labiaplasty labiaplasty labiaplasty (also known as labioplasty, labia minora reduction, and labial reduction) is a plastic surgery procedure for altering the labia minora (inner labia) and the labia majora (outer labia), the folds of skin surrounding the human vulva. there are two main categories of women seeking cosmetic genital surgery: those with congenital conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their genitals because they believe they do not fall within a normal range. labiaplastyresult of labiaplasty (top, left-before then right-after) in combination with clitoral hood reduction (bottom) the size, colour, and shape of labia vary significantly, and may change as a result of childbirth, aging, and other events. conditions addressed by labiaplasty include congenital defects and abnormalities such as vaginal atresia (absent vaginal passage), müllerian agenesis (malformed uterus and fallopian tubes), intersex conditions (male and female sexual characteristics in a person); and tearing and stretching of the labia minora caused by childbirth, accident, and age. in a male-to-female sexual reassignment vaginoplasty for the creation of a neovagina, labiaplasty creates labia where once there were none. a 2008 study reported that 32 percent of women who underwent the procedure did so to correct a functional impairment; 31 percent to correct a functional impairment and for aesthetic reasons; and 37 percent for aesthetic reasons alone. according to a 2011 review, overall patient satisfaction is in the 90–95 percent range. risks include permanent scarring, infections, bleeding, irritation, and nerve damage leading to increased or decreased sensitivity. a change in requirements of publicly funded australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the number of surgeries performed. unlike public hospitals, cosmetic surgeons in private practice are not required to follow these rules, and critics say that "unscrupulous" providers are charging to perform the procedure on women who would not want it if they had more information. images of vulvae are absent from the popular media and advertising: 19 and do not appear in some anatomy textbooks, while community opposition to sex education limits the access that young women have to information about natural variation in labias. many women have limited knowledge of vulval anatomy, and are unable to say what a "normal" vulva looks like.: 6 at the same time, many pornographic images of women's genitals are digitally manipulated, changing the size and shape of the labia to fit with the censorship standards in different countries. medical researchers have raised concerns about the procedure and its increasing prevalence rates, with some speculating that exposure to pornography images on the internet may lead to body image dissatisfaction in some women. although it is also suggested that evidence for this is lacking, the national health service stated that some women bring along advert or pornographic images to illustrate their desired genital appearance. size of the labia the individual size, coloration and shapes of the labia minora are subject to significant variability between women. the labia minora are completely covered by the labia majora in some women in a standing posture, while in others they protrude visibly from the pubic cleft. the external genitalia of a woman are collectively known as the vulva. this comprises the labia majora (outer labia), the labia minora (inner labia), the clitoris, the urethra, and the vagina. the labia majora extend from the mons pubis to the perineum. the size, shape, and color of women's inner labia vary greatly. one is usually larger than the other. they may be hidden by the outer labia, or may be visible, and may become larger with sexual arousal, sometimes two to three times their usual diameter. the size of the labia can change because of childbirth. genital piercing can increase labial size and asymmetry, because of the weight of the ornaments. in the course of treating identical twin sisters, s.p. davison et al reported that the labia were the same size in each woman, which indicated genetic determination. in or around 2004, researchers from the department of gynaeology, elizabeth garret anderson hospital, london, measured the labia of 50 women between the ages of 18 and 50, with a mean age of 35.6: measurements mean clitoral length (mm) 5.0 – 35.0 19.1 clitoral glans width (mm) 3.0 – 10.0 5.5 clitoris to urethra (mm) 16.0 – 45.0 28.5 labia majora length (cm) 7.0 – 12.0 9.3 labia minora length (mm) 20 – 100 60.6 labia minora width (mm) 7.0 – 50.0 21.8 perineum length (mm) 15.0 – 55.0 31.3 vaginal length (cm) 6.5 – 12.5 9.6 tanner stage (n) iv 4.0 (8%) v 46 (92%) color of the genital areacompared to the surrounding skin (n) same color 9 (18%) darker color 41 (82%) rugosity of the labia (n) smooth (unwrinkled) 14 (28%) moderately wrinkled 34 (68%) markedly wrinkled 2 (4%) surgery contraindications labia reduction surgery is relatively contraindicated for the woman who have active gynecological disease, such as an infection or a malignancy; the woman who is a tobacco smoker and is unwilling to quit, either temporarily or permanently, in order to optimize her wound-healing capability; and the woman who is unrealistic in her aesthetic goals. the latter should either be counselled or excluded from labioplastic surgery. davison et al write that it should not be performed when the patient is menstruating to reduce potential hormonal effects and the increased risk of infection. sex reassignment surgery further information: sex reassignment surgery (male-to-female) in sexual reassignment surgery, in the case of the male-to-female transgender patient, labiaplasty is usually the second stage of a two-stage vaginoplasty operation, where labiaplastic techniques are applied to create labia minora and a clitoral hood. in this procedure, the labiaplasty is usually performed some months after the first stage of vaginoplasty. anaesthesia labial reduction can be performed under local anaesthesia, conscious sedation, or general anaesthesia, either as a discrete, single surgery, or in conjunction with another, gynecologic or cosmetic, surgery procedure. the resection proper is facilitated with the administration of an anaesthetic solution (lidocaine + epinephrine in saline solution) that is infiltrated to the labia minora to achieve the tumescence (swelling) of the tissues and the constriction of the pertinent labial circulatory system, the hemostasis that limits bleeding. edge resection technique full ablation of the inner labia by use of the trim- (edge resection-) technique, that results