Labiaplasty

Are you considering Labiaplasty?

You may be thinking about having a labiaplasty for several reasons:

• • You may be self-conscious about the appearance of your labia minora, and this may have been the case for some time
  • Your labia may have enlarged after childbirth or with the natural ageing process
  • You may experience discomfort with certain sporting activities or when wearing tighter clothing
  • The cosmetic appearance of your labia minora is affecting your sexual confidence

A Labiaplasty or labia reduction is designed to decrease the size of the labia minora, or ‘inner lips’ of the vagina. Labiaplasty can be an embarrassing topic to discuss. However, there is greater awareness about the potential benefits of the procedure, and it is known to have a high satisfaction rate.

Labiaplasty can be combined with clitoral hood reduction when needed.

What is normal and why the controversy?

Labia minoras come in all shapes and sizes, and there is no definition of what is “normal” or “abnormal”.

Useful further information on vulval anatomy.

There is some controversy around labiaplasty, and it can be referred to as “designer vagina” surgery. We have a useful article exploring the main issues around this type of surgery. Please see further reading section below.

The procedure itself

Labia minora reduction is a surgical procedure. We use the wedge excision method which avoids leaving scars over the outer edge of the labia. Most of the sensitive labial tissue is left behind, and it is the extra, loose skin, which is removed.

Surgery is carried out under local or general anaesthetic as a day procedure. There is some discomfort for a few days after the surgery and swelling is expected to last no more than 7-10 days.

We do not post before and after images of labiaplasty on our website. You will be shown several before and after images including images immediately after surgery during your consultation.

Patient experience of labiaplasty in our clinic (external independent website

Your care

Please be assured that we will treat you with a level of professionalism, discretion and sensitivity expected of UK trained (FRCS Plast) NHS plastic surgeons practising at reputable, accredited private hospitals in Edinburgh. We all have expertise in gynaecological reconstructive plastic surgery. 

Labiaplasty Risks

The majority of women having the procedure are pleased with their results.

The following risks and complications can occur:

Minor spotting is common. Rarely, bleeding may occur that causes pain and swelling and can require a return to theatre to stop the bleeding and remove the clot that has formed.

Some swelling is expected over the first few days and varies between patients. The swelling can look dramatic, and it usually settles down by ten days.

Infection is relatively uncommon and may require treatment with antibiotics.

Delayed wound healing can result if the wound opens up. Wound problems can leave a notch which may require revision if it is noticeable.

The scars using the “wedge technique” are well hidden and settle well. Rarely scars can be sensitive and painful, but this usually improves with time.

You can expect a minor degree of asymmetry – this is normal.

A small number of patients (approx. 5%) may require further surgery to correct residual problems.

How much does labiaplasty cost?

Local anaesthesia £2500

General anaesthesia £3000

Consultation £150

All inclusive costs for one year following surgery

Further reading

Information from British Association of Aesthetic Plastic Surgeons BAAPS

Article exploring reasons for having labial reduction and the controversies

Several reports have shown that there has been a significant increase in the number of women seeking labiaplasty procedures both in the NHS and in the private sector. In the United States, there was a 49% increase in demand for labiaplasty from 2013 to 2014 and similar trends have been documented in other Western countries, including the UK and Australia.

Labiaplasty most commonly involves reducing the size of the labia minora, with the goal of achieving minimal or no protrusion of the labia minora beyond the labia majora. It may also be performed to correct asymmetry.

The procedure remains controversial for some, and this article is designed to discuss some of the main issues surrounding labiaplasty.

Why do women have labiaplasty?

Research shows that cosmetic concerns are the primary motivation for women seeking to undergo labiaplasty, followed by physical issues of both a sexual and non-sexual nature. For example, a study of 163 labiaplasty patients in 2000 showed that cosmetic dissatisfaction with labia (87%), discomfort when wearing clothing (64%) or when taking part in sports (26%), and painful sexual intercourse (43%) were the main reasons for having surgery. A more recent study of 35 women showed that 71% had concerns with appearance, 69% with physical (non-sexual), 60% with sexual function and 45% with psychological symptoms such as self-esteem.

