Labia and Labiaplasty
By Sara Twogood, MD
As part of Female Health Education, Dr. Quimby and I led a health education class at a local girls’ private high school. We wanted the talk to be straight from gynecologists, different than others they had heard. As part of it, we showed real photos of external female genitalia (images previously printed in the medical literature). The point? Let them see what normal vulvas look like! No other person has seen more vulvas than a gynecologist and we are the best equipped to give reassurance that variations on anatomy are normal and expected.
What happens when something does not look anatomically normal though, or if it is a normal variation but causing symptoms and problems in that person’s body? It depends on what body part we’re talking about of course, and it depends on the issues that are arising. Sometimes the answer is corrective surgery. And when we talk about the vulva, and more specifically the labia, that corrective surgery is called a labiaplasty.
Labia and labiaplasty - that’s my topic today. Here’s what you’ll find:
An anatomy lesson (let’s get clear on the vulva and labia)
The labiaplasty procedure
ANATOMY - VULVA AND LABIA
The vulva is the external part of female genitals. Here’s an illustration to help identify the various components and organs that make up the vulva.
The mons pubis is the top, somewhat fatty part on top of the pubic bone (covered with pubic hair).
There are 2 sets of “lips” of the vulva – the labia majora and labia minora.
The labia majora is the set that grows pubic hair, the most visible.
The labia minora is the set of lips inside the labia majora – these are smaller, more sensitive, delicate tissue and do not grow pubic hair.
The vulva also includes:
Clitoral hood and clitoris (the most important organ of female genitalia for sex but not one we will be discussing today)
Urethral opening
Vaginal opening called the introitus
Vaginal vestibule - the entry into the vagina, just inside the introitus
There are several other components - like Bartholin glands and Skenes glands that are less obvious (this article about Bartholin glands cysts and abscess is my most read article)
~ A quick interjection to talk about slang terms for the vulva ~
The overused “slang” of saying vagina instead of vulva is truly problematic. Example: “My vagina hurts after that wax.” You definitely mean the vulva. If your cosmetologist is waxing your vagina please run far far away.
I don’t have an issue with slang for genitals in and of itself– as long as it’s used with good humor and by adults for adults (kids should be learning the proper terms before starting to use nicknames or slang).
There are plenty of slang terms and nicknames for male genitalia : balls / nuts / cojones / sack / family jewels for testicles; cock / dick / rod / weenie / peter / prick / johnson / schlong for penis. I have no problem with these (besides some being gross) because each of these slang terms is for a specific and anatomically distinct body part. No one is using a slang “testicles” to describe a penis. No one says “penis” when they mean testicles. “Penis” and “testicles” are not used interchangeably as part of slang vernacular.
Why is it different with female anatomy? Why do we say “vagina” instead of vulva and so often refuse to say the term “vulva” altogether? Because of lack of knowledge? See above for anatomy lesson. Because our genitals are more complex? Pathetic excuse. Because the vulva is treated as an enigma or some “secret” that should not be spoken out loud? Those days are past. Let’s use accurate language. Let’s learn proper female anatomy. Let’s empower ourselves by not being embarrassed by the names of our organs. Let’s teach our kids (our daughters) their crucial and important body parts.
Take this as a plea from me – use the correct term. My daughter is growing up using the term vulva to describe her vulva. Unfortunately sometimes she also refers to my Volvo as a vulva too – but that’s a different post (but btw – she’s not embarrassed when she accidently says that).
Why is labiaplasty done?
Medical indications:
The primary medical diagnosis for labiaplasty is “labia minora hypertrophy” which means enlargement of the labia minora. It often means that one or both of the labia minora extend past the labia majora, although there are studies that show this is normal and I can tell you from the gazillion pelvic exams I’ve done in my career, there is vast variation in appearance and size of the labia majora and minora.
When labia minora extend past the protective labia majora, however, there is the possibility of irritation, pain, even infection of that delicate tissue. The pain and irritation are typically with exercise, when the friction of the labia against underwear and clothing is excessive. These symptoms would be considered an indication for labiaplasty.
Cosmetic indications:
This is the more common motivation for labiaplasty – to make the labia appear smaller or more symmetric. As with all cosmetic procedures, the questions abound: what is the ideal appearance and who judges this? Will the patient be happy with the results? Will this actually fix their insecurity about this particular body part?
In my next post I explore the indications in more detail …
For now, let’s talk about the labiaplasty procedure itself.
Having a Labiaplasty – details
The surgeon will explain the procedure, reviewing potential risks and expectations for recovery. This is typical of any surgical procedure. While the point of surgery is to fix whatever problem is occurring with the labia, there is no guarantee that the patient will be 100% happy with the results. While that’s the ultimate hope, improvement in symptoms is the goal.
The labiaplasty procedure itself is done in a procedure or operating room with anesthesia. The part of the labia minora that extends beyond the labia majora is removed with a scalpel and then sutures placed. Anatomy is assessed throughout. After care usually involves modified activity for up to 2 weeks: avoiding irritation to the area by wearing loose clothing and avoiding certain exercises or activity that can put friction on the sutures. Topical anesthesia like lidocaine spray or gel is often recommended too. As the sutures dissolve it is common to have itching or burning and is important to not rub or scratch the healing area as well.
And that’s the end of your lesson today!