Key Points
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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
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Media outlets, such as magazines, show mainly altered images of labia, which affects women's genital self-image
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Eleven surgical approaches to labiaplasty have been described, meaning no gold-standard technique exists
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Complication rates are low, and most complications are minor, but severe complications can occur with considerable consequences
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The limitations of current studies are small sample size, few reporting on satisfaction, complications, and outcomes, and lack of long-term data
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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.
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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
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DOI: https://doi.org/10.1038/nrurol.2018.1
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