Designer vaginas or Designer vulvas?

Labiaplasty is referred to by some as designer vagina surgery. The labia form part of the external genitalia and anatomically speaking the labia minora are part of the vulva and not the vagina. Therefore the term designer vagina should not be used to encompass labiaplasty.

Female Genital Mutilation (FGM)

FGM is defined by the World Health Organisation (WHO) as procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. Some commentators have used this to describe labiaplasty in consenting adults as a form of FGM.

This definition fails to take on board the fact that the procedures listed by the WHO refers to ones which include partial or total removal of the clitoris or deliberate narrowing of the vaginal opening designed to prevent sexual intercourse. The vast majority of such procedures are carried out on unconsenting children against their will. Labiaplasty does not fall into this category.

A fourth category cited by the WHO includes: all other harmful procedures to the female genitalia for non-medical purposes. The critical term here is “harmful”. Labiaplasty has one of the highest satisfaction rates amongst all cosmetic surgery procedures. The risks of the surgery are well known, and a reputable surgeon will inform prospective patients of these risks. All cosmetic surgery procedures by definition carry a risk of adverse outcomes. To say that labiaplasty falls under this fourth category by the WHO is akin to arguing that all cosmetic procedures are harmful.

Pornography and media exposure

There have been many ill-informed opinions on the reasons for the increased demand in labiaplasty. For example, an article published in the Observer Newspaper in 2011 blamed the increase in labiaplasty surgery on pornography. Many other commentators have expressed similar concerns. While the increased availability of pornography and its idealised portrayal of women’s external genitalia may have affected women’s perceptions of their labia it is essential to look at the available evidence.

A recent study published in the Aesthetic Surgery Journal in 2006 by Sharp and coworkers looked at factors that Influence the decision to undergo labiaplasty.  They compared a group of 35 women seeking to undergo labiaplasty to a control group of 30 women who were not. The two groups did not differ on their exposure to female genitals on television and in their exposure to pornography. The authors did, however, demonstrate a more significant exposure to media images of female genitals in the labiaplasty group, specifically via the Internet and genital cosmetic surgery advertising. The authors conclude that – the issue with mainstream media being women’s primary source of information regarding female genital appearance is that the mainstream only displays a very narrow range of labial appearances. For women who are already concerned about their genital appearance, seeing images of female genitals on the Internet (some of which have been air-brushed) may confirm to them that they are “abnormal” and require surgery to become “normal”.

There is no doubt that increased awareness of cosmetic surgery and reality TV shows such as Embarrassing Bodies have contributed to an increased acceptance of cosmetic surgery procedures. While increased availability of pornography may have an influence, the evidence is lacking, and it certainly does not explain the whole picture.

Labial Pride Movement

The labial pride movement is a feminist movement to raise awareness of the regular appearance of the vulva and to defy the trend towards cosmetic surgery on the female genitals.

The London-based feminist group UK Feminista organised “the muff march” through Harley Street, an area synonymous with its private medical providers, in December 2011. More than 320 women paraded the street, with slogans like: “Keep your mitts off our bits!”, “There’s nothing finer than my vagina!”, and “Harley Street puts my chuff in a huff”.

Other groups have encouraged women to release images of their vulvas by posting photo submissions of anonymous vulvas on their websites. For example, visit the labia library — the aim being to establish a sphere for women to get realistic impressions of normal vulvas. Others have criticised such campaigns for giving the false impression that protruding labia are the anatomical norm and small inner labia are the adaptation to beauty standards.

In an effort to make “real women” feel better about themselves, some labia proud ladies are taking shots at girls whose labia look like the imaginary “Barbie” ideal. It turns out, some girls are actually born like that. Labia, like boobs or entire bodies, come in all shapes, sizes, colours and textures. Shaming one to make another type feel better is bad news. Think of it in terms of thin women who are often shamed or shunned in support of body image advocacy for larger girls. Jessica Sager 2013

What is normal?

We inform all of our prospective patients that there is no definition of what is normal when it comes to labia minoras. Labia come in all shapes, sizes and colours.

