Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Labiaplasty: motivation, techniques, and ethics

Nature Reviews Urology volume 15, pages 175–189 (2018)Cite this article

Subjects

Key Points

  • No criteria exist to provide a definition of labia minora hypertrophy, and the perception of normal labia minora size differs among women, health-care professionals, and cultures

  • Media outlets, such as magazines, show mainly altered images of labia, which affects women's genital self-image

  • Eleven surgical approaches to labiaplasty have been described, meaning no gold-standard technique exists

  • Complication rates are low, and most complications are minor, but severe complications can occur with considerable consequences

  • The limitations of current studies are small sample size, few reporting on satisfaction, complications, and outcomes, and lack of long-term data

  • Patient-reported outcome measures are needed to enable evaluation of patient satisfaction

Abstract

Labiaplasty (also known as labia minora reduction) is attracting increasing attention in the media and in online forums. Controversy exists among health-care professionals on how to manage a request for this surgery. Furthermore, the indications for and outcomes of labiaplasty have not yet been systematically assessed, and long-term outcomes have not yet been reported. Labia minora hypertrophy is defined as enlargement of the labia minora; however, the natural variation of labia minora size has scarcely been studied, with only one study suggesting objective criteria. Perception of the 'normal' appearance of labia minora is influenced by culture, exposure to idealized photographs in media, health-care professionals' opinions, and family, friends, and sexual partners (although this influence has not been substantiated by research). The desire for labiaplasty is predominantly based on dissatisfaction with genital appearance and not on functional complaints. Most health-care professionals believe that women seeking labiaplasty should be referred to a psychiatrist or psychologist for consultation before surgery, although whether counselling and education are effective at alleviating dissatisfaction or a low genital self-esteem is not clear. As the nature of patient motivation for this type of surgery is often psychological, counselling and education could be useful in reducing the demand for labiaplasty. However, current studies on surgical technique and outcomes include few patients, therefore, evidence on the results of different labiaplasty techniques and patient satisfaction is inconclusive. Further research is required to assess the value of this treatment and the appropriate indications for it. Improved understanding as to why women seek this treatment is needed and whether conservative treatments (such as counselling) are effective. Furthermore, systematic assessment of the surgical and patient-reported outcomes of labiaplasty is needed to assess whether it is safe and effective. Moreover, understanding the effect of cultural trends, for example, the way in which many women in Western society see any exception to the ideal body as a problem, will be insightful.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: The Ellsworth algorithm for selection of technique for labiaplasty11.
Figure 2: Surgical technique for labiaplasty.

Similar content being viewed by others

References

  1. Chavis, W. M., LaFerla, J. J. & Niccolini, R. Plastic repair of elongated, hypertrophic labia minora. A case report. J. Reprod.Med. 34, 373–375 (1989).

    CAS  PubMed  Google Scholar 

  2. Hagisawa, S. & Arisaka, O. Effect of excess estrogen on breast and external genitalia development in growth hormone deficiency. J. Pediatr. Adolesc. Gynecol. 25, 61–63 (2012).

    Article  Google Scholar 

  3. Giraldo, F., Gonzalez, C. & de Haro, F. Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora. Plast. Reconstr Surg. 113, 1820–1825 (2004).

    Article  Google Scholar 

  4. Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 378: vaginal “rejuvenation” and cosmetic procedures. 110, 737–738 (2007).

  5. Gonzalez, P. I. Classification of hypertrophy of labia minora: consideration of a multiple component approach. Surg. Technol. Int. 27, 191–194 (2015).

    PubMed  Google Scholar 

  6. Crouch, N. S., Deans, R., Michala, L., Liao, L. M. & Creighton, S. M. Clinical characteristics of well women seeking labial reduction surgery: a prospective study. BJOG 118, 1507–1510 (2011).

    Article  CAS  Google Scholar 

  7. Burger, M. P. M. Het neotene genitaal [DUTCH]. Nederlands Tijdschrift Voor Obstetrie & Gynaecologie 121, 220–223 (2015).

    Google Scholar 

  8. Mauriceau, F. Traité des Maladies des Femmes Grosses et de Celles qui sont Accouchées [FRENCH] 3rd edn (Par la Compagnie des libraires, Paris, 1681).

