Labiaplasty (Labia Reduction Surgery)

Reviewed by Foad Nahai, MD

Growing numbers of women are choosing a below-the-belt plastic surgery called labiaplasty (labia reduction surgery or vaginoplasty) for a host of reasons, including genital pain, cosmetic reasons or to enhance sexual satisfaction.

Labiaplasty is a surgical procedure to trim down and shape the inner lips (labia minora) or outer lips (labia majora) of the vagina or both. The labia minora is the inner flap of skin that covers the clitoris and vagina. The labia majora is the part of the labia on the outside of the body.

The reasons that the labia may be elongated or assymetrical vary. It could result from sexual intercourse, childbirth, genetics or the aging process.

Labiaplasty Candidates

Candidates include women with enlarged inner and outer vaginal lips that cause pain or self-consciousness. For example, a long labia may cause pain during sexual intercourse, exercise or even while wearing tight-fitting jeans. Fully developed young women and adult women who are in good health make the most appropriate candidates. However, women who have any underlying medical conditions that would limit elective surgery may not be good candidates.

The surgery is not designed to enhance sexual pleasure or satisfaction. If your goal is to increase sexual satisfaction, talk with your surgeon about other procedures that may be more appropriate.

This is not the only type of cosmetic surgery that can be performed on the vagina. Vaginal rejuvenation, for example, involves tightening the vaginal and perineum area, which can become stretched during childbirth. Some surgeons suggest vaginal rejuvenation may increase sexual pleasure for both partners.

Labiaplasty Risks

In 2007, The American College of Obstetricians and Gynecologists issued a position statement warning against cosmetic surgery of the vagina. The group stated that the risks of the procedure outweigh its benefits at this time.

Risks include:

• Infection
• Bleeding
• Temporary numbness
• Asymmetry between the inner and outer labia lips
• Pigmentation changes
• Decreased feeling in that area
• Pain
• Excess scar tissue buildup (appearing as lumps on the treated area)
• Hematoma (break in blood vessel, causing localized blood-filled area or blood clot)
• Puckering or creases of the skin
• Sexual dysfunction

Preparing for the Procedure

It is a good idea to stop smoking and consuming alcohol for at least a week before surgery. Talk to your surgeon about ways to quit smoking for good.

Your plastic surgeon will likely suggest that you stop taking certain medications, including aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) and blood thinners, all of which can increase bleeding risk.

Certain herbal remedies may also increase bleeding risk. Just because a product or preparation is "all-natural" does not mean it is safe. For example, vitamin E, omega-3 fatty acids, green tea and gingko biloba all may increase bleeding risk during and after surgery.

Make sure you tell your surgeon about everything that you are taking. Never stop taking any medication abruptly without first speaking to your doctor.

Do not have sexual intercourse the night before the surgery.

The Labiaplasty Procedure

After an initial consultation and thorough review of your medical history, your surgeon will schedule the vaginoplasty procedure. It usually requires a local anesthetic and is done on an outpatient basis. The actual surgery takes about two hours.

During labia reduction surgery, larger or uneven inner vaginal lips are cut and shortened using specialized scissors, a scalpel or a laser. In addition, the labia majora, on the outside of the body, can be reduced with either surgery or liposuction if needed. A hoodectomy, which exposes the clitoris in an attempt to increase sexual stimulation, may be performed at the same time.

The appropriate incision location depends on many individual factors, including the configuration, texture and size of the labia. The doctor will then suture the incision closed with dissolvable stitches.

Recovery

After surgery, you can't have intercourse for about four weeks, and your genitals will be tender and swollen for several weeks. What's more, your labia and the surrounding area may be slightly bruised.

Oral medications can reduce pain. Oral antibiotics may be prescribed to reduce the risk of infection.

You will be asked to stop any heavy, strenuous exercise for three or more weeks after labia reduction surgery. Also you cannot use tampons for 10 days afterward. While recovering, you will need to wear a pad for one week or less, due to the bleeding that results.

Labiaplasty Statistics

The demand for labiaplasty is on the rise. According to the American Society of Plastic Surgeons (ASPS), vaginal rejuvenation procedures increased 30 percent between 2005 and 2006, from 793 procedures in 2005 to 1,030 procedures in 2006. During 2006, U.S. women spent $2.3 million on cosmetic vaginal procedures. The ASPS did not track vaginal rejuvenation procedures in 2007.

Consult a Qualified Surgeon

The evaluation of surgical skills specifically relating to vaginoplasty is not required for certification with the American Board of Plastic Surgery. There are no specific licensing requirements or required educational courses to perform the procedure. So you need to do two things:

• Select a board-certified plastic surgeon, a board-certified gynecologist or a board-certified urologist
• Make certain the surgeon has years of specific labiaplasty experience and expertise.

Labiaplasty Costs

The procedure includes three costs: local anesthesia fees, facility fees and surgeon fees. You may have a labia majora reduction or labia minora reduction, or both, to produce a fully satisfactory outcome. Both procedures may be performed at the same time, which reduces overall cost, since you pay only once for anesthesia and for the facility.

Labia minora or majora reduction fees can range from $5,000 to $10,000. If you require the procedure because your too long labia causes pain during sex or exercise, it may be covered by insurance. Talk to your insurance carrier to determine whether they will cover some or all of the cost of your labiaplasty.

If the cost of the procedure is difficult for you, ask the facility about payment plans and medical finance options. For financing options and tips, continue reading about patient financing.

About the Reviewer of This Article

Foad Nahai, MD, FACS, is a board-certified plastic surgeon and a Fellow of the American College of Surgeons. Dr. Nahai is the 2007-2008 president of the American Society for Aesthetic Plastic Surgery, first vice president of the International Society of Aesthetic Plastic Surgery and a director of the American Board of Plastic Surgery. He completed medical school in England, and his post-graduate surgical training was at Johns Hopkins in Baltimore and Emory in Atlanta. Before joining Atlanta's Paces Plastic Surgery in 1998, Dr. Nahai practiced at the Emory Clinic, where he was professor of plastic surgery at Emory's School of Medicine.

[page updated January 2009]