Labia minora hypertrophy
- Marc R Laufer, MD
Marc R Laufer, MD
- Professor of Obstetrics, Gynecology, and Reproductive Biology
- Harvard Medical School
- Jhansi Reddy, MD
Jhansi Reddy, MD
- Clinical Assistant Professor
- Obstetrics and Gynecology
- New York University Langone Medical Center
Girls and women sometimes seek medical and surgical attention due to concerns about the appearance of their external genitalia. One area of concern is the size of the labia minora, although a variation is size is consistent with normal anatomy. Clinical labia minora hypertrophy remains a poorly defined diagnosis. Interest in surgical correction of vulvar appearance may be associated with trends in pubic hair removal, exposure to idealized images of genital anatomy through digital applications or websites, and awareness of cosmetic vulvovaginal surgery .
The clinical manifestations, diagnosis, and treatment of hypertrophy of the labia minora will be reviewed here. Congenital anomalies of the reproductive tract and vulvovaginal discomfort syndromes are discussed separately. (See "Diagnosis and management of congenital anomalies of the vagina" and "Congenital cervical anomalies and benign cervical lesions" and "Clinical manifestations and diagnosis of congenital anomalies of the uterus" and "Clinical manifestations and diagnosis of generalized vulvodynia" and "Clinical manifestations and diagnosis of localized vulvar pain syndrome (formerly vulvodynia, vestibulodynia, vulvar vestibulitis, or focal vulvitis)".)
Labia minora hypertrophy is a largely subjective condition. This issue is usually brought to medical attention due to vulvar discomfort, functional symptoms (interference with activities), or concern about vulvar appearance. Discussion with the patient about symptoms and a physical examination help to guide management.
Symptoms — Hypertrophy of one or both labia minora can result in irritation, chronic infection, poor hygiene, or pain. In addition, the patient may complain that the labia interfere with activities including walking or sitting, sexual activity, and/or sports (eg, running, cycling, horseback riding, or swimming). A woman may describe discomfort with the fact that there is a "bulge" in her underwear. She may report that she needs to "fold up" her labia and push them into the vagina to reduce the bulge.
Concerns about the appearance of the labia minora can result in considerable emotional distress [2-7]. Given the physical and emotional changes that accompany puberty, adolescent girls are a particularly vulnerable group. For example, girls may become very self-conscious about the size of the labia if they need to change their clothes in the presence of their peers [2-8]. It is also important to make sure that it is the girl who is distressed, not anyone else (eg, parents, peers, sexual partner).
- Committee Opinion No. 662: Breast and Labial Surgery in Adolescents. Obstet Gynecol 2016; 127:e138.
- Rouzier R, Louis-Sylvestre C, Paniel BJ, Haddad B. Hypertrophy of labia minora: experience with 163 reductions. Am J Obstet Gynecol 2000; 182:35.
- Munhoz AM, Filassi JR, Ricci MD, et al. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast Reconstr Surg 2006; 118:1237.
- Laufer MR. Structural abnormalities of the female reproductive tract. In: Pediatric & Adolescent Gynecology, 6th ed, Emans SJ, Laufer MR (Eds), Wolters Kluwer Lippincott Williams & Wilkins, Philadelphia 2012. p.188.
- Reddy J, Laufer MR. Hypertrophic labia minora. J Pediatr Adolesc Gynecol 2010; 23:3.
- Alter GJ. A new technique for aesthetic labia minora reduction. Ann Plast Surg 1998; 40:287.
- Kato K, Kondo A, Gotoh M, et al. Hypertrophy of labia minora in myelodysplastic women. Labioplasty to ease clean intermittent catheterization. Urology 1988; 31:294.
- Jothilakshmi PK, Salvi NR, Hayden BE, Bose-Haider B. Labial reduction in adolescent population--a case series study. J Pediatr Adolesc Gynecol 2009; 22:53.
- Veale D, Naismith I, Eshkevari E, et al. Psychosexual outcome after labiaplasty: a prospective case-comparison study. Int Urogynecol J 2014; 25:831.
- Freidrich EG. Vulvar Disease, 2nd ed, WB Saunders, Philadelphia 1983.
- Radman HM. Hypertrophy of the labia minora. Obstet Gynecol 1976; 48:78S.
- Gowen RM, Martin VL. Labia minora reduction in an iron-lung disabled woman. Obstet Gynecol 1988; 71:488.
- Moran C, Lee C. What's normal? Influencing women's perceptions of normal genitalia: an experiment involving exposure to modified and nonmodified images. BJOG 2014; 121:761.
- www.largelabiaproject.org (Accessed on June 28, 2016).
- Motakef S, Rodriguez-Feliz J, Chung MT, et al. Vaginal labiaplasty: current practices and a simplified classification system for labial protrusion. Plast Reconstr Surg 2015; 135:774.
- Oranges CM, Sisti A, Sisti G. Labia minora reduction techniques: a comprehensive literature review. Aesthet Surg J 2015; 35:419.
- Hodgkinson DJ, Hait G. Aesthetic vaginal labioplasty. Plast Reconstr Surg 1984; 74:414.
- Laufer MR, Galvin WJ. Labia hypertrophy: A new surgical approach. Adolesc Pediatr Gynecol 1995; 8:39.
- Pardo J, Solà V, Ricci P, Guilloff E. Laser labioplasty of labia minora. Int J Gynaecol Obstet 2006; 93:38.
- Murariu D, Jackowe DJ, Parsa AA, Parsa FD. Comparison of wedge versus straight-line reduction labioplasty. Plast Reconstr Surg 2010; 125:1046.
- Liao LM, Michala L, Creighton SM. Labial surgery for well women: a review of the literature. BJOG 2010; 117:20.
- Alter GJ. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast Reconstr Surg 2008; 122:1780.