Labiaplasty

Reduction of the labia minora

Definition

Labiaplasty is a surgical procedure that reduces the size of the labia minora when these are too large or prominent.

Hypertrophy of the labia minora means that they extend beyond the labia majora and may be visible when the person is standing. Sometimes this change is present from puberty, while at other times it may appear after childbirth or with hormonal changes and the ageing of the tissues.

Naturally, the labia minora are not perfectly symmetrical, and a slight difference between the two sides is common. Nevertheless, one or both labia may sometimes be much more developed and may cause discomfort.

Beyond the aesthetic aspect, enlarged labia minora may cause:

• embarrassment when wearing certain clothes (tight jeans, underwear, swimsuits);
• discomfort during certain sporting activities (cycling, horse riding, climbing);
• a sensation of irritation or repeated rubbing;
• discomfort during sexual intercourse;
• psychological embarrassment related to the appearance of the intimate area.

There may sometimes also be hyperpigmentation of the edges of the labia, caused by repeated rubbing.

These changes can have an important impact on physical and psychological comfort, which is why the procedure may have a reconstructive and functional role, not only an aesthetic one.

Labiaplasty can be carried out once physical development is complete, in adulthood.

The procedure does not normally affect sexual life and does not subsequently prevent pregnancy or natural childbirth.

The aim of labiaplasty is:

• to reduce the size of the labia minora;
• to correct any significant asymmetry;
• to remove excess tissue when it extends forwards, close to the clitoris;
• to obtain a harmonious and natural shape of the vulva.

The objective is not to attain anatomical perfection, but to improve comfort and to obtain a proportionate result.

Before the procedure

Before the operation the following will be discussed:

• the reasons why the patient wishes to have the procedure;
• the expectations and the desired result;
• the anatomy of the vulvar area.

Depending on the situation, the following may be recommended:

• blood tests;
• a pre-anaesthetic consultation.

Before the operation:

• medication containing aspirin must not be taken for approximately 10 days beforehand;
• if there are risk factors, the doctor may recommend stopping oral contraceptives;
• abstaining from food and liquids is required for approximately 6 hours before the procedure.

Issues related to smoking

Smoking has a negative effect on tissue healing and increases the risk of complications.

Complete cessation of smoking is recommended at least one month before the procedure, continuing abstinence until healing is complete.

The same recommendation applies to electronic cigarettes.

Principle of the operation

The procedure consists of the controlled removal of excess tissue at the level of the labia minora.

There are several surgical techniques, the choice depending on the anatomy of the patient and on the desired result.

The marginal reduction technique

This is one of the most widely used methods.

The surgeon removes the excess part of the free edge of the labia, following a design established before the operation.

Advantages:

• it allows precise adaptation to each case;
• it can also correct forward extensions;
• it can reduce hyperpigmentation of the labial edge.

The edges are then sutured with absorbable stitches.

The wedge resection technique

This technique involves removing a central portion of the labium, usually in the shape of a small triangle.

The main advantage is that a large part of the natural edge of the labium is preserved.

The choice of technique will be discussed together with the surgeon.

How the operation is carried out

The technique is adapted to each patient.

At the end of the procedure:

• a simple dressing is applied;
• comfortable protective underwear is recommended.

The operation generally lasts between 30 and 60 minutes.

Complementary procedures

Augmentation of the labia majora

In certain situations, labiaplasty may be combined with increasing the volume of the labia majora.

This can be achieved through:

Hyaluronic acid

• a procedure carried out in the consulting room;
• a temporary effect;
• the product is progressively absorbed, usually within approximately 12-18 months.

Lipomodelling (transfer of the patient's own fat)

• it involves harvesting fat from another area of the body;
• the fat is then injected at the level of the labia majora;
• it provides a more durable result.

Labiaplasty may be carried out:

• under local anaesthesia combined with intravenous sedation;
• sometimes under spinal anaesthesia;
• in certain situations, under general anaesthesia.

Most frequently the procedure is carried out as day surgery, with the patient going home on the same day after a few hours of observation.

In certain cases a short hospital stay may be recommended.

After labiaplasty the following may appear:

• slight bleeding for a few days;
• local swelling;
• bruising;
• a feeling of tightness or discomfort.

Pain is usually moderate and can be controlled with ordinary painkillers.

Recommendations:

• wear loose and comfortable clothing;
• avoid pressure and rubbing of the operated area;
• carry out intimate hygiene as recommended by the doctor;
• use a soft towel to dry the area.

The sutures are usually absorbable and disappear on their own within approximately 8-12 days.

Resuming sexual activity is recommended after approximately 3-4 weeks, depending on healing.

Sports that involve pressure on the area (cycling, horse riding) should usually be resumed after approximately 2 months.

In most cases prolonged sick leave is not necessary.

Possible imperfections of the result

The following may sometimes persist:

• a slight asymmetry;
• an insufficient reduction in volume;
• the persistence of forward extensions.

If an additional correction is necessary, it is preferable after a period of complete healing, usually after 6-12 months.

Possible complications

Like any surgical procedure, labiaplasty involves certain risks.

Complications are rare, but they may occur.

General complications:

• reactions to the anaesthesia;
• venous thrombosis or pulmonary embolism (rare);
• bleeding.

Local complications:

• a haematoma which may require evacuation;
• infection;
• delayed healing;
• partial opening of the sutures;
• necrosis of a small portion of tissue (very rare);
• persistent changes in sensitivity (exceptional);
• increased sensitivity or pain at the level of the labial edge.

Choosing a qualified surgeon and following the post-operative recommendations significantly reduce the risk of these problems.

The result begins to be appreciable after approximately one month.

During this period:

• the shape of the labia becomes more harmonious;
• the swelling subsides;
• the scars begin to fade.

The scars usually become difficult to see after 1-2 months.

The aim of the procedure is to improve comfort and appearance, not to attain anatomical perfection.

When expectations are realistic, patients are generally satisfied with the result.

Labiaplasty is a procedure that can improve physical comfort, confidence and quality of life when there is significant hypertrophy of the labia minora.

Like any operation, it involves benefits, limits and risks which must be discussed in detail with the surgeon before the decision is taken.