Also known as labioplasty, labia minora reduction and labial reduction, labiaplasty is a plastic surgery procedure for altering the inner labia (labia minora) and the outer labia (labia majora), the folds of skin surrounding the human vulva. The size, color and shape of labia vary significantly and can change as a result of childbirth, aging and other events. Conditions addressed by labiaplasty include:
- congenital defects and abnormalities: vaginal atresia (absent vaginal passage), Müllerian agenesis (malformed uterus and fallopian tubes), intersex conditions (male and female conditions in a person)
- tearing and stretching of the labia minora caused by childbirth, accident and age
A study published in 2008 in the Journal of Sexual Medicine reported that 32% of women who underwent the procedure did so to correct a functional impairment, 31% to correct a functional impairment and for aesthetic reasons, and 37% for aesthetic reasons only. Overall patient satisfaction is in the 90-95% range.
Who Is a Good Candidate for Labiaplasty?
There are 2 main categories of women seeking cosmetic genital surgery:
- those with congenital problems, such as intersex
- those with no underlying condition who experience physical discomfort
- those who wish to alter the appearance of their genitals because they believe they do not fall within a normal range
The best candidates include women who are either experiencing sexual dysfunction, embarrassment, or pain because their labia is oversized or asymmetrical. Also, women who dislike their large labia or shape of their labia, which may cause inelegance or awkwardness with a sexual partner, are good candidates for this procedure.
Risks and Safety Information
Labia reduction surgery in relatively contraindicated for the woman who:
- has an active gynecological disease (infection or a malignancy)
- is a tobacco smoker and is unwilling to quit, either temporarily or permanently, in order to optimize her wound-healing capability
- is unrealistic in her aesthetic goals
As with any surgical procedure, there are certain risks. The most common can include:
- anesthesia risks
Before surgery, your doctor will discuss all risks and will provide you with safety information. You will be asked to sign consent forms to ensure that you have fully understood the procedure and everything it involves.
During your consultation, you should be prepared to discuss your surgical goals with your doctor. You will need to inform the surgeon about your medical conditions, drug allergies and medical treatments, your current medications, vitamins intake, tobacco and drug use if the case. You will also need to inform the surgeon about any previous surgeries that you may have had in the past.
How Do I Prepare for Surgery?
Before surgery, your doctor will evaluate your general health status and any pre-existing health conditions or risk factors. After he or she provides you with detailed preoperative instructions, in advance of your procedure, you will be asked to:
- stop smoking well before undergoing surgery to better promote healing
- avoid taking aspirin, herbal medications and certain anti-inflammatory medications that can cause bleeding
- keep yourself hydrated at all times before and after surgery for a safe and speedy recovery
Procedures, Recovery and Results
The first step in labial reduction surgery is anesthesia. The procedure can be performed under local anesthesia, conscious sedation, or general anesthesia, either as a discrete, single surgery, or in conjunction with another gynecologic or cosmetic surgery procedure. There are 6 available procedures:
- edge resection technique
- central wedge resection technique
- de-epithelialization technique
- labiaplasty with clitorial unhooding
- laser labiaplasty technique
- labiaplasty by de-epithelialization
Edge Resection Technique
The original technique was simple resection of tissues at the free edge of the labia minora. One variation features a clamp placed across the area of labial tissue to be resected, in order to establish hemostasis. The surgeon then resects the tissues, and then sutures the cut labium.
Central Wedge Resection Technique
This procedure involves cutting and removing a full-thickness wedge of tissue from the thickest portion of the labium minus. Unlike the procedure above, the resection pattern of the central wedge technique preserves the natural rugosity (wrinkled free-edge) of the labia minora.
This procedure involves cutting the epithelium of a central area on the medial and lateral aspects of each labium minus, either with a scalpel or with a medical laser.
Labiaplasty with Clitorial Unhooding
Surgery occasionally includes the resection of the clitorial prepuce (clitorial hood), when the thickness of its skin interferes with the woman’s sexual response. The surgical procedure involves a V-to-Y advancement of the soft tissues.
Laser Labiaplasty Technique
Laser resection of the labia minora involves the de-epithelialization of the labia, but the disadvantage of laser labiaplasty is that the removal of excess labial epidermis risks causing the occurrence of epidermal inclusion cysts.
Labiaplasty by De-Epithelialization
In this procedure, the surgeon cuts and removes the unwanted tissue and preserves the natural rugosity (wrinkled free-edge) of the labia minora, and preserves the capabilities for tumescence and sensation.
Pain is minimal after the procedure, and the woman is usually able to leave hospital the same day. After surgery, women may experience some mild discomfort and swelling, which usually disappears completely after 1-2 weeks. Incisions usually heal and are rarely noticeable. The initial post-labiaplasty consultation with the surgeon is recommended a week after surgery. Physically unstrenuous work can be resumed 3 to 4 days after surgery. To allow the wounds to heal, women are instructed not to use tampons, wear tight clothes and to abstain from sexual intercourse for 4 weeks after the surgery. Results are immediately visible after the surgery.