Labiaplasty is a surgical procedure that refers to the reduction in size of the labia minora, the thin inner lips of the vaginal introitus.
This is mostly a cosmetic procedure and as such efforts are aimed at making the surgery as minimally invasive as possible, keeping the size and shape of the introitus essentially unchanged, and matching the color and texture of the labia as closely as necessary, while preserving the circulation and nervous supply.
It may be a reflection of the modern obsession with sexuality and promiscuous sexual practices that labiaplasty has gained a sudden popularity in the developed countries out of proportion to its practical utility.
Firstly, it is important to note that there is a wide range of labial sizes which are encountered in perfectly normal and asymptomatic women, so that defining labial hypertrophy is itself a difficult task.
Various distances from the midline to the edges of the labia minora have been assigned ‘abnormal’ status, while lately it has become the fashion to measure labial protrusion from the level of the surrounding skin as well as the distance from the lateral edge of the labia minora to that of the labia majora.
Again, many studies have shown that women who want ‘designer’ labia are influenced by pornographic and other images, mostly of prepubescent girls, or edited images showing vulval structures resembling those of younger girls. They are often not aware that the normal mature labia are larger than those of a girl who has not attained maturity, under the influence of the female hormones. They then form noticeable folds of thin skin on either side of the vaginal opening, without obstructing it or causing any other physical problem.
Male partners used to pornography images may also sometimes contribute to the problem by thinking that the woman’s labia are abnormally large due to their false expectations born of unrealistic media exposure.
Since there are very few medical reasons for why a woman ought to have smaller labia, guidelines to regulate this ostensibly medical procedure are lacking. There are a number of non-medical reasons why a woman might request it to be done.
One may be a false image of what normal labia look like, similar to body dysmorphic disorder (BDD), which may have to be dealt with, probably by psychological counseling. It is also true that many patients exaggerate or even make up physical symptoms to account for their request for a labiaplasty, despite really wanting it for aesthetic reasons.
More than two of every three labiaplasty subjects cited aesthetic reasons, either solely or in part, for their desire to have it done. In defence, many surgeons point to the high rate of patient satisfaction following the surgery as sufficient reason to perform it.
The primary reason for performing this surgery continues to be because “the patient wants it to be done” due to dissatisfaction with the appearance or feeling that the labia are asymmetrical.
Functional problems due to irritation of over-large labia and psychological distress due to the labia being visible when wearing extremely tight or very scanty clothing are much rarer as reasons for labiaplasty.
Some supposedly genuine indications are listed below, said to be due to enlarged labia, such as:
- Hypertrophied labia which cause irritation during sports or hobby activities that require constant sitting or wearing of tight-fitting underclothing
- Dyspareunia due to labial enlargement
- Chronic urinary tract infection due to pooling of sweat or secretions in the space created by labial hypertrophy
- Difficulties with altered odor or hygiene of the genitalia due to enlarged labia minora, including not being able to wipe properly with toilet paper or itching due to bacterial accumulation
However, even in these cases it is significant that these complaints are often prompted by advertising relating to the presumed (but unproven) role of labia in causing the alleged discomfort.
Thorough study is necessary before women subject normal parts of their genital apparatus to the surgeon’s knife for what is after all a purely cosmetic surgery. Moreover, it is well known that surgery on the genital area can disrupt nervous and vascular connections and deprive the woman of full sexual pleasure in the future.
The really urgent indication for reshaping the female vulva would be in the case of a person with ambiguous genitalia to improve the chances of a normal sexual life. This includes feminizing the shape of the clitoris and labia, or removing the fusion between the labia which occurs in some cases.
However, this often requires repeated surgeries before the desired feminine shape is attained surgically. Moreover, this has never been shown to be of benefit in achieving the normal psychological mindset appropriate to the female sex. And when female genital anatomy shows such wide variations, it would be arrogant to set up any fixed parameters as achieving a ‘feminine’ appearance.
Acceptance of the limitations and correction only within essential limits would probably be a better choice for the patient.
Some researchers have found that dyspareunia does not always improve after labiaplasty, perhaps because the true difficulty was psychological rather than physical. Again, a history of feeling unattractive because of supposedly ‘large’ labia may overshadow future encounters with one’s partner as well.
Whatever the indication is, a woman desiring a labiaplasty should be properly counseled as well as have opportunity to consider the risks and the expense (usually not covered by health insurance) associated with the procedure.
In addition, the results may feel to meet expectations, though this is rare. The discomfort attributed to large labia may be due to other medical issues.
Most importantly, it does not address the psychological factors responsible for the negative feelings about one’s body but allows the woman to shift the responsibility for her present condition on the doctor doing the procedure.
Reviewed by Afsaneh Khetrapal BSc (Hons)