Girls with large labia

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Labiaplasty is associated with high patient satisfaction and low complication rates. The three basic labia minora reduction techniques—edge excision, wedge excision, and central deepithelialization—as well as their advantages and disadvantages are discussed to assist the surgeon in tailoring technique selection to individual genital anatomy and aesthetic desires.

We present key points of the preoperative anatomic evaluation, technique selection, operative risks, perioperative care, and potential complications for labia minora, labia majora, and clitoral hood alterations, based on a large operative experience.

Labiaplasty competency should be part of the skill set of all plastic surgeons. Although ranked relatively low on volume lists of overall cosmetic surgery procedures in the United States, 1 aesthetic alteration of the genitalia is increasingly sought by women unhappy with the size, shape, and appearance of their vulva.

It is therefore essential that the entire anatomic region—labia minora, labia majora, clitoral hood, perineum, and mons pubis—be evaluated in the preoperative assessment of women seeking labiaplasties.

Descriptions, reviews, and illustrations of female external genital anatomy and labiaplasty procedures and techniques are abundant, and readily available in the recent literature.

Rather, I offer what I have learned in performing over labiaplasties. Key points of preoperative anatomic evaluation, technique selection, operative caveats, and perioperative care for labia minora, clitoral hood, and labia majora alterations are presented.

Female external genital cosmetic surgery procedures are viewed by many plastic surgeons and gynecologists as being technically simple operations.

They often are. Many women, however, present with anatomic challenges that make achieving good aesthetic outcomes difficult. Simply reducing the labia minora in women with complex anatomic issues may result in unnatural-appearing genitalia and the perception of genital deformity as unintended consequences.

Prominent lateral clitoral hood folds or labial remnants between the introitus and anus Figures 1 and 2 , proportional to large labia minora before surgery, may appear more unnatural after a simple labia minora reduction, regardless of the labiaplasty technique employed.

Patient dissatisfaction and an augmented sense of genital embarrassment may occur. A year-old woman with thick, hyperpigmented labia minora and redundant labia minora tissue extending between the introitus and anus.

Accurate evaluation of anatomic issues, surgical planning, and technical execution are essential in achieving optimal aesthetic outcomes. As previously stated, reduction of the labia minora is by far the most commonly requested female external genital cosmetic procedure Figures 3 and 4.

Those seeking surgery, in my experience, have labia minora that, albeit large, fall within the normal minora size range.

Very few women have minora that can be considered abnormally large. Female genital cosmetic surgery is overwhelmingly sought for aesthetic reasons.

Although minor functional complaints ie, irritation are common, significant issues are rare. This experience mirrors the published findings of Crouch et al.

The main indication for labiaplasty, therefore, is overwhelmingly the same as for other aesthetic procedures: patient preference. Veale et al 17 found that labiaplasty patients did not differ from controls on measures of depression or anxiety, but reported a significantly greater frequency of avoidance behaviors.

Eighteen percent of women in their study met the diagnostic criteria for body dysmorphic disorder. A Preoperative photograph of a year-old woman with large labia minora.

B Postoperative photograph obtained 3 months after bilateral labia minora reduction edge excision. A Preoperative photograph of a year-old woman with large labia minora and right lateral clitoral hood fold.

B Postoperative photograph obtained 3 months after bilateral labia minora reduction wedge excision and right clitoral hood fold excision.

Labia minora size and shape show almost unlimited variations. Surgical procedures must be tailored to individual anatomy and preference.

Labia thickness, pigmentation, and pigment variation, if present, must be considered. Clitoral hood redundancy, in either a vertical hood too long or horizontal redundant lateral folds dimension, should be addressed if present.

Significant pigmentation variation from the labia free edge inward, if present, may warrant edge preservation. This situation is most often encountered in women of color.

Excising the pigmented edge in this cohort may result in unnatural-appearing labia. Edge excision techniques are preferable for these patients.

Prominent lateral clitoral hood folds and redundant labial tissue posterior to the introitus, when present, should be excised Figure 5.

Failure to do so may yield an unacceptable result. A Preoperative photograph of a year-old woman with large labia minora, bilateral lateral clitoral hood folds, and labial tissue posterior to introitus.

B Postoperative photograph obtained 3 months after bilateral labia minora reduction edge excision , lateral clitoral hood fold excision, and excision of posterior labial tissue.

Labiaplasty technique selection should be based on the patient's unique anatomy and aesthetic preference.

Generally, the minora should remain at least one centimeter in length from free edge to base inter-labial sulcus in its central portion. Edge excision, with its many variations, was the first popularly reported labiaplasty technique.

Overzealous resection, however, is possible, and can result in labial amputation: a disastrous outcome. Excision of the minora edges can result in unnatural-appearing labia in women with significant pigmentation variation.

