There has been an increasing awareness of genital appearance and function over the past decade.  As a woman ages, from puberty on up, the labia and the surrounding tissues change in shape, size and elastic tone.  These changes can be a  problem for many since childhood and for others it occurs following a pregnancy.  There is a wide variation in what any individual considers to be normal in the labial area.  In general most woman when asked consider the aesthetic ideal to be a labia minora that does not protrude past the outer labia majora.

Many woman are born with a labia that they consider too large or irregular.  It is also not unusual to have one side larger than the other.  The labia can be stretched or elongated as the result of childbirth or as a woman ages.  A common complaint from woman who have this condition is not so much at aesthetic appearance but a function encumbrance.   There can be sexual embarrassment while others may have pain or irritation when wearing a bathing suit or tight clothing.  Also can be pain in physical activities or  riding a bicycle. 

The large size of the labia can interfere with hygiene and can cause constant irritation. 

From a medical standpoint the most common cause of an enlarged labia minor is congenital.  The enlargement, while present at birth, becomes more prominent during puberty, pregnancy and aging. 

There have been many changes in the surgical approach to labial reduction.  The key to a technically sound approach is to avoid irritation to the outer edge of the labia, maintain sensitivity and function.  Most techniques, which will vary from patient to patient depending upon the size and degree of elongation of the labia, involve some type of central wedge excision or V excision of the overgrown portion and a reapproximation of the edges.  These techniques preserve the normal labial edge and color as well as decreasing the risk of pain or tenderness along the scar. 

In a publication by the American Society of Plastic Surgeons in March 2007 reported that some labiaplasty patients simply “have a desire to look neat,” while the majority of patients desire a labiaplasty “for a combination of aesthetics and to alleviate discomfort, be it during intercourse, wearing tight clothes or participatintg in horseback riding and other sports.  ASPS statistics prove that female genital surgery is one of the fastest growing types of cosmetic surgery in the U.S.  – It has increases 30% from 2005 to 2006. 

Who is a candidate for a labial reduction or labiaplasty?

You may be a candidate for a labiaplasty if you have a large, elongated or asymmetric labia that causes some of the following symptoms:

            Embarrassment in intimate settings

            Pain while exercising, riding a bicycle

            Discomfort when wearing a tight bathing suit or clothing

            Problems with hygiene, irritation or trapped moisture

            Painful sexual intercourse

            Labia that are noticeable when wearing tight clothing

 How is a labiaplasty performed? 
There are many different surgical techniques available for performing a labiaplasty.  Since each patient is unique the final scar and incision pattern may be different.  The surgical procedure selected are designed to avoid  potential advantages and disadvantages. Dr. Zwiren believes it is important to determine whether the location and position of any excess labial tissue and to remove it with the best surgical pattern available.   The excess labial tissue is excised followed by closure using dissolvable sutures. This technique preserves the normal labia edge and color with less chance for discomfort of the scar line.

Where is the labiaplasty performed? 

IDr. Zwiren performs most labiaplasty surgeries in our private accredited surgery center at  Prima Center for Plastic  Surgery.   

Are you thinking about Labiaplasty?

If you are considering surgery, we want you to be thoroughly educated about this procedure as possible. Reading our printed information is the first step in this process. However, a personal consultation with Dr. Zwiren is the best way to obtain any additional information you need. 

What is Labiaplasty?

Cosmetic surgery of the outer genital area and more specifically of the labia is also called labioplasty or labial reduction.  This procedure is often combined with a clitoral hood reduction.

Is Labiaplasty for me?

Women are often concerned about the appearance of their genital area.  There are many factors which have contributed to the rising popularity of a labiaplasty not the least of which is a growing understanding of large labia minora as a real problem with real symptoms.  In addition to being a purely aesthetic problem may women complain of some degree of discomfort in tight clothing as well as during exercise and sexual activity.   Abnormally large labia can also be a hygienic problem causing constant irritation.  Thanks to recent media coverage the demand and request for the procedure is on the rise. 

The inner labia may actually protrude so far out of the outer labia that it produces functional problems.  It may cause chaffing on underwear; it may cause folds which become irritated and painful. Large labia may also be visible through underwear or swim suits, causing embarrassment.

Consultation and Examination

During the initial consultation, you may be asked about your concerns and what you would like to see improved. 

You will be asked about your medical history including:

·         Previous operations

·         Past and present medical conditions

·         Current medications.

In order to provide you with the best information and safest options, it is important that you give us complete information. The medical conditions that may increase risks of surgery include high blood pressure, thyroid problems, diabetes and bleeding problems.

Physical examination will be performed, with a female nurse present at all times. The labial anatomy and the extent of the problem will be assessed and a plan for a possible corrective procedure will be formulated by your surgeon.

Preoperative photographs may be taken during your initial consultation or a subsequent visit with your consent. We will discuss with you the details of the operation and the possible risks and complications associated with the procedure.

Preparation for Surgery
We want to make your surgical experience as easy and comfortable for you as possible.
• Smokers must stop smoking 3 weeks before surgery.
• Aspirin and some anti-inflammatory drugs should be discontinued for 2 weeks prior to surgery
• It is helpful to have the genital area shaven or waxed several days prior to surgery as you will find it easier to look after the stitches after surgery.
• Apart from a normal diet and hygiene, no special preparation is necessary.

Labioplasty is performed in our office operating room under an anesthesia of your choice, this can include local anesthesia with oral sedation, conscious sedation or general anesthesia
.
The day of Surgery

The operation will take around 1to 1 ½ hours, depending on the type and extent of the operation.
The incisions will be places according to the preoperative plan formulated by your surgeon. The stitches used in the operation are dissolving, so that looking after the operation will be easier. Once the operation itself is finished, antibiotic ointment is applied to the sutures.

After Surgery
During the procedure a long acting local anesthetic will be used in order to decrease discomfort. After the procedure you will be taken to our recovery room where our nurses will continue to monitor your recover. The pain medication that was prescribed during your pre-operative visit is usually sufficient to control any discomfort after surgery.
Activities to be avoided include straining, bending and lifting. These activities can cause bleeding and increased swelling. The surgery itself may interfere with walking for the first few days but in general most patients are able to move about without discomfort. . It is important that you keep the area clean. Showering or warm sitz baths are helpful in keeping the area clean and reducing discomfort. The antibiotic ointment is to be applied to the suture lines 3-4 times a day to minimize the chance of infection. 

Normal appearing labia minora and clitoral hood	Hypertrophic labia minora
Aarea designed for surgical excision, in general a V shaped wedge is removed leaving the subcutaneous tissues intact, dissolvable sutures are used	Completed surgical repair of hypertrophic or enlaraged labia minora, the surgical repair can differ depending upon individual anatomy.
Labial hypertrophy with clitoral hooding	Surgical repair of labial hypertrophy with clitoral hooding