One of the concerns that some of my patients have regards their genitalia, specifically the size of the labia minora. There are two sets of female genital “lips”. The outer lips. or labia majora are thick skin folds that comprise the outer border of the female genitalia. They are of variable length, but even when on the longer side, they still only measure no more than 2 cm or so. The labia majora are thick, and as such, are not very movable. The inner lips, or labia minora, are much thinner than the outer lips. They lie on either side of the border of the vaginal opening. The outer layer of the labia minora is comprised of skin. The inner layer is comprised of vaginal mucosa transitioning to skin as you move away from the vaginal opening towards the thigh. The intervening tissue between these layers is only a couple of millimeters thick. The length of the labia minora, from vaginal opening towards the thigh is very variable. Sometimes the length can be up to 4 or 5 centimeters (about 2 inches).
In most women, when standing, the labia minora are either flush (even) with the labia majora or even receded back behind the labia majora and not visible from view. When the labia minora are lengthened, they protrude past the labia majora and hang beyond them downward. For women, a lengthened labia minora is a cause of concern. For some women, the appearance of the lengthened labia is a concern for aesthetic reasons. Back in 1995, the first labiaplasty I performed was on a woman who was a nudist and was concerned about the appearance of her genitalia. The other concern is more functional. For some women, a lengthened labia gets pulled into the vagina during intercourse and this causes discomfort. Whether for aesthetic concerns or functional issues, a labiaplasty is an easy to perform procedure that will address both of these problems.
How is labiaplasty performed?
Prior to going to the operating room, the patient is marked with a gentian violet surgical skin marker while she observes using a large hand held mirror. This allows her to give me input upon exactly how much tissue she desires to remove, rather than me try to venture a guess. Every woman has a personal preference and this preference is variable. There is no right or wrong here. It’s whatever the woman is comfortable with. Labiaplasty is best performed under general anesthesia, although it could be performed under local anesthesia. My personal opinion is that a woman would be far more comfortable having the surgery performed while asleep than being subjected to local anesthesia being injected into such a sensitive area. After the excess tissue is removed, the skin is closed with an absorbable suture, so no suture removal is required. After surgery, the patient applies bacitracin ointment a few times a day to the area to prevent infection and scabbing. The labia minora are fairly swollen for several days, but this resolves over the next few weeks. There is no other dressing required, other than a thick pad such as a maxi pad or combine dressing for the first few days. There is no problem with toileting. Sexual intercourse can be resumed in about two weeks when the wounds are healed and not tender.
In my experience, patient satisfaction has been very high with this procedure. Complications are very rare, and have been limited to small areas of wound separation that healed spontaneously with no special care other than application of bacitracin ointment.