Although commonly reiterated in the literature, but rarely, in my opinion, observed in clinical practice, edge excision techniques can be complicated by tender scars or scar contractures.

Edge scalloping may also occur and, if significant, compromise the aesthetic result. It has been suggested that it may be mitigated by minimizing tension when tying sutures.

Wedge excision techniques, first described and popularized by Alter, 14 , 18 preserve labia edges and edge pigmentation.

As previously stated, this is often desirable in those women with significant pigmentation variation from the free minora margins inward.

Incision line dehiscence, usually a consequence of excess tension, can be problematic. When it occurs, repair is required to avoid notching of the labium with persisting deformity.

Wedge excision techniques also frequently require modification to adequately address clitoral hood issues or other anatomic variations.

Central deepithelialization or excision procedures are, in my opinion and practice, less commonly utilized than either edge excision or wedge resection techniques.

The procedures have several shortcomings. They result in multiple incision lines medial and lateral surfaces of the labia and prolonged postoperative minora edema.

Inclusion cyst formation, as a consequence on incomplete deepithelialization, can occur. Central deepithelialization can increase labia minora thickness, which, in my experience, is usually undesirable.

Furthermore, it is difficult to make the minora as small as is possible with the other, aforementioned labiaplasty techniques.

Clitoral hood redundancy, when present, may be in the horizontal or vertical planes, or both. Horizontal excess, in the form of extra hood folds parallel and lateral to the central portion of the clitoral hood, is most commonly observed Figure 6.

Clitoral hood folds may be unilateral or bilateral, and result in a widened appearance. Vertical excess manifests as a ptotic, elongated clitoral hood.

A Preoperative photograph of a year-old woman with prominent bilateral lateral clitoral hood folds and hyperpigmented, thick labia minora. B Postoperative photograph obtained 3 months after bilateral labia minora reduction edge excision and excision of bilateral lateral clitoral hood folds.

When present, clitoral hood redundancy should be dealt with during labiaplasty. Not doing so may yield unnatural-appearing genitalia.

Excision is generally oriented parallel to the sulcus between the clitoral hood and the labia majora Figure 7 A. Vertical hood excess is addressed by transverse excision of a portion of the hood, usually as an inverted V wedge, across its full width.

Excision is usually done cephalic to the free margin of the hood Figure 7 B. In no circumstance, in my opinion, should the clitoral glans be exposed if covered or further exposed if partially covered.

Doing either will result in an unpredictable, and perhaps undesirable, effect on clitoral sensation. In all cases, excision must be superficial.

Photographs of a year-old woman with digitally-added clitoral hood alteration markings. A Lateral vertically-oriented excision markings for horizontal excess, with digitally-added wedge excision minora reduction markings patient's left labium and edge excision minora reduction markings patient's right labium.

Labia majora alteration is sought by women bothered by puffy, prominent majora at one extreme, and deflated, sagging majora at the other Figure 8.

Fatty fullness without skin redundancy may occasionally be effectively treated by liposuction. Improvement is usually modest.

Prolonged postoperative edema is common. Women with flat majora, or deflated majora with minimal skin excess, may seek augmentation. It is easily achieved utilizing standard autologous fat grafting techniques.

Usually several grafting sessions are necessary to achieve the desired result. In general, no more than 20 cc of fat should be injected into each labium at one sitting.

Ptotic, deflated labia majora, in my opinion, are best treated by reduction rather than augmentation. Surgical excision of redundant majora, in my experience, yields consistently excellent results and high patient satisfaction.

Although others suggest that excision should be from the central portion of the majora 20 or laterally at the vulva-thigh crease, 5 I disagree.

I see no benefit in placing the resulting excision scar in the thigh crease or on the labia majora itself. I always resect the medial segment of the majora.

The medial incision is in the sulcus between the minora and majora, with the lateral incision in the majora. Incisions are made along the full anterior-posterior length of the majora.

Cresenteric excision of the redundant width of the majora is performed. The resulting scar, located within the interlabial sulcus, is virtually imperceptible.

It is therefore determined with the patient supine in maximum frog leg position. Pinching of redundant majora, without tension on the introitus, is done.

The lateral incision line is then marked. Resection should always be in a superficial plane: skin and subcutaneous tissue only. The labia majora are very vascular.

Absolute hemostasis prior to closure is essential to avoid hematoma formation. A Preoperative labia majora reduction markings on a year-old woman with ptotic labia majora and moderately large, asymmetric labia minora.

B Immediately postoperative photograph after bilateral labia majora and labia minora edge excision reduction and left clitoral hood fold excision.