in no protuberance of labial tissue the original labiaplasty technique was simple resection of tissues at the free edge of the labia minora. one resection-technique variation features a clamp placed across the area of labial tissue to be resected, in order to establish hemostatis (stopped blood-flow), and the surgeon resects the tissues, and then sutures the cut labium minus or labia minora. this procedure is used by most surgeons because it is easiest to perform. the technical disadvantages of the labial-edge resection technique are the loss of the natural rugosity (wrinkles) of the labia minora free edges, thus, aesthetically, it produces an unnatural appearance to the vulva, and also presents a greater risk of damaging the pertinent nerve endings. moreover, there also exists the possibility of everting (turning outwards) the inner lining of the labia, which then makes visible the normally hidden internal, pink labial tissues. the advantages of edge-resection include removal of the hyper-pigmented (darkened) irregular labial edges with a linear scar. another disadvantage of the trim or "amputation" method, is that it is unable to excise redundant tissues of the clitoral hood, when present. complete amputation of the labia minora is more common with this technique, which often requires additional surgery to correct. in addition, the trim method does not address the clitoral hood. clitoral hood deformities are common with this approach, again requiring additional corrective surgery. some women complain of a "small penis" when the trim procedure is performed, owing to the un-addressed clitoral hood tissue and completely removed (amputated) labia minor. most plastic surgeons do not perform this procedure, and instead favor the extended wedge approach, which is technically more demanding, but produces a more natural result and is able to create a natural and proportioned appearance to the vulva. reconstructive procedures are often required after the trim (amputation) labiaplasty. central wedge resection technique labial reduction by means of a central wedge-resection involves cutting and removing a partial-thickness wedge of tissue from the thickest portion of the labium minus. unlike the edge-resection technique, the resection pattern of the central wedge technique preserves the natural rugosity ("wrinkled" edge) of the labia minora. if performed as a full-thickness resection, there exists the potential risk of damaging the pertinent labial nerves, which can result in painful neuromas, and numbness. a partial thickness removal of mucosa and skin, leaving the submucosa intact, decreases the risk of this complication. f. giraldo et al. procedurally refined the central wedge resection technique with an additional 90-degree z-plasty technique, which produces a refined surgical scar that is less tethered, and diminishes the physical tensions exerted upon the surgical-incision wound, and, therefore, reduces the likelihood of a notched (scalloped-edge) scar. the central wedge-resection technique is a demanding surgical procedure, and difficulty can arise with judging the correct amount of labial skin to resect, which might result in either undercorrection (persistent tissue-redundancy), or the overcorrection (excessive tension to the surgical wound), and an increased probability of surgical-wound separation. the benefit of this technique is that an extended wedge can be brought upwards towards the prepuce to treat a prominent clitoral hood without a separate incision. this leads to a natural contour for the finished result, and avoids direct incisions near the highly-sensitive clitoris. de-epithelialization technique labial reduction by means of the de-epithelialization of the tissues involves cutting the epithelium of a central area on the medial and lateral aspects of each labium minus (small lip), either with a scalpel or with a medical laser. this labiaplasty technique reduces the vertical excess tissue, whilst preserving the natural rugosity (corrugated free-edge) of the labia minora, and thus preserves the sensory and erectile characteristics of the labia. yet, the technical disadvantage of de-epithelialization is that the width of the individual labium might increase if a large area of labial tissue must be de-epithelialized to achieve the labial reduction. labiaplasty with clitoral unhooding labiaplasty with clitoral unhooding (with genital piercings) labial reduction occasionally includes the resection of the clitoral prepuce (clitoral hood) when the thickness of its skin interferes with the woman's sexual response or is aesthetically displeasing. the surgical unhooding of the clitoris involves a v–to–y advancement of the soft tissues, which is achieved by suturing the clitoral hood to the pubic bone in the midline (to avoid the pudendal nerves); thus, uncovering the clitoris further tightens the labia minora. laser labiaplasty technique labial reduction by means of laser resection of the labia minora involves the de-epithelialization of the labia. the technical disadvantage of laser labiaplasty is that the removal of excess labial epidermis risks causing the occurrence of epidermal inclusion cysts. labiaplasty by de-epithelialization labial reduction by de-epithelialization cuts and removes the unwanted tissue and preserves the natural rugosity (wrinkled free-edge) of the labia minora, and preserves the capabilities for tumescence and sensation. yet, when the patient presents with much labial tissue, a combination procedure of de-epithelialization and clamp-resection is usually more effective for achieving the aesthetic outcome established by the patient and her surgeon. in the case of a woman with labial webbing (redundant folding) between the labia minora and the labia majora, the de-epithelialization labiaplasty includes an additional resection technique – such as the five-flap z-plasty ("jumping man plasty") – to establish a regular and symmetric shape for the reduced labia minora. post-operative care this photo demonstrates the appearance of the labia minora and clitoral hood just after surgery in the operative theater. note that the inner labia are less prominent than before surgery.this photo was taken one week after an extended wedge labiaplasty with clitoral hood reduction. the inner and outer labia can be seen as edematous, with the most swelling noticed in the clitoral hood area. post-operative pain is minimal, and the woman is usually able to leave hospital the same day. no vaginal packing is required, although she might choose to wear a sanitary pad for comfort. the physician informs the woman that the reduced labia are often very swollen during the