Labiaplasty: Labia Minora and Labia Majora Reduction

Labiaplasty: Labia Minora and Labia Majora Reduction

Labiaplasty (also known as labioplasty, labia minora reduction, and labial reduction) is a plastic surgery procedure for altering the labia minora (inner labia) and the labia majora (outer labia).  These are the outer folds of skin surrounding the human vulva. There are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to improve the appearance of their genitals.

The size, color, and shape of labia vary significantly, and may change as a result of childbirth, aging and other events.  Conditions addressed by labiaplasty include congenital defects and abnormalities such as vaginal atresia (absent vaginal passage), Müllerian agenesis (malformed uterus and fallopian tubes), intersex conditions (male and female sexual characteristics in a person); and tearing and stretching of the labia minora caused by childbirth, accident and age. In a male-to-female sexual reassignment, a vaginoplasty is for the creation of a neovagina and a labiaplasty creates labia where there are none.

A 2008 study in the Journal of Sexual Medicine reported that 32 per cent of women who underwent the procedure did so to correct a functional impairment; 31 per cent to correct a functional impairment and for aesthetic reasons; and 37 per cent for aesthetic reasons alone.[1] According to a 2011 review, also in the Journal of Sexual Medicine, overall patient satisfaction is in the 90–95 percent range.[2] Risks include permanent scarring, infections, bleeding, irritation, and nerve damage leading to increased or decreased sensitivity.

Anatomy and Size of Labia
The external genitalia of a woman are collectively known as the vulva. Labia Anatomy The vulva comprises the labia majora (outer labia), the labia minora (inner labia), the clitoris, the urethra, and the vagina. The labia majora extend from the mons pubis to the perineum.

The size, shape, and color of women’s inner labia vary greatly.  One is usually larger than the other. They may be hidden by the outer labia, or may be visible, and may become larger with sexual arousal, sometimes two to three times their usual size.

The size of the labia can change because of childbirth. Genital piercing can increase labial size and asymmetry, because of the weight of the ornaments. In the course of treating identical twin sisters, S.P. Davison et al reported that the labia were the same size in each woman, which suggests a genetic predisposition.[3]

Surgery 

Labial reduction can be performed as an out-patient procedure under local anaesthesia, conscious sedation, or general anaesthesia. Labiaplasty can be performed alone or with another gynecologic or cosmetic surgery procedure.  The resection is facilitated with the administration of an anesthetic solution that is infiltrated into the labia minora to help with pain control and to limit bleeding.

Labiaplasty Surgical Techniques

Edge resection technique
The original labiaplasty technique was simple resection of tissues at the free edge of Labiaplasty Surgery Techniquesthe labia minora. One resection-technique variation features a clamp placed across the area of the labial tissue to be resected in order to decrease bleeding.  The surgeon then resects the tissues, and sutures the edges together. This procedure is used by most surgeons because it is the easiest technique to perform and has a high success rate with low risk.  The technical disadvantages of the labial-edge resection technique are the loss of the natural wrinkles of the labia minora edges.  There exists the possibility of everting (turning outwards) the inner lining of the labia, which then makes visible the normally hidden internal, pink labial tissues. The advantages of edge-resection include removal of the hyper-pigmented (darkened) irregular labial edges with a linear scar.  The edge resection technique does not address clitoral hood deformities.

Central wedge resection technique
Labial reduction by means of a central wedge-resection involves cutting and removing a partial-thickness wedge of tissue from the thickest portion of the labium minora.  Unlike the edge-resection technique, the resection pattern of the central wedge technique preserves the natural wrinkles of the labia minora. If performed as a full-thickness resection, there exists the potential risk of damaging the pertinent labial nerves, which can result in painful neuromas, and numbness. A partial thickness removal of mucosa and skin, leaving the submucosa intact decreases the risk of this complication.  The central wedge resection technique may include a Z-plasty, which produces a refined surgical scar that is less tethered, and diminishes the physical tensions exerted upon the surgical incision.  This reduces the possibility of a notched or scalloped scar.   The central wedge-resection technique is a more demanding technique which can lead to undercorrection (persistent tissue-redundancy), or overcorrection leading to excess tension on the incision causing the incision to separate. The benefit of this technique is that an extended wedge can be brought upwards towards the prepuce to treat a prominent clitoral hood without a separate incision.  This leads to a natural labia contour and avoids direct incisions near the highly-sensitive clitoris.

De-epithelialization technique
Labial reduction by means of the de-epithelialization of the tissues involves cutting the epithelium of a central area on the medial and lateral aspects of each labia minora. This labiaplasty technique reduces the vertical excess tissue while preserving the natural wrinkles of the labia minora.  This preserves the sensory and erectile characteristics of the labia.  The technical disadvantage of de-epithelialization is that the width of the individual labia might increase if a large area of labial tissue must be de-epithelialized to achieve the labial reduction.  This technique is not performed very often.

Labiaplasty with clitoral unhooding
Labial reduction occasionally includes the resection of the clitoral prepuce (clitoral hood) when the thickness of the skin interferes with the woman’s sexual response or is aesthetically displeasing.

The surgical unhooding of the clitoris may involve a V–to–Y advancement of the soft tissues, which is achieved by suturing the clitoral hood to the pubic bone in the midline (to avoid the pudendal nerves).  This uncovers the clitoris and helps tighten the labia minora.

Laser labiaplasty technique
Labial reduction by means of laser resection of the labia minora involves the de-epithelialization of the labia. The technical disadvantage of laser labiaplasty is that the removal of excess labial epidermis risks causing the occurrence of epidermal inclusion cysts.

Sex reassignment surgery
In sexual reassignment surgery for the male-to-female transgender patient, labiaplasty is usually the second stage of a two-stage vaginoplasty operation.  Labiaplasty techniques are applied to create labia minora and a clitoral hood. In this procedure, the labiaplasty is usually performed some months after the first stage of vaginoplasty.

Contraindications

Labia reduction surgery is relatively contraindicated for woman who have an active gynecological disease, such as an infection or a malignancy; pregnant woman; and a woman who is unrealistic in her aesthetic goals. It is also best to avoid labiaplasty during menstration to reduce potential hormonal effects and the increased risk of infection.

Post-operative care

Post-operative pain is minimal. No vaginal packing is required. One may shower and gently clean the area with soap and water and apply antibiotic ointment twice a day.  Loose clothing and skirts are best to minimize moisture.  A sanitary pad is worn for comfort and protection. One cannot use tampons, wear tight clothes i.e. thong underwear, or have sexual intercourse for up to six weeks after the surgery.

Complications

Complications after a labiaplasty procedure are uncommon. They include bleeding, infection, labial asymmetry, poor wound-healing, undercorrection or overcorrection. Difficulty with sexual intercourse due to scarring may occur but is extremely rare.

To learn more about labiaplasty, call 804 673-8000 and schedule a consultation at DeConti Plastic Surgery today. 

1. Lloyd, Jillian; Crouch, Naomi S.; Minto, Catherine L.; Liao, Lih-Mei; Creighton, Sarah M. (May 2005). “Female genital appearance: “normality” unfolds”. BJOG: An International Journal of Obstetrics & Gynaecology. Wiley. 112 (5): 643–646.

2. Goodman, Michael P. (June 2011). “Female genital cosmetic and plastic surgery: a review”. Journal of Sexual Medicine. Wiley. 8 (6): 1813–1825.

3. Davison S.P. et al. “Labiaplasty and Labia Minora Reduction”, eMedicine.com, 23 June 2008.

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