A Preoperative photograph of a year-old woman with redundant labia majora. B Postoperative photograph obtained 3 months after bilateral labia majora reduction using the described technique note the absence of visible scars.

Although many recommend general anesthesia, 2 , 14 I perform virtually all labiaplasty procedures, including combined majora and minora reductions, using local anesthesia, with mild oral sedation mg of diazepam.

Topical anesthetic ointment or cream is applied at the same time oral sedation is administered. Approximately half of women undergoing minora procedures will not experience injection pain if 45 minutes elapse between topical anesthetic application and injection.

Anesthetic buffering with sodium bicarbonate, if utilized, will further reduce infiltration discomfort. One dose of a cephalosporin oral antibiotic or clindamycin for Beta-lactam allergic patients is taken 2 hours preoperatively.

Procedures are performed with the patient supine, in frog leg position. Lithotomy position, although commonly recommended by many authors for labiaplasty procedures, 2 , 14 should be avoided in my opinion, as external genital anatomy can be distorted.

All surgical markings must be made before local anesthetic injection. Deviation from markings should be avoided. Tissue distortion should be avoided.

Adequate time should be allowed for vasoconstriction to occur. Twenty minutes is ideal for maximum effect, but a minimum of 10 minutes is suggested.

In combined labiaplasty procedures, the majora should be done first. For labia minora edge excision techniques, use of a traction suture placed in the most prominent portion of the labium is helpful.

Clitoral hood folds, if present, should be excised first, followed by minora excision. Resection of redundant labial tissue posterior to the introitus may occasionally be difficult with the patient in frog leg position.

It can be facilitated, if necessary, by placing gauze pads between the buttocks posterior to the anus to separate them and increase visualization of the posterior perineum.

The operating table may also be placed in a slight Trendelenburg position if further exposure is needed.

I perform the procedures using number 15 scalpel blades and a needle-point electrocautery. Absolute hemostasis is essential.

A single-layer closure with interrupted 4. For wedge resection techniques, a two-layer closure is suggested to reduce incision dehiscence risk.

I recommend 4. The clitoral hood, analogously to the foreskin of the penis in men and also termed, like the latter, by the Latin word prepuce , serves to cover most of the time the shaft and sometimes the glans which is very sensitive to the touch to protect the clitoris from mechanical irritation and from dryness.

Yet the hood is movable and can slide during clitoral erection or be pulled upwards a little for greater exposure of the clitoris to sexual stimulation.

The frenulum Latin for little bridle is an elastic band of tissue attached by its one end to the clitoral shaft and glans and by its other end to the prepuce.

It allows two-way shifting of the clitoral hood: firstly, it can extend to let the hood be moved upwards to expose the glans for stimulation or hygienic cleansing, and secondly, it contracts to pull the hood back to protect it.

On the opposed surfaces of the labia minora are numerous sebaceous glands not associated with hair follicles. Like the whole area of the vulval vestibule, the mucus secreted by those glands protects the labia from dryness and mechanical irritation.

Being thinner than the outer labia, the inner labia can be also more narrow than the former, or wider than labia majora, thus protruding in the pudendal cleft and making the term minora Latin for smaller essentially inapplicable in these cases.

They can also be smooth or frilled, the latter being more typical of longer or wider inner labia. From to , researchers from the Department of Gynaecology, Elizabeth Garret Anderson Hospital in London, measured the labia and other genital structures of 50 women from the age of 18 to 50, with a mean age of The study has since been criticized for its "small and homogenous sample group" consisting primarily of white women.

Due to the frequent portrayal of the pudendal cleft without protrusion in art and pornography, there has been a rise in the popularity of labiaplasty , surgery to alter the labia - usually, to make them smaller.

Its proponents stress the beauty of long labia and their positive role in sexual stimulation of both partners.

Labiaplasty is also sometimes sought by women who have asymmetrical labia minora to adjust the shape of the structures towards identical size.

Labia stretching has traditionally been practised in some African nations in the East and South [11] and the South Pacific. The inner lips serve to protect from mechanical irritation, dryness and infections the highly sensitive area of the vulval vestibule with vaginal and urethral openings in it between them.

During vaginal sexual intercourse they may contribute to stimulation of the whole vestibule area, the clitoris and the vagina of the woman and the penis of her partner.

Stimulation of the clitoris may occur through tension of the clitoral hood and its frenulum by inner labia pulling at them. During sexual arousal they are lubricated by the mucus secreted in the vagina and around it to make penetration painless and protect them from irritation.

As the female external urethral opening meatus is also situated between labia minora, they may play a role in guiding the stream of the urine during female urination.

