Genital surgery for women
Labial augmentation | Labial firming | Clitoral firming | Vaginoplasty | Perineal scars | Firming of the mons pubis
Labial reduction is a form of labiaplasty and refers to a surgical procedure to reduce the inner labia (labia minora).
Enlarged or asymmetrical labia minora may be present at a young age (known as congenital variants) or may accentuate over time. Having labia that are particularly large or long can cause women considerable psychological problems. Many of these women seek treatment because of problems they experience when wearing tight clothing, when swimming or during sexual activity. Feelings of shame and rejection are not infrequent in these cases. Sometimes labia that are too large can cause problems that are not only aesthetic but also physical, such as when their size means that they lead to pain or discomfort during sports such as cycling or horseback riding, for example. Labial reduction is the most frequently performed procedure within the field of labiaplasty and can enhance the wellbeing of women tremendously.
CAUSES AND SYMPTOMS – REDUCTION OF THE INNER LABIA
In addition to congenital enlargement of the labia minora, the main cause of anatomical change is due to ageing. The older the woman is, the larger the inner labia and the smaller and less full the outer labia are. This is part of the natural ageing process. Multiple pregnancies, hormonal treatments and weight loss or gain also amplify this process.
Physical symptoms can arise if the inner labia are no longer covered by the outer labia, allowing them to dry out and leaving them insufficiently protected from pressure and chafing. This can lead to pain, irritation and recurring infections.
Many women feel ashamed, won’t wear tight clothing and even avoid sports activities.
THE OPERATION – LABIAL REDUCTION
After taking the patient’s history and performing a clinical examination, the procedure is usually performed on an outpatient basis under general anaesthetic, or under local anaesthetic if preferred. The most commonly used surgical technique, which is associated with the fewest complications, is longitudinal resection (lazy-S resection), in which the protruding part of the inner labia is removed. Figure 1: Before the labial reduction, the excess skin is marked. This varies in each individual.
Figure 2: The procedure is performed under local anaesthetic on an outpatient basis. The labia are anaesthetised using a local anaesthetic. The excess tissue is then removed with a scalpel and the bleeding is stanched.
Figure 3: Absorbable sutures are used on the labia. These stitches do not have to be removed.
(From left to right)
Possible side effects and complications for this relatively small procedure are manageable. However, in rare cases, these may include aesthetically unsightly scars, prolonged weeping of the wounds, soft tissue damage and discomfort.
As a woman ages, the outer labia can become smaller and less full. To compensate for the loss of volume, they can be reconstructed with fat grafting using the woman’s own tissue or with hyaluronic acid. Building volume with hyaluronic acid alone can be carried out under local anaesthetic. Fat grafting using the woman’s own tissue is performed under general anaesthetic. This surgery is often combined with additional firming of the outer labia.
If there is loss of volume in the outer labia, the lack of fullness can mean that there is excess skin. The outer labia can look empty and wrinkled. The excess skin can be removed in a brief procedure so that the outer labia appear smooth again. If desired, they can also be filled for additional volume (with the woman’s own fatty tissue or hyaluronic acid).
Too much skin around and above the clitoris can be problematic both sexually and aesthetically. In a short procedure, the excess skin can be carefully removed so that the clitoral hood looks smoother. This surgery is often combined with reduction of the inner labia.
Following several pregnancies and births, the entrance to the vagina can be enlarged and may not return to its original form by itself. Many women feel that something is not quite right “down there”. Concerned patients may describe “feeling open”. Sexual intercourse is no longer experienced as being intense. In this case, the vaginal entrance can be surgically reduced.
Perineal tears may occur during birth or an episiotomy may be performed. The resulting scars may not heal in a satisfactory way. If this causes problems, correction of the scar can be performed.
If weight gain is significant, it can lead to considerable unwanted enlargement of the mons pubis. If desired, this can be reduced through liposuction. If excess skin is present, this must also be removed.