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Considering labiaplasty? Read this first (NSFW)

Labiaplasty, reducing and/or reshaping the size of the labia minora, is on the rise. Twenty years ago I was asked about it maybe a handful of times and always by women with a significant size discrepancy (more than 4-5 centimeters) between sides. Now I am asked about it routinely and almost always by women who have labia minora that are anatomically normal.

Reasons for wanting smaller labia range from entirely cosmetic to misperceptions about size (it is normal for the labia minor to stick out past the labia majora), about symptoms (labial size doesn’t affect vulvar symptoms or cause yeast infections) or sex (smaller labia does not enhance sexual pleasure).

What do the labia minora do?

The opening to the vagina (the vestibule) is filled with nerve endings, that is why it feels so good when it is touched (in the right way of course). The tissue in this area is mucosa (like the inside of your mouth) and is more delicate that regular skin. Given the sensitivity (all the nerve endings), the delicate nature of the tissue, and the fact that this is a high traffic area (sitting and the wear and tear of emptying bladder and bowels) the vaginal opening needs protection. This is the primary role of the labia minora.

What is “normal”

I encourage people to discard this term and if they are concerned about size to think instead of average. The labia minora are a bit like the nose in that way, there is no “normal” size medically although there are cultural ideals. Labia minora can range in size significantly.

BJOG 2005, Lloyd et al

BJOG 2005, Lloyd et al

When I counsel a woman about her labia I show images that give show the range of labial appearance. I use this one from the BJOG (Lloyd et. al. 2005). I discuss that among women with no symptoms labia minora range from 2-10 cm in length and 0.7-5 cm in width. Labia, like women, come in all sizes and shapes. I also explain that the labia minora often protrude beyond the labia majora.

You can’t consider the labia minora without considering pubic hair 

Removing or trimming pubic hair will make the labia minora appear more prominent. In addition, removing pubic hair increases vulvar irritation and can cause symptoms that women mistakenly (and many doctors) blame on the labia minora. In addition, without pubic hair the labia minora may actually enlarge and thicken in response to the increased friction.

Labia minora size doesn’t affect sexual pleasure

The mechanics of sexual pleasure are not affected by labia size. Telling a woman that sex will be better with smaller labia is the equivalent of saying a smaller nose gives a better sense of smell. It is true that for some women cosmetic surgery may improve body image and that can affect sexual confidence, but any improvement is not mechanically related to the size change. It is an important distinction.

Culture plays a role

Smaller labia has become the norm (or so it seems) in Western society, however, in other cultures large labia are the idea and women actually work on stretching their labia.

Porn could impact what you think is “normal”

To help understand what women perceive as normal when it comes to labia researchers in Australia evaluated the effect of viewing images of surgically reduced labia on women’s perceptions of “normal” and “desirable” genital appearance. One group of women looked at images of modified genitalia first and another group viewed images of unaltered genitalia first. What they found isn’t surprising – viewing modified genitalia alters the perception of normal among women ages 18-30. In addition, all women rated smaller labia as more ideal.

How does this relate to porn? Many adult performers have very small labia minora. Whether this is a self selecting feature or the result of surgery is hard to know. Regardless, if you see a lot of images of small labia minora you are more likely come to view that as “normal” or desirable. It’s not much different from seeing women with impossibly thin bodies in the movies or women with flawless features due to Photoshop.

Labiaplasty can have undesirable consequences

Smaller labia minora can lead to irritation at the vestibule (the vaginal opening). This is more likely to happen if pubic hair has been permanently removed. There are no long-term studies regarding complications and outcomes. After menopause the tissue at the vaginal opening gets more fragile and it is not known if smaller labia could have health repercussions decades later.

Has your partner made comments?

About 1/3 of women who seek labiaplasty recall specific negative comments about their labia versus 3% of women who don’t seek surgery. It’s hard to know what to say to that, except cosmetic surgery should always be for you and not for someone else. I worry that some women try to convince themselves that their labia are causing symptoms in order to justify or soften the impact of a partner’s comments.

If your partner thinks your labia are “too large” I encourage showing him/her images of the range of labial length and appearance. In addition to the images in this post there is the Great Wall of Vagina (although it is incorrectly named, it should be the great wall of vulvas).

 

I’ll end with these thoughts –

Labia minora, like women, come in all size and shapes.

If you have symptoms of irritation see a vulvar expert, not a plastic surgeon.

If your gynecologist suggests a labiaplasty to treat symptoms get a second opinion.

If you do want to significantly reduce the size of your labia minora understand one consequence could be irritation at the vaginal opening.

If your partner has made comments about your labia minora (and you never thought about them before so he’s not just trying to be supportive of your decision to have surgery) consider asking him how he would feel if you made comments about the size of his penis.

Women who choose labiaplasty for cosmetic reason are generally happy with the outcome, however, the long-term medical implications of labial reduction are unknown.

 

 

Discussion

8 thoughts on “Considering labiaplasty? Read this first (NSFW)

  1. Very good article, thank you. Il like what you suggest to say to the insensitive and ignorant partner who makes degrading remarks. Personnally, I would just dump him.

    Posted by Une femme libre | August 9, 2015, 3:59 pm
  2. The Royal Australian College of General Practitioners has just released a publication on female genital cosmetic surgery, available on their website. From what I’ve read so far, it’s excellent.

    Posted by araikwao | August 10, 2015, 3:07 am
  3. Very interesting read. Definitely worth a share!

    Posted by Livi Soleil | August 10, 2015, 10:02 am
  4. Check out the large labia project (largelabiaproject.org), a “body-positive blog that aims to show that vulvas and labia of any size, shape, texture and coloration are normal and beautiful,” and where where women share their stories and encourage each other.

    Posted by Mark Evans | August 11, 2015, 6:07 am
  5. How does any of this surprise you? I discovered at the merry old age of 57 that my younger male peers were all shaving their pubes. And they started in their teens. It’s all about the looks – and yes, I think porn DOES shape our culture in a big, big way, when “sex performer” is seen as a valid career choice and people of all ages worry considerably about the appearance of their, well, privates.

    It’s also quite sad that you as a doctor would need to say anything about it, but you do, after all, hail from San Fran.

    Posted by R | August 15, 2015, 4:51 pm

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