Being very sensitive by their structure to any irritation, and situated in the excretion area where traces of urine, vaginal discharge , smegma and even feces may be present, the inner lips may be susceptible to inflammatory infections of the vulva such as vulvitis.

The likelihood of inflammation may be reduced through appropriate regular hygienic cleansing of the whole vulval vestibule, using water and medically tested cleansing agents designed for vulvas.

To avoid contamination of the vulva with fecal bacteria, it is recommended that the vulva is washed only from front to back, from mons pubis to the perineum and anus.

Apart from water and special liquid cleansing agents lotions , there are commercially available wet wipes for female intimate hygiene.

Some women wipe the vulval vestibule dry with toilet tissue after urination to avoid irritation and infections from residual drops of the urine in the area.

However, incorrect choice of cleansing agents, or their incorrect application, may itself cause labial irritation and require medical attention.

Over-vigorous rubbing of the labia of little girls while washing, combined with the lack of estrogen in their bodies, may lead to the mostly pediatric condition known as labial fusion.

If fused labia prevent urination, urine may accumulate and cause pain and inflammation. In adult females, irritation of the area may be caused by wearing too-tight underwear especially where wider inner labia protrude in the pudendal cleft ; while G-strings , which rub against the labia during body movements, may cause irritation or lead to infection from bacteria transferred from either the external environment or the anus.

From Wikipedia, the free encyclopedia. Flaps of skin on either side of the human vaginal opening in the vulva. Labia minora inner labia - vertical folds of skin in the very middle of the photo of a vulva external female genitals between rounded thicker labia majora the outer labia.

Merriam-Webster's Medical Dictionary. Merriam-Webster, Inc. Gender Forum. May British Journal of Obstetrics and Gynaecology.

Life and style. Archived from the original on

Girls With Large Labia Video

Labia stretching: Why some British girls are told to do it - BBC Stories

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Asymmetry Worries

The fashion for this has become almost universal among young girls over the last few years, and I am in a good position to know. In my opinion, it is driven by peer pressure and a wrong-headed sense that no pubic hair makes them more attractive to the opposite sex.

But whatever the reason, it has had another unwanted side effect — to expose their labia to personal scrutiny. Labia, which include the labia majora the outer lips and the labia minora the thinner inner lips are remnants of pigmented tissue that would have changed into the scrotum and male genitalia in the womb had a foetus been male.

They are not always neat and tucked away. They enlarge during sexual arousal and can be a range of colours. There is no hard and fast rule about what they have to look like.

Shaving also leads to skin irritation and chafing. The labia are not protected by a cushioning blanket of pubic hairs and the girls feel discomfort and itching.

The banishment of pubic hair is not the only reason there is an epidemic of girls wanting labia reduction procedures. Another massive change over the last decade is the kind of underwear that girls tend to wear.

The tiny thongs that they prefer offer no support to the undercarriage. If they would wear knickers that actually existed beyond a string, they may find that their problem vanishes overnight.

However, incorrect choice of cleansing agents, or their incorrect application, may itself cause labial irritation and require medical attention.

Over-vigorous rubbing of the labia of little girls while washing, combined with the lack of estrogen in their bodies, may lead to the mostly pediatric condition known as labial fusion.

If fused labia prevent urination, urine may accumulate and cause pain and inflammation. In adult females, irritation of the area may be caused by wearing too-tight underwear especially where wider inner labia protrude in the pudendal cleft ; while G-strings , which rub against the labia during body movements, may cause irritation or lead to infection from bacteria transferred from either the external environment or the anus.

From Wikipedia, the free encyclopedia. Flaps of skin on either side of the human vaginal opening in the vulva.

Labia minora inner labia - vertical folds of skin in the very middle of the photo of a vulva external female genitals between rounded thicker labia majora the outer labia.

Merriam-Webster's Medical Dictionary. Merriam-Webster, Inc. Gender Forum. May British Journal of Obstetrics and Gynaecology.

Life and style. Archived from the original on Retrieved Nat Rev Urol. Aesthetic Plast Surg. Female reproductive system.

Germinal epithelium Tunica albuginea cortex Cumulus oophorus Stroma Medulla. Isthmus Ampulla Infundibulum Fimbria Ostium. Ovarian ligament Suspensory ligament.

Gartner's duct Epoophoron Vesicular appendages of epoophoron Paroophoron. Endometrium epithelium Myometrium Perimetrium Parametrium.

Round ligament Broad ligament Cardinal ligament Uterosacral ligament Pubocervical ligament. Uterine glands. Fossa of vestibule of vagina Vaginal fornix Hymen Vaginal rugae Support structures Vaginal epithelium.

Crus of clitoris Corpus cavernosum Clitoral glans Hood. Urethral crest. G-spot Urethral sponge Perineal sponge.

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