Years ago a gynecologist told me I have a "hooded clitoris." It did not seem to matter much in my 20s and 30s -- but it does now. What should I do? Viagra for women? More blood to the area? A little surgery? Yes, I take my estrogens, and no, I don't have inhibitions. I guess I'm just getting (gulp) OLDER! -- M

Dear M:

Thanks for writing about this unusual condition, which affects a small percentage of all women. All women have a hood (prepuce) which covers their clitoral glans (head); that hood is movable by pulling up on the inner lips, or labia minora. Women with a "hooded" clitoris have a thickened membrane that protects the actual "pearl" that is the clitoris. Often, before discovering the condition, a woman reports such problems as dulled sensation, no orgasms, or complaints from partners who have been unable to rub them to ecstasy. Because most women require direct or indirect clitoral stimulation to reach a climax, having a hood can be a problem for pleasure and especially for that orgasmic release. I applaud your gynecologist for detecting your cover-up.

This condition can become a difficulty for women of all ages. The issue is not age or aging, it's how it affects your sexuality, your sense of self as a woman and your sexual response. If, up till now, you have never experienced troubles in that department, then be grateful. If, instead, this has been a lifelong issue that has contributed to dampening your sexual pleasure, alone or with a lover, then you certainly have options.

Usually, you can open up the hooded coverlet by applying natural oil on a Q-tip. Gently insert it under the hood around its perimeter. Doing this deliberately and steadily, on a daily basis, may release its grip. If you are truly hooded, where the tissue is grown over the clitoral area, then surgery may be in order. Ask your gynecologist to advise you on the severity of your condition and consider having it loosened under the surgical knife. Then let go of those thoughts of taking pills or increasing your hormone replacement; the problem is purely mechanical. But think through your options thoroughly -- surgery should never be undertaken lightly.