and sexual intercourse (pelvic pain with thrusting motions). Or, to remove tumors or pathology once childbearing is complete. During this procedure, removal of fallopian tubes (or salpingectomy) is strongly recommended to decrease the risk of future cancer.

Oophorectomy: Removal of ovary or ovaries for pelvic pain associated with sex or menses or is chronic or for cyst or mass. These are the organs that secrete hormones so removal of both will result in surgical menopause. Removal of one ovary will not affect hormones. Removal of one ovary is recommended once a woman is in menopause if hysterectomy is performed to decrease risk of cancer. If a woman has significant chronic pain on one side of her pelvis during her cycles or sex or chronic, removal of that ovary is considered.

Enterolysis: Minimally invasive (laparascopic or robotic) removal of internal adhesions of bowel to pelvic organs that cause pelvic pain with sex, menses, bowel movements or is chronic in nature.

Removal/Fulgurtion of Endometriosis: Minimally invasive (laparoscopic or robotic) removal and destruction of endometriosis lesions that cause painful menses or pain with sex or is chronic.

Salpingectomy: Removal of tubes for sterilization. Note: Tubal ligation without removal of tubes is not recommended because tubal removal will decrease future cancer risks but tubal ligation will not.