    Google Scholar 

  9. Meissner, F. L. Die Frauenzimmerkrankheiten nach den neuesten Ansichten und Erfahrungen, ersten Bandes erste Abtheilung [GERMAN] (Otto Wigand, Leipzig, 1842).

    Google Scholar 

  10. Treub, H. Leerboek der Gynaecologie (van Doesburgh, Leiden,1892).

    Google Scholar 

  11. Goodman, M. P. Female cosmetic genital surgery. Obstetr. Gynecol. 113, 154–159 (2009).

    Article  Google Scholar 

  12. Placik, O. J. & Arkins, J. P. Plastic surgery trends parallel Playboy magazine: the pudenda preoccupation. Aesthet. Surg. J. 34, 1083–1090 (2014).

    Article  Google Scholar 

  13. Alter, G. J. Aesthetic labia minora and clitoral hood reduction using extended central wedge resection. Plast. Reconstr. Surg. 122, 1780–1789 (2008).

    Article  CAS  Google Scholar 

  14. Lowenstein, L. et al. Physicians' attitude toward female genital plastic surgery: a multinational survey. J. Sex. Med. 11, 33–39 (2014).

    Article  Google Scholar 

  15. Ellsworth, W. A. et al. Techniques for labia minora reduction: an algorithmic approach. Aesthet. Plast. Surg. 34, 105–110 (2010).

    Article  Google Scholar 

  16. Franco, T. & Diogo, F. Nympha hypertrophy. J. Bras. Ginecol. 103, 163–168 (1993).

    Google Scholar 

  17. Lloyd, J. N. S. C., Minto, C. l., Liao, L. M. & Creighton, S. M. Female genital appearance: 'normality' unfolds*. BJOG 112, 643–646 (2005).

    Article  Google Scholar 

  18. Basaran, M., Bayar, U. & Civelek, B. Characteristics of external genitalia in pre- and postmenopausal women. Climacteric 11, 416–421 (2008).

  19. Michala, L., Koliantzaki, S. & Antsaklis, A. Protruding labia minora: abnormal or just uncool? J. Psychosom. Obstet. Gynaecol. 32, 154–156 (2011).

    Article  Google Scholar 

  20. Pérez, G. M., Mubanga, M., Aznar, C. T. & Bagnol, B. Zambian women in South Africa: Insights into health experiences of labia elongation. J. Sex. Res. 52, 857–867 (2015).

    Article  Google Scholar 

  21. Choi, H. Y. & Kim, K. T. A new method for aesthetic reduction to the labia minora (the deepithelialized reduction labioplasty). Plast. Reconstr. Surg. 105, 423–424 (2000).

    Article  Google Scholar 

  22. Maas, S. M. & Hage, J. J. Functional and aesthetic labia minora reduction. Plast. Reconstr Surg. 105, 1453–1456 (2000).

    CAS  PubMed  Google Scholar 

  23. Rouzier, R. M., Louis-Sylvestre, C., Paniel, B. J. & Haddad, B. Hypertrophy of labia minora: experience with 163 reductions. Am. J. Obstet. Gynecol. 182, 35–40 (2000).

    Article  CAS  Google Scholar 

  24. Moran, C. & Lee, C. What's normal? Influencing women's perceptions of normal genitalia: an experiment involving exposure to modified and nonmodified images. BJOG 121, 761–766 (2014).

    Article  CAS  Google Scholar 

  25. Laan, E., Hesselink, S., Snijders, N. & van Lunsen, R. H. W. Young women's genital self-image and effects of exposure to pictures of natural vulva. J. Psychosom. Obstet. Gynaecol. 38, 249–255 (2017).

    Article  Google Scholar 

  26. Brauer, M. et al. Motives for vulvar surgery of women with lichen sclerosus. J. Sex. Med. 12, 2462–2473 (2015).

    Article  Google Scholar 

  27. Schober, J., Chan, J., Mayoglou, L. & Meyer-Bahlburg, H. Self-assessment of genital anatomy, sexual sensitivity and function in women focusing on the labia for surgical implications. J. Sex. Med. 7, 456 (2010).

