Is the correction of unequal labia justified?
In the debate about morality and cosmetic surgery, everyone is entitled to their personal opinion. However, fact-based debates are not satisfied with expressions of opinion about “good or evil”. Obtaining a diagnosis and weighing a therapy requires study, specialized training and a certain amount of professional experience as a practicing physician. When properly indicated and performed, studies on labiaplasty show treatment success of over 90 percent, with few complications (Lista F, et al., 2015, Aesthet Surg J).
The argument that women should accept themselves as nature created them is not new. In the 1990s, it was common to point a moral finger at women who pursued their desire for beautiful attractive breasts. It was claimed that education about the various sizes and shapes of “normal” breasts would bring about women’s satisfaction and freedom from discomfort. For decades, research in the field of plastic and aesthetic surgery has focused on deviations from “normal sizes” and the reasons for dissatisfaction with appearance. The positive effects of plastic surgery on well-being and quality of life are very well documented scientifically for both reconstructive and aesthetic surgery (Papadopulos N.A., et al., 2007, J Plast Reconstr Aesthet Surg; McCarthy CM, et al., 2012, Plast Reconstr Surg; von Soest T., et al., 2011, Plast Reconstr Surg).
Physicians’ or physicians’ personal attitudes toward what they consider average may determine what you recommend to your patients. A personal bias may inadvertently lead to a failure to take the patient’s concerns seriously and to educate the patient fully and according to the state of medical science. Culture of guilt and culture of shame are incompatible with the values of medical ethics. Our goal is to help our patients in the best possible way to make an informed decision about their health.
Why are labia of equal size perceived as beautiful?
The body shape of humans, like that of vertebrates in general, is fundamentally symmetrical. Unlike in mathematics, the symmetry in biology is an approximate symmetry. Since there is no Perfect Symmetry in biology, it is not surprising that the mathematical symmetry of a photomontage is perceived as unnatural. A symmetrical body, symmetrical color patterns of flowers, butterflies and coral fish are intuitively perceived as beautiful. Symmetrical faces and symmetrical breasts are perceived as more beautiful than unequal ones. However, why humans and animals have preferred symmetry in such a way throughout evolution is not known (Enquist M, et al, 1994, Nature).
Epochs, cultures and individual perspective shape our perception of beauty. In addition, an average appearance, a youthful appearance, and symmetry are generally considered attractive. The following features of the female genital area are considered seductive:
- symmetrical labia minora, which do not protrude beyond the labia majora
- full labia majora that cover the inner labia
- a clitoral sheath that barely covers the glans
- a tight discreetly bulging pubic mound that does not protrude under clothing
What are the reasons for correction of unequal labia minora?
Women do not make the decision to have labiaplasty of unequal labia carelessly. Aesthetic reasons, i.e. the desire to improve the appearance are the most common motivations, similar to non-symmetrical breasts. However, there are also medical reasons for surgical correction. For example, unilaterally enlarged labia can impair the formation of the urinary stream or even cause pain during sexual intercourse. This in turn can have a negative effect on perceived female sexuality. In addition, affected women often suffer from skin irritation when wearing tight clothing and discomfort during sports. Labiaplasty of unilaterally enlarged labia is a safe plastic surgery procedure and is associated with high patient satisfaction (Surroca MM, et al, 2018, Ann Plast Surg).
What does the correction of unequal labia minora cost?
A cost calculation is made during the consultation. However, if you would like to gather more information about the price range in advance, please visit our cost page. Whether costs are covered by health insurance must be checked specifically. You can find an overview of this on our page on the insurance companies’ obligation to pay benefits.
The anatomy of the labia minora (labia minora)
The vulva (vagina) includes the mons pubis, the clitoris and its prepuce, the vaginal vestibule , the labia majora and labia minora. The labia minora of the female genital area are thin folds of skin located within the labia majora. The anterior union site of the labia majora is called the anterior commissure (commissura labiorum anterior). The posterior joining point of the labia majora toward the perineum is called the posterior commissure (commissura labiorum posterior) or fourchette. The labia minora cover and protect the clitoris, urethral opening and vaginal entrance. They form two folds in the anterior portion that enclose the clitoris. The upper pair of folds forms the foreskin of the clitoris, and the lower pair of folds is called the frenulum clitoridis.
