Labiaplasty or labial reduction are surgical operations to repair, reshape or reduce the labia minora (inner lips) of the vulva. There is considerable variation from one women to another with some women having very small labia and others large. There is no correct length and the great majority are normal. However some people find there labia minora ‘get in the way’, are uncomfortable or cause embarrassment. Surgical reduction or reshaping can be helpful.
The surgical procedures
Triangular or wedge excision labiaplasty
A widely used approach is to remove a triangle of tissue from the edge of the labia minora and then close the gap with dissolving stitches. This reduces the size and extent to which the labia hang down. The reduction is not as great as for the labia trim technique. However the end result is more natural in appearance. There is less likelihood of symptoms such as dryness and itching after surgery.
Labial trim procedure
The labial trim operation involves simply removing the excess tissue by cutting the excess off. The wound is then closed with dissolving stitches. This results in a greater reduction but may give a less natural appearance and symptoms such as dryness and itching.
What is involved in having surgery?
You come into hospital on the day of your operation. It is normally carried out under general anaesthesia (asleep). You can go home the same day if you are well or stay overnight. You would then be offered an appointment with out nurses one week following surgery and you would be followed up by Mr Hurren 4 weeks after your surgery. The stitches are dissolving and do not need to be removed.
How long will I need to recover?
People vary considerably in how long they need to recover from surgery. If you had complications then your recovery can take considerably longer.
When can I go home from hospital?
Most people go home from hospital either on the day of surgery or the next day.
When can I shower or have a bath?
There is normally no problem in having a shower after 48 hours. Soaking the wounds for long periods in the bath is best avoided until the wounds are fully healed. This is usually at least 2 weeks. If the area is sore or stinging then a warm bath with salt may be helpful or at least more comfortable. (usually a good handful of salt in a typical bath, this is less than normal body salt concentration and much less than sea water).
When will I be able to drive?
It is illegal to drive with in 48 hours of a general anaesthetic. Most people return to driving after 3-7 days after surgery. The most important consideration is that you feel comfortable and safe to drive. You have to be able to react appropriately in an emergency. If you are taking medication such as painkillers you need to check the instructions and consider whether these may affect your ability to drive.
When will I be able to return to work?
Usually people return to sedentary office-type work about one weeks after surgery. Some people are back sooner or work from home. More active work may require longer time to recover: Very active work (e.g. teaching aerobics) will require 4 to 6 weeks off vigorous activity. You will need to be guided by your body, if you are causing pain or swelling you are doing too much!
When will I be able to exercise?
You should rest for 2 weeks following the surgery. However walking is good and protects you against clots in the legs. So taking regular short walks is recommended. Some people may recover faster and others will require longer. You need to see how your body responds to activity. If you experience pain or swelling then you need to reduce your activity.
You should avoid swimming until the wounds are fully healed. You should normally avoid swimming for 4 weeks following surgery.
Walking only for 2 weeks after surgery. Light exercise from 4 weeks. Back to normal 4-6 weeks.
When and what can I lift?
Lifting small things around the house is not a problem. It is best to be guided by your body, so if it hurts stop. You should not be straining to lift anything for 2-4 weeks.
When can I have sex again?
Sex should be avoided for a minimum of four weeks. Some people will need to wait longer. Also you should be sure that the wounds are fully healed, you feel comfortable and ready. If you are causing pain or swelling then you are over doing it.
When will I be back to normal?
Recovery varies from one person to another. The majority of people feel they are mostly recovered by a month following surgery. However some areas of tenderness, lumpiness or swelling may take longer to settle.
What outcome can I expect?
Most people are pleased with the outcome of labiaplasty surgery. The surgery is successful in making the labia minora smaller.
What are the risks and complications of labial reduction?
The following describes the principal complications of labial reduction type operations; it does not cover all possible complications. Serious complications are rare in healthy individuals however very rarely, as with all surgery, it is possible to have serious complications which can even be life threatening. Patients who smoke, are overweight or have medical problems such as diabetes are more likely to suffer complications and may not be suitable for this type of surgery.
The anaesthetist will be a consultant anaesthetist. Modern anaesthetics are very safe and serious complications are very rare. You should discuss concerns about your anaesthetic with your anaesthetist. Your anaesthetist will give you drugs to control pain and sickness during your recovery.