The artist Jamie McCartney has focused on female genital anxiety through his work ‘The Great Wall of Vagina‘. The Great Wall of Vagina comprises 400 plaster casts of women’s genitals arranged in ten panels. It is a provocative response to the exponential rise in cosmetic labial surgery. By confronting the viewer and revealing the diversity of female genital appearance, McCartney opposes any notion of a singularly “perfect” aesthetic, thereby forcing society to rethink its relationship with the vulva.

For any woman considering labial surgery, it is well worth reflecting on this quote,

Vulvas and labia are as different as faces and many people, particularly women, don’t seem to know that. McCartney hopes this sculpture will help to combat the exponential rise, seen in recent years, of cosmetic labial surgeries. This new fashion for creating ‘perfect’ vaginas sets a worrying trend for future generations of women.

Cosmetic surgery can be defined as “the intentional alteration of physical features to enhance the appearance“. With some procedures, there are also functional benefits such as relief of physical symptoms which many labiaplasty patients display. The argument that labiaplasty involves the removal or destruction of normal tissue is not valid in this context. Other common plastic surgery procedures such as breast surgery and facial rejuvenation essentially involve the alteration/ removal of “normal” tissue yet there is not the same controversy involved with these procedures.

“Barbie” Labiaplasty

Dr Alinsod, a gynaecologist from California, developed the “Barbie” labiaplasty. He describes the procedure as a more aggressive reduction of the labia minora to the point of complete excision. According to his website, this is the most popular technique of labial surgery Dr Alinsod performs, and the appearance most wanted on the West Coast.

This procedure is essentially a complete amputation of the labia minora and is achieved using the “trim” method of labiaplasty. While there is no definition of what is normal for labia minora size, what is not in doubt is that it is normal to have some labia minora!

In our practice, we would never perform a complete amputation of the labia minora, and the technique we use (“wedge” method) makes it impossible to remove too much tissue as it would not be possible to close the wounds edges together.

Trends in shaving/ tighter clothing

Recent trends in shaving the pubic area have also been postulated to have made women more aware of labia minora which may be protruding. Likewise, the trend in tighter clothing such as skinny jeans may also be implicated in increasing possible discomfort.

Evidence of labiaplasty outcomes

As mentioned previously, several studies have reported very high satisfaction rates amongst women who have had labiaplasty. These studies have been published not just by plastic surgeons but by gynaecologists and psychologists.

A recent study by Goodman and colleagues published in 2016 supported earlier findings that body, genital, and sexual dissatisfaction shown by labiaplasty patients improved with time following surgery. Over time, rates of genital, body, and sexual satisfaction among study participants became equal to or better than rates for the control group in their study.

A sizeable multicenter study looking at 258 women who had female genital cosmetic surgery found that 91.6% of patients were satisfied with the results of their operation after a 6-42 month follow-up. Significant subjective enhancement in sexual functioning was noted, and complications were acceptable and not of significant consequence.

Author:

Dr Omar Quaba

Consultant Plastic Surgeon

MA FRCS (Plast)

Disclaimer: Article written by a plastic surgeon who performs labiaplasty

References:

A large multicenter outcome study of female genital plastic surgery.
Goodman MP, Placik OJ, Benson RH 3rd, Miklos JR, Moore RD, Jason RA, Matlock DL, Simopoulos AF, Stern BH, Stanton RA, Kolb SE, Gonzalez F.
J Sex Med. 2010 Apr;7(4 Pt 1):1565-77

Evaluation of Body Image and Sexual Satisfaction in Women Undergoing Female Genital Plastic/Cosmetic Surgery.
Goodman MP, Placik OJ, Matlock DL, Simopoulos AF, Dalton TA, Veale D, Hardwick-Smith S.
Aesthet Surg J. 2016 Oct;36(9):1048-57

Factors That Influence the Decision to Undergo Labiaplasty: Media, Relationships, and Psychological Well-Being.
Sharp G, Tiggemann M, Mattiske J.
Aesthet Surg J. 2016 Apr;36(4):469-78.