The labia minora have important functions for the female sex organ. They keep the vaginal vestibule moist and prevent germs from entering the inner part of the female genitals. At the same time, they also protect the opening of the urethra. The labia are sensitive to touch and swell during sexual arousal. The labia minora are supplied by the external and internal labial arteries (external and internal pudendal arteries) and have a dense vascular network. The tissue is interwoven with numerous nerve endings and lymphatic vessels. There is no subcutaneous fat tissue in the labia minora (Cao Y., et al., 2020, Int Urogynecol J).
The color of the labia minora
The labia minora contain sebaceous glands and sweat glands. The dark color of the labia minora or pubis is caused by a higher concentration of the skin pigment melanin in the pigment cells (melanocytes) and the horn-forming cells (keratinocytes). These cells are located in the lowest layer of the epidermis (basal cell layer). Under the influence of sex hormones, such as during pregnancy, the areas can become darker in color. During sexual arousal, the small lips fill with blood and acquire an increasingly red color.
What is the “normal” size of the labia minora?
The length, and width of the labia minora vary greatly from individual to individual and change with age and body weight. The average width of the labia minora from the anterior to the posterior commissure is 4 centimeters. The length of the labia minora averages one centimeter (Kreklau A., et al., 2018, BJOG). If the labia minora protrude beyond the labia majora, this is called enlarged labia (labial hypertrophy) (Triana L, et al., 2012, Aesthetic Plast Surg).
When the labia minora protrude beyond the labia majora or are disproportionately larger than the labia majora, patients may find this aesthetically unappealing. Labia can also be enlarged on one side. Visible side imbalance can be associated with emotional discomfort and, to a certain extent, physical discomfort. Symmetry in the intimate area can be restored through a minimal surgical procedure to reduce or equalize the size. Labia surgery can meet the needs of women both cosmetically and functionally and improve the well-being of female patients.
What are the size divisions of the labia?
The size of the labia minora is indicated with the measurements of length, width and thickness in centimeters. Numerous classifications of labia size have been described. The proposed categories do not allow conclusions to be drawn about the severity of the complaint or treatment recommendations. The usefulness of these classifications is therefore controversial. Nevertheless, we would like to provide an overview of common classifications:
The first published classification of the maximum measured length of the labia minora by Felicio (Felicio Y, 1992, La Ver Chir Esth Lang Franc).
- I: The inner labium is smaller than two centimeters.
- II: The length of the inner labium is two to four centimeters.
- III: The length of the inner labium is four to six centimeters.
- IV: The inner labium is larger than six centimeters.
Classification of the maximum measured length of the labia minora according to Cunha (Cunha F., et al., 2011, Rev. Bras. Cir. Plást.).
- I: Excess skin in the posterior/lower region, adjacent to the vaginal entrance.
- II: Excess in the middle and anterior region, adjacent to the clitoris.
- III: Excess in the entire region, including the prepuce of the clitoris.
Modified classification of the maximum measured length of the labia minora by Chang (Chang P, et al., 2013, Aesthetic Plast Surg).
- The labia minora is less than two centimeters. The labia minora do not overhang the labia majora.
- The labia minora is larger than two centimeters and protrudes beyond the pubic cleft.
- The inner labium is larger than two centimeters and protrudes beyond the pubic cleft. In addition, the clitoral sheath overhangs the labia majora.
- The inner labium overhangs the clitoris and anus.
Classification of the maximum measured length of the labia minora according to Motakef (Motakef S, et al., 2015, Plast Reconstr Surg). Categories I to III are supplemented with the letters “A” in case of additional asymmetry and “C” in case of pendulous clitoral mantle.
- I: The inner labia is smaller than two centimeters.
- II: The length of the inner labium is two to four centimeters.
- III: The length of the inner labia greater than four centimeters.
The possibilities of correction of asymmetrical labia.
An approximation of the size of the labia can be aimed at from a size difference of one to two centimeters. Often the genital procedures or methods are combined, for example, with a clitoral mantle lift. If there is a size-related imbalance of the two labia minora, the expert can restore the symmetry of the vulva during a labia reduction procedure of both labia. A unilateral reduction is rarely performed. After labia minora reduction and clitoral hood tightening, 93 percent of women report an improvement in self-esteem, 71 percent have an improved sex life, and 95 percent have less discomfort (Alter GJ., 2008, Plast Reconstr Surg).
The goal of surgical reduction is to use a holistic approach to achieve average labia size, improve clinical symptoms, balance asymmetrical labia, and achieve a beautiful appearance. Enlargement of the labia majora in conjunction with reduction of the labia minora is a good procedure to rejuvenate the appearance of the vagina and thus the appearance of the entire genital area.
