Labiaplasty

Overview

Labiaplasty is a surgical procedure aimed at altering the size of your labia, which are the folds of skin surrounding the opening of your vagina. Typically, individuals opt for this surgery to address physical discomfort or as a component of gender-affirming procedures. While some may consider labiaplasty for cosmetic reasons, it’s crucial to understand that labia come in a wide range of shapes and sizes, and there is no singular “normal” or ideal appearance for them.

The labia consist of two sets of folds: the labia majora, also known as the outer lips, and the labia minora, or inner lips. The labia majora are the larger, fleshy folds that provide protection to your external genital organs and become covered with pubic hair after puberty. In contrast, the labia minora are the smaller, inner folds that safeguard the openings of your urethra (where urine exits the body) and your vagina.

During a labiaplasty procedure, the surgeon may choose from different techniques depending on the patient’s specific needs:

• Reduction: If the goal is to decrease the size of the labia, the surgeon will remove excess tissue from the labia.
• Augmentation: In cases where enlargement is desired, a filler material or fat may be injected into the labia to increase their size.
• Reconstruction: For certain individuals, the surgeon may reconstruct the labia using tissue from other areas of the body.

Enlarged labia can cause from various factors, including pregnancy and childbirth, fluctuations in body weight, genetic predispositions, hormonal changes associated with menopause, and growth spurts during puberty. Typically, individuals seeking labiaplasty fall between the ages of 18 to 50, but it is prudent to contemplate the procedure after completing one’s family planning due to the potential for labial stretching during pregnancy and childbirth. Labiaplasty for minors is only considered when it becomes imperative to address issues significantly impacting daily function and activities.

Reasons for undergoing the procedure

Labiaplasty, a surgical procedure aimed at altering the appearance and function of the labia minora and/or labia majora, is performed for various reasons. These can be broadly categorized into medical and physical reasons, cosmetic and emotional reasons, as well as instances where it is a component of gender-affirming surgery.

Medical and physical reasons:

• Size reduction: Labiaplasty is conducted to reduce the size of the labia minora, ensuring they do not protrude beyond the edges of the labia majora. This helps prevent physical discomfort, irritation, and potential complications that can arise during activities like exercise, biking, jogging, and sexual intercourse. Excess labial tissue can get twisted, pinched, or tugged, leading to discomfort.
• Hygiene and health: Excessive labial tissue can impede proper cleansing and create an environment where bacteria can thrive. This may increase the risk of urinary tract infections (UTIs). Labiaplasty can improve hygiene and overall health by addressing these concerns.

Cosmetic and emotional reasons:

• Symmetry enhancement: Labiaplasty can be chosen to address aesthetic concerns, such as asymmetry in the labia minora or labia majora. When one side is longer or differently shaped than the other, some individuals may opt for surgery to achieve a more symmetrical appearance.
• Emotional well-being: For many individuals, the appearance of their genitalia plays a significant role in their self-confidence and comfort during intimate moments. Labiaplasty can contribute to improved comfort, self-assurance, and overall sexual well-being by enhancing the appearance of the genital area. It is essential to recognize that labial appearance varies widely, and there is no universally defined “normal” appearance.

Gender-affirming surgery: In the context of gender-affirming surgery, labiaplasty can serve a pivotal role. During this process, surgeons may utilize existing genital tissue to create labia, aligning the individual’s physical characteristics with their gender identity. Labiaplasty may also be performed either before or after other reconstructive surgeries as part of the broader gender-affirming journey.

Risks

Complications are rare, but may encompass:

• Scars
• Bleeding
• Bruising
• Infection
• Wound breakdown
• Excessively extracting tissue or insufficient removal of tissue
• Continual pain, discomfort during sexual activity, or diminished sensitivity

Before the procedure

First, you will have a consultation with your surgeon to discuss your reasons for wanting to undergo labiaplasty. During this discussion, you will also talk about your expectations and desired outcomes, as well as the potential risks associated with the surgery. Additionally, a psychological assessment may be conducted to assess any underlying issues such as depression or anxiety.

Following the consultation, your surgeon will provide a detailed explanation of the surgical procedure. This will include information on where incisions will be made and what changes you can expect in terms of the size and shape of your labia.

Before the surgery, you may be required to undergo various presurgical tests, including blood work, urinalysis, and a chest X-ray. Your surgical team will provide instructions on:

• Appropriate attire for the day of the procedure.
• Guidelines for fasting before the surgery.
• Necessary adjustments or temporary cessation of certain medications.

In addition to these instructions, your surgical team will provide you with further details on how to prepare for your surgery.

During the procedure

Upon arrival, you will be instructed to change into a surgical gown. A doctor will assess your vital signs, including temperature, pulse, blood pressure, oxygen level, and breathing rate. Additional blood work and urinalysis may be conducted. An Intravenous line (IV) will be established in your arm or hand, and a urinary catheter may be inserted into your urethra.