    Google Scholar 

  28. Schick, V. R., Rima, B. N. & Calabrese, S. K. Evulvalution: the portrayal of women's external genitalia and physique across time and the current Barbie Doll ideals. J. Sex. Res. 48, 74–81 (2011).

    Article  Google Scholar 

  29. Koning, M. Female attitudes regarding labia minora appearance and reduction with consideration of media influence. Aesthet. Surg. J. 29, 65–71 (2009).

    Article  Google Scholar 

  30. Meer, P. V. D. Wij noemen haar het liefst gewoon niet en geven haar een magere 7. Híj geeft onze vagina een dikke 8. Yes, Sanoma (2007).

    Google Scholar 

  31. Martens, L. Your vagina is more beautiful than you think. YouTube https://www.youtube.com/watch?v=Dp8-dYvEfuk (2017).

    Google Scholar 

  32. Ozer, M., Laan, E. T. M. & van Lunsen, R. H. W. Read my lips: het effect van counseling van vrouwen met een verzoek tot labiareductie [DUTCH]. Reproductieve geneeskunde, gynaecologie en obstetrie 646–650 (2009).

  33. Cassell, W. A. Body awareness and somatic delusions involving sexual organs. Am. J. Psychoanal. 40, 125–135 (1980).

    Article  CAS  Google Scholar 

  34. Amos, N. & McCabe, M. Positive perceptions of genital appearance and feeling sexually attractive: is it a matter of sexual esteem? Arch. Sex. Behav. 45, 1249–1258 (2016).

    Article  Google Scholar 

  35. Reinholtz, R. K. & Muehlenhard, C. L. Genital perceptions and sexual activity in a college population. J. Sex. Res. 32, 155–165 (1995).

    Article  Google Scholar 

  36. Berman, L., Berman, J., Miles, M., Pollets, D. & Powell, J. A. Genital self-image as a component of sexual health: relationship between genital self-image, female sexual function, and quality of life measures. J. Sex. Marital Ther. 29 (Suppl. 1), 11–21 (2003).

    Article  Google Scholar 

  37. Schick, V. R., Calabrese, S. K., Rima, B. N. & Zucker, A. N. Genital appearance dissatisfaction: Implications for women's genital image self-consciousness, sexual esteem, sexual satisfaction, and sexual risk. Psychol. Women Q. 34, 394–404 (2010).

    Article  Google Scholar 

  38. Schober, J. M., Alguacil, N. M., Cooper, R. S., Pfaff, D. W. & Meyer-Bahlburg, H. F. Self-assessment of anatomy, sexual sensitivity, and function of the labia and vagina. Clin. Anat. 28, 355–362 (2015).

    Article  Google Scholar 

  39. Placik, O. J. & Arkins, J. P. A prospective evaluation of female external genitalia sensitivity to pressure following labia minora reduction and clitoral hood reduction. Plast. Reconstr. Surg. 136, 442–452 (2015).

    Article  Google Scholar 

  40. McDougall, L. J. Towards a clean slit: how medicine and notions of normality are shaping female genital aesthetics. Cult. Health Sex. 15, 774–787 (2013).

    Article  Google Scholar 

  41. Veale, D. et al. Validation of genital appearance satisfaction scale and the cosmetic procedure screening scale for women seeking labiaplasty. J. Psychosomat. Obstetr. Gynecol. 34, 46–52 (2013).

    Article  Google Scholar 

  42. Hungry Beast The labiaplasty FAD? YouTube https://www.youtube.com/watch?v=pK9GtT-khb0&oref=https%3A%2F%2Fwww.youtube.com%2Fwatch%3Fv%3DpK9GtT-khb0&has_verified=1 (2011).

  43. Reddy, J. & Laufer, M. R. Hypertrophic labia minora. J. Pediatr. Adolesc. Gynecol. 23, 3–6 (2010).

    Article  Google Scholar 

  44. Zwier, S. “What motivates her”: motivations for considering labial reduction surgery as recounted on women's online communities and surgeons' websites. Sex. Med. 2, 16–23 (2014).

    Article  Google Scholar 

  45. Crouch, N. S. & Creighton, S. M. Long-term functional outcomes of female genital reconstruction in childhood. BJU Int. 100, 403–407 (2007).