Commonly used surgical procedures include straight-line shortening of the labia minora (“edge resection”) and V-shaped removal of excess skin (“wedge resection”). Other techniques include epidermis removal (“deepithelialization”) and variation of flap plasty (“W-plasty”). In addition, Dr. Santos Stahl has experience with a variety of surgical techniques. This allows her to develop the appropriate surgical plan according to the patient’s specific findings and to choose the adequate procedures for labia reduction. In this way, the asymmetry can be compensated and the patient can be relieved of any discomfort.
Straight-line shortening – “edge resection”.
In the so-called “edge resection” the marginal area of the labia minora is removed. This technique was described as early as 1976 and continues to be performed with good success (Radman H.M., 1976, Obstet Gynecol). Asymmetrical or protruding labia minora can be corrected by the expert reducing the excess part at the edge. This technique is particularly suitable for the reduction or approximation of very prominent labia. For the average closure of the vaginal entrance, a minimum length of the labia minora of one centimeter must be spared. The edge area of the labia minora occasionally has a dark skin color, which can be perceived as disturbing. Here, this technique of labia reduction offers the advantage that with the excess, the dark skin of the labia are also reduced. The disadvantage of the technique is that the scar site on the outer edge of the labia is exposed and may be irregularly shaped. Skin peaking may occur at the ends of the suture site.
V-shaped reduction – “wedge resection”.
The V-shaped removal of excess tissue of the inner labia was described by the American plastic surgeon Alter in 1998 (Alter GJ., 1998, Ann Plast Surg). In this procedure, the protruding tissue is removed like a “V”. The doctor tightens the peripheral area of the labia. With this technique, labia of different length or volume can be aligned as-is well. The remaining scar is usually inconspicuous. The risk of excessive labia reduction tends to be less than with straight shortening of the labia minora. The likelihood of gaping wound edges is low with careful planning and execution, good postoperative care, and good health. Nevertheless, unlike straight labia minora shortening, follow-up surgery may be required if wound healing is impaired. Due to the tightening effect on the labia, additional clitoral sheath reduction should be considered with this technique.
Tightening of the inner labia – “deepithelialization”
A labia lift can be done by removing unwanted tissue, also known as deepithelialization. This is an extremely nerve-saving technique. By precisely planning the incision, the desired size and shape can be achieved precisely by reducing the size of the labia. The scars can be easily hidden in the natural skin folds and are therefore barely visible to the naked eye. The reduction can be done on the inside or the outside of the labia minora. A reduction in the size of the inner labia by one centimeter is possible with this procedure. Therefore, if the labia are large, an additional technique may be required.
How is labia surgery performed?
The operative symmetrical adjustment of the labia of unequal size can be carried out completely without pain in local anesthesia or in twilight sleep. An overnight stay in the clinic is not necessary. For your convenience, an anesthetic cream is applied in front of the syringe to provide local anesthesia. The surgical plan will be prepared in consultation with you by the specialist Dr. Transfer Santos Stahl to the skin with a marker.
In order to be able to work with the greatest precision, the doctor performs the reduction with magnifying glasses. The cut is always based on the individually adapted planning. The expert then gently removes the numb tissue that has been marked by the local anesthetic. At the end of the procedure, the wound is closed with fine, self-dissolving sutures. These dissolve on their own around 20 days after the labia reduction.
The duration of the outpatient surgery on the vulva is around 45 minutes. An inpatient stay with general anesthesia in a clinic is not necessary for the labia surgery. Immediately after the labioplasty, you will be continuously monitored in a so-called recovery room. You can have a drink after fully awakening and, if you can tolerate it, you can eat something too. When you go to the toilet for the first time, you will be supported by our nursing staff. Before you leave the practice, control appointments are made and the behavioral measures are discussed in detail with you. You will be given a comprehensive written report and a telephone number where you can reach the surgeon 24 hours a day in an emergency.
Before, after and even during the procedure, you can watch movies or your favorite series with virtual reality glasses. Not only is this entertaining, the distraction has also been shown to decrease sensitivity to pain.
Labia correction with a scalpel or laser?