Subsequently, the doctor will cleanse and shave the pubic area as needed. The administration of anesthesia follows, with the option of IV sedation alongside local anesthesia or general anesthesia, contingent upon the nature of your procedure. The choice of anesthesia will have been discussed during the pre-surgical planning phase.

The doctor will then determine the appropriate surgical technique based on the desired resizing or reshaping of your labia (labia majora and/or labia minora). Typically, the surgery is performed using a scalpel, scissors, or laser.

Reduction procedures

There are two primary methods for diminishing the size of your labia (labia minora and/or labia majora):

• Trim procedure. Under this method, your surgeon eliminates surplus tissue from the outer edges of one or both sides of your labia minora, ensuring they are level with or contained within the borders of your labia majora.
• Wedge procedure. In this technique, your surgeon excises a wedge or pie-shaped segment of tissue from the inner regions of one or both sides of your labia minora. The submucosa is preserved, ensuring the wrinkled edge of your labia remains intact after suturing. This preserves a more natural appearance for your labia minora. Likewise, if you are undergoing surgery to diminish your labia majora, your surgeon eliminates an inner section from each labium of your labia majora.

Alternative approaches may be employed by your surgeon, contingent on their surgical proficiency or your specific desired outcome. Collaboratively, you and your surgeon will decide on the most suitable surgical approach that aligns with your goals and addresses your concerns.

Enlarging procedure

To augment the size of your labia majora, your surgeon extracts a small quantity of fat from another area of your body, such as your abdomen or thigh (utilizing a liposuction procedure), and injects it into your labia majora. Alternatively, an alternative option involves injecting hyaluronic acid into your labia majora.

Gender-affirming surgery

Your surgeon has the option to utilize tissue from the penis for the construction of your labia. It’s important to note that labiaplasty constitutes just one phase within the comprehensive gender-affirming reconstructive surgery process.

In all the procedures outlined above, the incisions are sealed with absorbable stitches (sutures) that naturally dissolve over time. Subsequently, your surgeon concludes the process by applying a surgical dressing to the site.

Labiaplasty is conducted on an outpatient basis, generally lasting less than two hours. In contrast, gender-affirming surgery necessitates a more extended duration.

After the procedure

Following the surgical procedure, your healthcare provider removes the urinary catheter (if one was inserted), and you gradually regain alertness as the effects of anesthesia diminish. The healthcare team monitors for any unexpected bleeding. Prior to your discharge, your providers furnish you with guidelines on caring for the healing wound. Additionally, they provide instructions on pain management, limitations on activities, and details about scheduled follow-up appointments.

Outcome

• Managing discomfort and swelling after labiaplasty:
  • Discomfort and pain management: It’s common to experience swelling, discomfort, and pain after labiaplasty. You can easily manage these symptoms with over-the-counter medications like acetaminophen or prescription medication, as recommended by your surgeon. If the discomfort persists despite medication, reach out to your surgeon for guidance.
  • Home Remedies: Cold compresses or ice packs can also help reduce pain and swelling. Apply an ice pack to the surgical area (over a cloth undergarment) on a 20-minute-on/20-minute-off schedule. Most individuals report only mild pain or tenderness for a few days.
  • Antibiotics: Your healthcare team may prescribe oral antibiotics or topical antibiotics to prevent infection in the surgical wound.
  • Clothing: During the healing period, wear loose-fitting pants and undergarments to avoid friction against the wound, which can hinder healing.
• Managing bleeding: It’s normal to experience minor bleeding for up to a week after surgery. You can use a pad to absorb this bleeding.
• Healing process: The initial swelling, soreness, and temporary discoloration will decrease over the first few weeks after surgery. Most swelling subsides after about six weeks. However, it may take four to six months for swelling to completely resolve and for you to see the final results of your labiaplasty. Scarring is usually minimal or absent.
• Post-Surgery Care:
  • Cleaning the Surgical Area: Use lukewarm water only (no soap) to clean your surgical wound. After urinating, gently dab the area dry, avoiding rubbing the surgical site.
  • Preventing Constipation: Your surgeon may recommend medication or dietary changes to prevent constipation, as straining can stress the stitches.
• Returning to normal activities: You can typically return to work and light activities a few days after surgery. However, if your job involves physical exertion or lifting, you may need more time off. Avoid strenuous exercise, physical activities like cycling and running, and sexual intimacy for four to six weeks or until your surgeon provides clearance. Prematurely engaging in these activities can put pressure on the wound, potentially causing stitch problems and delaying healing.
• Long-term results: Labiaplasty performed as a reduction surgery is intended to be a one-time, long-lasting procedure. Unless complications arise, you may not need additional surgeries. In contrast, enhancement labiaplasty involving injections of fat or fillers may require periodic touch-ups over time. Keep in mind that having children after your procedure may impact the results of your labiaplasty. Many individuals choose to undergo labiaplasty after completing their families.
• Contacting your surgeon: Reach out to your surgeon if you experience excessive swelling, worsening pain, increased bleeding, unusual discharge, severe discomfort during urination or bowel movements, fever, or if you notice any issues with the surgical site.