Increasing numbers of girls and young women are seeking medical and surgical attention due to concerns about the appearance of their external genitalia. One area of concern is enlarged labia minora, which usually are a variant of normal anatomy. Clinical labial hypertrophy remains a poorly defined diagnosis.
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, provoked vulvodynia (formerly vulvar vestibulitis)".)
DIAGNOSIS AND CLINICAL MANIFESTATIONS
There are no standard diagnostic criteria for the diagnosis of labia minora hypertrophy. Clinicians generally use labial width measurements or the presence of symptoms to determine treatment options.
Labial width — Labia minora hypertrophy is generally described as protuberant labial tissue that projects beyond the labia majora. However, there is no consensus among gynecologists, pediatricians, or plastic surgeons regarding the use of objective clinical measurements to confirm the diagnosis.
In an early description of this condition, Friedrich classified labia minora as hypertrophic when the maximal width between the midline and the lateral free edge of the labia minora (when the labia were extended laterally by the examiner) measured greater than 5 cm . Others have proposed that the normal width of the labia minora should be less than 3 to 4 cm [2,3].