In the general public, the thought of lasers and laser beams arouses associations with a modern, miraculous painless treatment. The use of lasers in surgery dates back to 1964 (Goldman L, et al, 1963, Nature). Nevertheless, the fascination for laser surgery in the media is unbroken. The exaggerated hopes have led to an ethically questionable use of lasers in medicine (Raulin C., et al, 2001, Lasers Surg Med). There are no scientific comparative studies. A leading plastic surgeon (surgeon) in the field of intimate surgery writes that using a scalpel, laser, or scissors to remove the unwanted tissue is probably irrelevant, but careful, side-by-side removal of the tissue and the occlusion is most likely to be irrelevant the most important are (Alter GJ., 2008, Plast Reconstr Surg). The fact that the cutting radius of a scalpel is over 2,000 times finer than that of the CO2 laser speaks against the use of the laser. The use of the scalpel enables a more precise operation and thus protects the surrounding tissue. PD Dr. Stahl has the specialist knowledge to carry out the risk assessment and the specialist knowledge to carry out calculations of exposure to laser radiation in accordance with Section 5 of the Occupational Safety and Health Ordinance on artificial optical radiation. Nevertheless, we refrain from using lasers, as this does not result in any benefit for our patients.
From what age can a labia correction be carried out?
The patient’s quality of life is crucial for the timing of the vaginal surgery. It is often difficult for outsiders to understand the suffering. Without medical training and many years of experience, neither the type nor the severity of a malformation can be assessed. Insecurity or fear of sexual contact can affect self-confidence and be very stressful. The questions of young patients are answered with great sensitivity by a very experienced plastic surgeon in a personal consultation with the parents. This appointment is very helpful for everyone involved. Before treating young women, the consent of both parents is essential. The careful risk assessment usually takes place in at least two meetings. Especially in the case of minors, it can be helpful for those affected and the parents to obtain a second opinion. The size and shape of the labia change only slightly after puberty. A labia correction can therefore be carried out for the first time before the age of 18 in justified exceptional cases.
What are the risks of asymmetrical labia correction
The surgical techniques of intimate surgery have been performed by plastic aesthetic surgeons with good success for many years. The scientific data is very good in comparison with related surgical techniques. The surgical results of over 1,200 patients are summarized here in extracts. 92 to 94 percent of patients are satisfied with the result of the intimate surgery and report an improved sex life and self-esteem (Alter GJ., 2008, Plast Reconstr Surg; Goodman MP, et al., 2010, J Sex Med; Rouzier R, et al., 2000, Am J Obstet Gynecol). In about 3 to 6 percent of cases, there can be mostly slight and temporary complications, such as wound healing disorders, an encapsulated thread (thread granuloma) or temporary scar pain (Alter GJ., 2008, Plast Reconstr Surg; Felicio YA., 2007, Aesthet Surg J) . Other general surgical risks are inflammation, secondary bleeding, thrombosis or embolism. Scarring complaints are very rare and can be corrected. Swelling is a temporary, common, and inevitable result of surgery. Compliance with behavioral recommendations after the labia surgery and the general state of health have a decisive influence on the complication rate. For example, cigarette smoking leads to more frequent wound healing disorders and inflammation. In a personal consultation, the specialist doctor answers frequently asked questions and analyzes your case together with you. It provides information on rules of conduct before and after the procedure.
Why can you contact Dr. Entrust Santos Stahl?
Competence, security and comfort are values that distinguish CenterPlast. Miss Dr. Santos Stahl is a highly qualified plastic surgeon who acquired her technical skills in Brazil and refined it in the USA as well as France and Germany. Brazil is the country where most of the pioneers in aesthetic and plastic surgery come from. Miss Dr. Santos Stahl is proficient in a variety of procedural techniques in intimate surgery. This means that she can offer you the technology that will produce the best results for you. Experience is essential for surgical planning as every patient is different. The decisive factor for the result of the labia correction is not only the perfect technical execution of the methods, but also sensitive listening in order to offer you the treatment that will satisfy you. Your concerns will of course be taken into account when selecting the surgical interventions. The joint decision is crucial to ensure your satisfaction.
How can you prepare for a labia surgery?
You have been thinking about a labia correction for a long time. Make sure you are well prepared. On our page about intimate surgery you will find some information and advice to be able to face the procedure as calmly and calmly as possible.
What should be considered after a labia surgery?
As after any operation, you should behave carefully after a labia surgery. Certain behaviors and physical activities can negatively influence or endanger the result of the operation. You can also accelerate the healing process through active follow-up care and have a positive effect on it. The postoperative guidelines and recommendations can be found on our page about intimate surgery.
Experience reports on correcting asymmetrical labia
Some women who have been treated at Centerplast in the past have agreed to share their experiences and have rated Centerplast doctors on Google and Jameda on the Internet. Visit the Testimonials page for more information.
Before and after pictures to correct asymmetrical labia
If you wish to see before and after pictures, you have the option of viewing anonymously during the consultation, for which the patients have given us permission. You can find more information about this possibility on our Before and After pictures page.
Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.