If you thought you knew everything there was to know about the clitoris, hold onto your labia, because there's another layer to it that could make sex way more pleasurable: the clitoral hood. First, it's important to understand that every clitoris is different, but all clitorises have a "hood" or "prepuce," which is a flap of skin that connects to the labia minora (the inner lips of the vulva), explains Rachel Rubin, MD, a urologist in Washington, D.C., who focuses on sexual medicine and has researched the clitoris. Just like foreskin covers the head of a penis, the clitoral hood covers up the glans clitoris, Dr. Rubin says.
"In normal clitoral anatomy, you should be able to fully retract the hood and see the complete glans clitoris," Dr. Rubin says. When a person is aroused, their glans clitoris swells, which usually is enough to move the clitoral hood aside. But some clitoral hoods just don't retract or get stuck, so you can't fully expose the glans clitoris, she says. Some people are also just born with larger-than-usual clitoral hoods (a.k.a. a "hooded clitoris"), which prevents them from really getting into the glans clitoris. This is totally normal, and it just means you have to dig a little deeper if you want to stimulate your glans clitoris.
Occasionally, clitoral hoods (particularly bigger ones) can get stuck, which doctors call "clitoral adhesions." In fact, recent research found that 23% of women who visited a sexual medicine clinic for any reason had clitoral adhesions, Dr. Rubin says. Medically speaking, this is usually no big deal, but it could be painful or interfere with how you access and pleasure the clitoris.
Some clitorises are prone to adhesions because of the way they're structured, Dr. Rubin says. What happens is sweat, skin cells, and bacteria build up around the clitoris and cause inflammation, she says. "In women, this can cause clitoral pain, hypersensitivity, or difficulty reaching orgasm," she says. "Think of it as having a piece of sand in your eye; it's a tiny piece of sand, but it hurts so much." Usually, seeing a doctor who can break down the adhesions is enough to help get to your clitoris, so you can experience all the sensations your clit has to offer at their full potential, Dr. Rubin says.
Hygiene is also key to preventing these adhesions from happening in the first place, says Patti Britton, PhD, MPH, a clinical sexologist. It's not that people with clitoral adhesions aren't cleanly, but because of the way their clitoral anatomy is built, they can be more prone to having debris or buildup (which can cause adhesions) in and around their clit, Dr. Britton says. It's kind of like how people with uncircumcised penises have to spend a little more time making sure the folds of their skin are totally clean — the same goes for hooded clitorises, she says. (But, to avoid infections, do not use soap or scented wipes; plain water will do the trick.)
Think of it as having a piece of sand in your eye; it's a tiny piece of sand, but it hurts so much.
Rachel Rubin, MD
If you think this sounds like your clitoris, Dr. Britton suggests taking a Q-tip and rubbing some vitamin E around your clit to lubricate the area. "Most women don't put a finger under the hood and look for the head of the clitoris on a tactile level," she says. In extreme cases, surgery is required to free up the clitoris, but it's important to see a trained specialist in that case, she says.
The best way to tell if your clitoral hood is getting in the way of your clitoris is to watch yourself masturbate in front of a mirror, Dr. Britton says. Sit on a pillow in a well-lit area, facing a mirror with your vulva exposed, she suggests. "Your clitoris is really intricate, and it's not always visible without stimulation," she says. Once you're aroused, you might be able to see a roundish nub (your clitoris!), depending on your anatomical structure, Dr. Britton says. Now, you might not even know exactly what you're seeing at first, but it's a good idea to get a sense of what your vaginal anatomy looks like so you can report back to your doctor.
If clitoral hoods and adhesions are such a common and prohibitive issue that people with clitorises deal with, why have you never heard of it before? "Most doctors do not examine the clitoris and aren't taught what a normal clitoris should look like," Dr. Rubin says. There's a good chance that your gynaecologist has never asked you to examine your clitoris before, and most anatomical text books don't even have accurate or detailed descriptions about the clitoris, Dr. Rubin says.
"Women and physicians must become more comfortable understanding and looking at clitoral anatomy," she says. In Dr. Rubin's office, they use a camera and TV screen to let their patients watch their exams while it happens. If you're concerned about your own clit, and your gynaecologist has never mentioned anything to you before, you might want to bring it up to them during your next appointment. Together, you can work on some ways to free — or access — the clit, because you deserve it.