Labiaplasty – Medical and Cosmetic Indications

By Sara Twogood, MD

Diving straight in with more labiaplasty insight today.

If you need a quick anatomy refresher on what body part we are talking about – the labia minora – hop over herefor your lesson!

Details of the procedure, reviewed in the last post, are copied below as well.

 What is Labiaplasty?

Labiaplasty is surgical repair of the labia. There are 2 sets of labia, as described above: labia majora and labia minora. Labiaplasty almost always refers to labia minora and the “surgical repair” is to reduce its size.

Why is labiaplasty done? There are medical and cosmetic indications.

Medical reasons for labiaplasty

The primary medical diagnosis for labiaplasty is “labia minora hypertrophy” which means enlargement of the labia minora. The problem is the lack of a standardized definition of “enlargement”, so it turns into a judgment, an opinion that the labia are enlarged, not an actual fact. It often means that one or both of the labia minora extend past the labia majora, but there is no specific measurement, size, or criteria to say how far beyond the labia majora the labia minora needs to extend to consider it hypertrophied.  In one study looking at anatomy in females, more than 50% of females had “labia minora hypertrophy”. This statistic alone tells us extension of the labia minora past the majora is not an abnormal enlargement but a common, expected, normal anatomic variation of the vulva. 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.

The follow up question is then: If it’s normal, why would there be a medical indication for surgical repair?

When labia minora “hypertrophy” exists, extending past the protective labia majora, there’s the possibility of chronic 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.

A few of my patients have had these concerns too:

• Complaining that their labia minora is long enough to sneak outside or get caught on their underwear. You can see how this would be really uncomfortable and distracting.

• Interfering with sex is another one –the longer labia minora gets pulled or tethered.

• I once had a patient with a very thin skin tag hanging from her labia minora, about 1 centimeter long. It had grown over the course of a few months, likely an inflammatory response to injury of the tissue. It was getting caught when she wiped herself after peeing, during sex, and sometimes just putting on underwear, causing pain and even more inflammation and irritation. I removed it with a quick office procedure. The pathology? Labia minora hypertrophy.

Considerations for Cosmetic Requests for Labiaplasty

Cosmetic procedures is a layered topic in general. The goal with procedures solely on the focus of cosmetics – what something looks like - is to make the individual person undergoing the procedure feel better about their appearance. Sometimes fixing the one feature that is causing someone distress – be it their nose, boobs, labia, or whatever – really, truly fixes the problem. Sometimes, however, that feature was a temporary focus of that person’s dissatisfaction with themselves and when it’s cosmetically altered, the fixation turns to some other body part. Over and over again. The root of the problem is their view on their body as whole, not just that one specific body part. They need to work on their body image and their brain. In this population, the wrong body part is being worked on.

In a culture with a heavy emphasis on appearance AND where porn is widely available, the appearance of a hairless, small vulva and labia is often thought of as the ideal appearance, especially for heterosexual men. Females are then pressured, either overtly or discretely, to obtain this “ideal”. This is where cosmetic requests for labiaplasty come in.

Cosmetic labiaplasty is then fraught with this question – will the surgery actually be helpful? What if it still doesn’t look like their ideal? For these complicated reasons, many cosmetic surgeons require patients to have a psychologic evaluation and be older than 18 years old prior to a cosmetic labiaplasty.

 Don’t get me wrong - I do think there is a role for cosmetic labiaplasty. I also think cosmetic labiaplastys are sometimes done for a bad reason. Any cosmetic procedure may turn out to be the most important surgery of someone’s life and restore their confidence … or it can be a useless surgery with the potential for complication and lifelong regret. That’s a lot to consider.

 If you have concerns with your labia, let your gynecologist know! As always (and as with everything on the internet), this information is not intended to be a substitute for individual medical advice.

Try your best not to be embarrassed – we’ve heard it before!