Labiaplasty - Labial Hypertrophy

Labial Hypertrophy

Etiology

The causes of labial hypertrophy, the overdevelopment of the labia minora, are etiologically varied, and can derive from factors such as the woman having been born with oversized labia (genetic inheritance), or having been caused by the mechanical stresses (stretching, pulling, and tearing) characteristic to coitus (sexual intercourse), masturbation, childbirth, urinary incontinence, lymphatic congestion (stasis), chronic dermatitis, granulomatous disease, myelodysplastic disease, and by the application of topical and systematic hormones. In some women, vaginal childbirth causes the development of labial hypertrophy by means of the formation of a hematoma during the parturition. Moreover, the cultural practice of genital piercing can cause labial hypertrophy and asymmetry, because of the heavy weight of the metal ornaments inserted to the labium or to the labia. Furthermore, the report Labiaplasty and Labia minora Reduction (2008), indicated the occurrence of labia minora of the same size in identical-twin women treated for labial hypertrophy, which indicated a possible genetic determination of the size of the labia minora.

Clinical definition

Therapeutically, because there is no formal, medical definition of labial hypertrophy, nor a standardized method for grading the degree of hypertrophy present in the labia minora of the woman (patient), the plastic surgeon gives especial consideration to the anatomic particulars of the vulvo-vaginal complex of the woman. Likewise, the surgeon must give especial consideration to the wide variance among women’s perceptions of the ideal genital body image — what the woman (patient) considers and does not consider to be an aesthetically normal and proportionate vulva. (See: Body dysmorphic disorder and Body image)

Pathophysiology

• The dimensions of oversized labia minora are established by:

1. horizontally measuring the size of each labium minus, from the midline.
2. vertically measuring the size of each labium minus the between the base and the free-edge of the labium.
3. applying a 3–5 cm range of measure as “hypertrophy” of the labia minora.

• The degree of labial hypertrophy is characterized as:

1. No hypertrophy — the labia minora are concealed within, or extend to, the free edge of the labia majora.
2. Mild-to-moderate hypertrophy — the labia minora extend approximately 1–3 cm beyond the free edge of the labia majora.
3. Severe hypertrophy — The labia minora extend an approximate distance >3.0 cm beyond the free edge of the labia majora.

Presentation

The woman seeking the surgical reduction of her oversized labia minora often presents labial asymmetry that causes her awkward vulvo-vaginal hygiene (e.g. toilet-paper bits attaching to the labia); the catching of the labia in garment-zipper closures; pubic discomfort when wearing tight clothes; pubic-area pain when practicing sport (bicycling, running, et cetera); either a disrupted or a diffused urinary stream; and dyspareunia (painful sexual intercourse). In the case of labial asymmetry, wherein one labium minus is longer, wider, and thicker than the corresponding labium minus, only the oversized lip is reduced in order to match the smaller lip. Labioplasty can be safely performed any time after sexual maturity (to a woman who is minimally 18 years of age); it can be performed either before or after pregnancy, in order to minimze hormonal interference with her body’s capacity to heal a surgical wound. Yet, labiaplasty is not performed upon a woman who is menstruating, lest she risk post-operative infection of the surgical-incision site(s). Generally, the woman’s most common complaint of self perception is that, when observed in the standing position, her labia minora protrude too much beyond the labia majora, which physical condition often leads to low self-esteem, and subsequent difficulty in achieving emotional and sexual intimacy in her private life. (See: Sex appeal and Body dysmorphic disorder)