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The theme of the past month in my gynecologic practice has been labia, labia, labia. We’ve discussed it all…big labia, small labia, uneven labia…irritated labia, torn labia, ugly labia, “in the way labia.”   Although several patients I saw actually had a legitimate concern and need for a little nip and stitch, most women were reacting to complaints from their partners or from personal insecurities. I did schedule two labial reduction surgeries and assisted on another this week. This procedure is better known in the medical community as a Labiaplasty (also Labioplasty). But a majority my patients just need someone on their side to keep it real.

The Anatomy Lesson

Let us back it up for minute for those of you who need an anatomy lesson. Don’t be embarrassed. I’ve met many women over 40 who never made the time to even look. They finally felt inspired one day, put a mirror to their genitals, and became afraid enough to schedule an appointment to discuss their findings.

We are going to focus on the vulvar anatomy, which is external and often confused with the vagina, which is internal. Your vulva consists of your mons pubis, labia majora, labia minora, your clitoris, and the openings to your urethra and vagina. The mons is the soft fatty area over your pubic bone where the majority of pubic hair grows. The labia majora are the more fatty, larger skin folds that extend downward from the mons pubus. Most patients call the labia majora their “larger vaginal lips.” The labia minora are the often smaller, thinner and hairless folds of skin between your labia major and vagina. The labia minora cover and protect the very sensitive skin around the vaginal opening and urethra.

Asymmetrical Labia and the Meaning of “Normal”

It is important for you to know that there is a tremendous variation in the look of all women’s external genitalia. We often call this genital diversity. No two women are the same. The contour, length, size and shape of your labia majora and minora are unique to your physical make up. Many women have one labium that is longer than the other.   It is also common to see the labia minora protrude beyond the labia majora. In recent years there have been websites and blogs aiming to demystify how things look “down there.” Two are the Labia Library and The Large Labia Project. Opinions fly about the appropriateness of these sites, but I feel any resource used to raise awareness and start a healthy dialogue should be celebrated. Most of us couldn’t pick our own labia out of a crowd even if offered a reward. These sites just reinforce there is no such thing as “normal.” Most of the women’s genitalia featured on this site are white, so ethnic viewers beware. There is a normal range of skin coloration and variation in women who are Black, Indian, Asian, Latina, and from other ethnic groups.

Be Mindful of Influences

Many have blamed the pornography industry on tainting women’s expectations and painting a picture of the ideal vulva. But I’m not so sure all of the women I meet are holding their standard against their favorite porn star. There are a large amount of pornographic images on websites catering to many preferences and labia types. Also marketing and the availability of plastic surgery procedures have found their way to the desktops of many young women.

I do find trends in pubic hair removal contribute drastically to women being more sensitive about the appearance of their vulvas. It just makes sense, with the absence of hair, one is able to see more and analyze and critique more. If you don’t like what you see, don’t be afraid to bring back the bush! Hair has its purpose.

Size Doesn’t Matter, Symptoms Do

 I sometimes have women with legitimate labial hypertrophy. This is the term physicians use to describe labia or a labium that is enlarged, markedly elongated and causing symptoms of pain or irritation with walking, sitting, during sports activities or sex. Some women describe having to tuck or roll their labia into their underwear. Some are just deeply affected by the cosmetic appearance of their labia and request a procedure to remove the excess skin. This is the Labiaplasty procedure.

Undergoing a Labiaplasty is relatively straightforward in experienced hands. It is an outpatient, ambulatory procedure. We carefully remove the excess skin and place stitches for 7-14 days to put the labial skin edges back together to promote healing.

This procedure can deliver beautiful, satisfying results. But there are risks of infection, scarring, breakdown of the stitches, need for future surgeries to make minor changes or revisions, and sometimes women are not happy with the final cosmetic result.   Rest after the procedure is key. Keeping the area clean, wearing loose fitting clothing, and ice are a must. Ultimately it’s important to have the surgery for the right reasons, not because of your sexual partner’s opinion or anyone else’s.

Now keep in mind the vulvar skin can be affected by chronic conditions causing inflammation, scarring and discoloration. But for women with normal healthy skin, chronic itching, swelling, irritation, and discoloration should not be experienced. If you are experiencing these symptoms, you need to make an appointment with your gynecologist to rule out infection, allergies, and for a potential vulvar biopsy. Lastly, be mindful your vulvar skin will change with time, age, and potentially after giving vaginal birth.

Embrace Health Vow # 1

I Pledge to Honor My Body with Acceptance