    Article  Google Scholar 

  46. Bramwell, R., Morland, C. & Garden, A. S. Expectations and experience of labial reduction: a qualitative study. BJOG 114, 1493–1499 (2007).

    Article  CAS  Google Scholar 

  47. Sharp, G., Tiggemann, M. & Mattiske, J. Predictors of consideration of labiaplasty: an extension of the tripartite influence model of beauty ideals. Psychol. Women Q. 39, 182–193 (2015).

    Article  Google Scholar 

  48. Veale, D. et al. A comparison of risk factors for women seeking labiaplasty compared to those not seeking labiaplasty. Body Image. 11, 57–62 (2014).

    Article  Google Scholar 

  49. Sharp, G., Tiggemann, M. & Mattiske, J. Factors that influence the decision to undergo labiaplasty: media, relationships, and psychological well-being. Aesthet. Surg. J. 36, 469–478 (2016).

    Article  Google Scholar 

  50. Laumann, E. O. & Rosen, R. C. Sexual dysfunction United States. Prevalence predictors. JAMA. 281, 537–544 (1999).

    Article  CAS  Google Scholar 

  51. Veale, D. et al. Psychological characteristics and motivation of women seeking labiaplasty. Psychol. Med. 44, 555–566 (2014).

    Article  CAS  Google Scholar 

  52. Reitsma, W., Mourits, M. J. E., Koning, M., Pascal, A. & van der Lei, B. No (wo)man is an island—the influence of physicians' personal predisposition to labia minora appearance on their clinical decision making: a cross-sectional survey. J. Sex. Med. 8, 2377–2385 (2011).

    Article  Google Scholar 

  53. Iglesia, C. B., Yurteri-Kaplan, L. & Alinsod, R. Female genital cosmetic surgery: a review of techniques and outcomes. Int. Urogynecol. J. 24, 1997–2009 (2013).

    Article  Google Scholar 

  54. Felicio Y. Labial surgery. Aesthet. Surg. J. 27, 223–228 (2007).

    Google Scholar 

  55. Laufer, M. R. G. & Galvin, W. J. Labia hypertrophy: a new surgical approach. Adolesc. Pediatr. Gynecol. 8, 39–41 (1995).

    Article  Google Scholar 

  56. Alter, G. A new technique for aesthetic labia minora reduction. Ann. Plast. Surg. 40, 287–290 (1998).

    Article  CAS  Google Scholar 

  57. Kelishadi, S. S., Elston, J. B., Rao, A. J., Tutela, J. P. & Mizuguchi, N. N. Posterior wedge resection: a more aesthetic labiaplasty. Aesthet. Surg. J. 33, 847–853 (2013).

    Article  Google Scholar 

  58. Munhoz, A. M. et al. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast. Reconstruct. Surg. 118, 1237–1247 (2006).

    Article  CAS  Google Scholar 

  59. Ostrzenski, A. Fenestration labioreduction of the labium minus: a new surgical intervention concept. ISRN Obstet. Gynecol. 2014, 1–7 (2014).

    Article  Google Scholar 

  60. OCEBM Levels of Evidence Working Group. The Oxford levels of evidence 2. CEBM http://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf (2011).

  61. Lista, F., Mistry, B. D., Singh, Y. & Ahmad, J. The safety of aesthetic labiaplasty: a plastic surgery experience. Aesthet. Surg. J. 35, 689–695 (2015).

    Article  Google Scholar 

  62. Goodman, M. P. Female genital cosmetic and plastic surgery: a review. J. Sex. Med. 8, 1813–1825 (2011).

    Article  Google Scholar 

  63. Goodman, M. P. et al. Evaluation of body image and sexual satisfaction in women undergoing female genital plastic/cosmetic surgery. Aesthet. Surg. J. 36, 1048–1057 (2016).

    Article  Google Scholar 

  64. Jothilakshmi, P. K., Salvi, N. R., Hayden, B. E. & Bose-Haider, B. Labial reduction in adolescent population—a case series study. J. Pediatr. Adolesc. Gynecol. 22, 53–55 (2009).

    Article  CAS  Google Scholar 

  65. Veale, D. et al. Psychosexual outcome after labiaplasty: a prospective case-comparison study. Int. Urogynecol. J. 25, 831–839 (2014).