Complications of the surgery
- Bleeding and haematoma (build up of blood under the skin)
Occasionally bleeding does occur after the operation. Usually this will stop on its own, very rarely a second operation may be necessary to remove the build up of blood under the skin (called a haematoma). If this does occur a normal recovery usually takes place after the blood has been removed.
- Infection and wound break down
Infection may complicate any operation; usually it simply requires treatment with antibiotic. Severe infections can result in the wound opening up and this may take time to heal. With the triangular excision technique this can result in a notch or irregularity on the margin of the labia.
- Poor scarring
Individuals heal differently and so the same operation will produce different scars in different people. Labiaplasty scars are usually very good and difficult to see. Persisting pain in the scar or site of the operation can rarely be a problem.
- Asymmetry (difference between the sides)
Surgery is not an exact science and some degree of asymmetry after surgery may be present. This is particularly likely where there was significant asymmetry before the operation.
- Discomfort or pain on intercourse (dyspareunia)
Many women experience discomfort or pain on sexual intercourse. This type of surgery would not normally be expected to help these symptoms. If you do not normally have these symptoms then this form of surgery would not normally cause problems. However, results of surgery and scarring are not entirely predictable and discomfort or pain on intercourse could be caused by surgery to the vulval area.
- Persisting discomfort – itching and dryness
Some women experience itching and dryness of the vulva following surgery. Itching is coming from the nerves and usually settles although it can last several months and persist. Dryness is due to the loss of tissue that produced the normal surface tissue fluid and can be due to the area being more open. These are more likely following the ‘trim’ procedure but can follow triangular excisions.
Child-birth requires the vulva to dilate sufficiently to allow the babies head to be delivered. Reducing the labia minora will reduce the ability for the tissues to stretch. This will increase the likelihood of tearing. You should discuss the surgery you have had with your midwife and obstetrician. It may be advisable for you to have a Caesarean section rather than a vaginal delivery. If you are planning to have children it would be advisable to consider deferring surgery until after you have completed your family.
- Urinary retention
Surgery to the labial area can cause people to feel inhibited about passing urine and this can result in urinary retention (unable to pass urine). This usually resolves on its own quite quickly. Sometimes it is necessary to pass a catheter. The catheter may be removed immediately, or sometimes may be left in overnight. There is a small risk of urinary infections (cystitis) if a catheter is required.
- Deep vein thrombosis (DVT) and pulmonary embolus (PE)
Deep vein thrombosis is a blood clot forming in the veins (usually in the legs) and a pulmonary embolus is where one of these clots breaks off and travels to the lungs, which can be life threatening. This would be considered a rare complication of this type of surgery. Risk factors include previously having had a clot in the legs (DVT), obesity, the oral contraceptive pill, being immobile and long surgical operations. For patients undergoing surgery precautions are routinely employed to protect against thrombosis (clots). You can help to protect yourself by getting up and walking around as soon as you can following your operation.
What are the alternatives to a labial reduction operation?
Not have surgery
There is seldom a medical reason for labial reduction. Reassurance that your anatomy is normal may reassure you that do not need or want surgery.
There are different techniques for carrying out labial reduction. There are not any significant alternatives to surgery to reduce the size of the labia.
Where can I get further information?
Department of Health (England and Wales):
www.dh.gov.uk/ search under – Cosmetic surgery and non-surgical cosmetic treatments.
Independent and objective advice on cosmetic surgery from the department of health.
British Association of Aesthetic Plastic Surgeons (BAAPS):
The association of British Plastic Surgeons with a particular interest in cosmetic surgery. Jeremy Hurren is a member of BAAPS.
British Association of Plastic Reconstructive and Aesthetic Plastic Surgeons (BAPRAS):
The association of British Plastic Surgeons. Jeremy Hurren is a member of BAPRAS.
Formerly British Association of Plastic Surgeons (BAPS).
General Medical Council (GMC):
www.gmc-uk.org/ Tel: 0207 915 3630
The register of British registered doctors. Check whether a particular doctor is on the medical register as a specialist. Jeremy Hurren is on the GMC register (registration number 3243048) as a specialist Plastic Surgeon.