    Article  Google Scholar 

  66. Klassen, A. F. et al. Development and psychometric validation of the FACE-Q Skin, Lips, and Facial Rhytids Appearance Scales and Adverse Effects Checklists for Cosmetic Procedures. JAMA Dermatol. 152, 443–451 (2016).

    Article  Google Scholar 

  67. J. Johnsdotter, S. & Essén, B. Genitals and ethnicity: The politics of genital modifications. Reprod. Health Matters. 18, 29–37 (2010).

    Article  Google Scholar 

  68. Borkenhagen, A. & Kentenich, H. Cosmetic genital surgery as “normalizing practice”. Sexuologie 16, 37–42 (2009).

    Google Scholar 

  69. Bewley, S. Should a psychiatrist give legal advice on cosmetic genital surgery? Arch. Sex. Behav. 42, 323 (2013).

    Article  Google Scholar 

  70. Cartwright, R. & Cardozo, L. FOR: women should be free to opt for cosmetic genital surgery. BJOG 121, 767 (2014).

    Article  Google Scholar 

  71. Matlock, D. L. & Simopoulos, A. FOR: cosmetic vulvar surgery is a safe and effective option for our patients. BJOG 121, 767 (2014).

    Article  Google Scholar 

  72. Creighton, S. AGAINST: labiaplasty is an unnecessary cosmetic procedure. BJOG 121, 768 (2014).

    Article  Google Scholar 

  73. Tracy, E. E. Elective vulvoplasty: a bandage that might hurt. Obstet. Gynecol. 109, 1179–1180 (2007).

    Article  Google Scholar 

  74. Westermann, L. B. et al. Attitudes Regarding Labial Hypertrophy and Labiaplasty: A survey of members of the Society of Gynecologic Surgeons and the North American Society for Pediatric and Adolescent Gynecology. Female Pelvic Med. Reconstr. Surg. 22, 175–179 (2016).

    Article  Google Scholar 

  75. Nederlandse Vereniging voor Plastische Chirurgie & Nederlandse Vereniging voor Obstetrie en Gynaecologie. Counseling en behandeling van vrouwen met een verzoek om reductie van de labia minora. NVPC https://www.nvpc.nl/uploads/stand/22labiumreductie_rl.pdf (2008).

  76. Royal College of Obstetricians and Gynaecologists. Joint RCOG/BritSPAG release: issues surrounding women and girls undergoing female genital cosmetic surgery explored. RCOG https://www.rcog.org.uk/globalassets/documents/guidelines/ethics-issues-and-resources/rcog-fgcs-ethical-opinion-paper.pdf (2013).

  77. Society of Obstetricians and Gynaecologsts of Canada. Female genital cosmetic surgery. SOGC https://sogc.org/wp-content/uploads/2013/09/December2013-CPG300-ENG-Online_final.pdf (2013).

  78. van Moorst, B. R., van Lunssen, R. H., van Dijken, D. K. & Salvatore, C. M. Backgrounds of women applying for hymen reconstruction, the effects of counselling on myths and misunderstandings about virginity, and the results of hymen reconstruction. Eur. J. Contracept. Reprod. Health Care. 17, 93–105 (2012).

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic, Reconstructive and Hand Surgery, Vrije Universiteit Amsterdam Medical Center, Amsterdam, Netherlands

    Müjde Özer & Margriet G. Mullender

  2. Peninsula College of Medicine and Dentistry, John Bull Building, Science Park, Plymouth, UK

    Indiana Mortimore

  3. Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam Medical Center, Amsterdam, Netherlands

    Elise P. Jansma

Authors
  1. Müjde Özer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Indiana Mortimore
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elise P. Jansma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Margriet G. Mullender
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

M.Ö., I.M., and E.P.J. researched data for the article. M.Ö. decided the content. M.Ö. and I.M. wrote the manuscript, and M.Ö. and M.G.M. reviewed and edited the article before submission.

Corresponding author

Correspondence to Müjde Özer.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Özer, M., Mortimore, I., Jansma, E. et al. Labiaplasty: motivation, techniques, and ethics. Nat Rev Urol 15, 175–189 (2018). https://doi.org/10.1038/nrurol.2018.1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2018.1

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing