Posts Tagged Labia minora
Clients come to the office frequently anxious about considering surgery of their genitals. Many are understandably worried as the impressions online from those having elective genital surgery vary enormously. Some had had a great experience and others warn of the “dangers.” Not all surgery of the genitals is performed the same way and the results vary with the technique and experience. Then again you can’t expect all operations done “down there” to address the same issues.
As I have written here before, I limit the operations I do in the genitalia to labiaplasty, specifically modification of the outer structures. These are usually reductions. Some are designed to reduce the discomfort of patients with larger lips (usually the Labia minora) and others are for more cosmetic issues like “evenness.” Vaginoplasty refers to operations on the inside of the vagina. These are frequently designed to tighten things internally. Some labiaplasty patients report increased “tightness” after surgery, but this is not usually the case.
My personal opinion is that vaginoplasty operations are higher risk…risk to internal structures and often the nerves. Long standing pain after vaginoplasty is not as uncommon as it is in properly performed labiaplasty surgery. My patients tend to have a pretty good experience.
Be sure if you are to consider an operation of your genitalia, that you review the risk and benefit of your specific operation before you decide to proceed. Realize that not all operations “down there” are the same and each one comes with its own risk/benefit profile. What different surgeons call “Labiaplasty” and “Vaginoplasty” also varies between surgeons. You need to ask an adequate number of questions beforehand to figure if the operation a particular surgeon is offering you might be right for you.
John Di Saia MD
Originally posted 2011-06-28 07:30:56.
A recent study…shows that male physicians and plastic surgeons are more inclined to recommend surgery to alter the physical appearance of an otherwise healthy vulva. Published in the Journal of Sexual Medicine, the study was conducted in the Netherlands with a set of 210 doctors who were shown photos four healthy vulvas, two pre-labiaplasty and two post, following about six months of healing. These vulvas belonged to two women, one age 35 and the other 40, who underwent cosmetic surgery to shrink the size of their labia minora (aka inner pussy lips) which they felt extended abnormally beyond their labia majora (aka outer pussy lips). 164 of these 210 doctors completed this survey, and most (90 percent) agreed that the smaller labia minora were closer to society’s ideal.
I have written a labiaplasty article for the Journal of Sexual Medicine. I have also served as an article reviewer for articles being considered for publication at the journal. I did not review this article. Even if I had I am not sure I would have recommended it for publication.
Needless to say there are quite a few misconceptions about labiaplasty surgery. Each labiaplasty surgeon has his (or her) own particular philosophy through which he offers the surgery. Mine has not been to judge women’s privates, but rather serve to make them more to the liking of their owners within reason. I am not running some kind of Playboy bikini contest. Local Orange County women do not drop their drawers to ask me whether they “need” their Labia reduced either. When the question is presented in this manner, very few do. Women have their reasons for considering labiaplasty surgery and some of these make pretty good sense.
This study seems to have looked at the impressions of a group of doctors regarding what was more acceptable by current societal standards in the way of the Labia. My contention is that these standards really do not matter. “Normal” labial lip size can still be large enough to cause pain in today’s small string underwear. So normalcy per se has little to do with the consideration of labiaplasty in many cases. In consultation, the patient and I try to figure out what bothers her and what I might do about it. I am not there to label. I am not there to judge. We are there to figure what (if anything) might be improved.
Studies like this one just muddy the waters and they are already pretty muddy. It is all a matter of philosophy anyway.
John Di Saia MD
Labiaplasty is a common topic here. Motivation and post-operative results are probably the most common issues, but how a woman gets on sexually afterward is a pretty common concern as well. Sexual function is one of the more common reasons patients consider having this operation in the first place. In my own Orange county practice of reduction labiaplasty (mostly of the Labia minora,) patients are usually advised to abstain from sex for 4-6 weeks. I prefer to see a patient a few times over that time to ascertain the healing of her wounds before she “stress tests” them. Then I advise she eases into things such as not to have problems. Having a four hour sex session as a first post-operative sexual experience is not a good idea.
This has worked well over the last ten years as I have had a 0% major revision rate. No one has broken anything having sex when they have waited for the “OK” first. Some people have poked fun at this statement, but it is true.
These are my general recommendations for my own wedge Labia minora reductions. If you have had surgery elsewhere you are advised to discuss any variations from your surgeon’s plan with your surgeon before implementing them.
John Di Saia MD
We have discussed reduction labiaplasty surgery here before. Some women consider this small but delicate operation due to the size of their Labia minorae. Others do it for aesthetic concerns. A woman with large labia can experience pain in tighter clothing. It is all relative of course.
The key to a maximizing safety with this operation is choosing the right method and focusing on the outer structures using an experienced surgeon.
There are many ways the inner lip reduction operation can be performed, but the two most common techniques are called the “Trim” and “Wedge.”
The Trim is a simple operation in which the unwanted portion of the Labia minora is simply cut off and sutures are used to close the openings. “Simple” does not necessarily translate to “better.” The PROs of the Trim procedure include that it is easy to teach and learn and can easily be performed under local anesthesia. Amongst the CONs are the facts that pain after surgery can be severe and longstanding and it is common for “too much to be removed” leaving a pretty unnatural appearance. This is the most commonly performed version of labiaplasty surgery at present.
The Wedge operation involves the removal of a “pie shaped” piece of the labia. This tends to leave the appearance of the remaining “lip” looking untouched. This version of the operation is harder to learn and is harder to perform under just local anesthesia. The sensation of the remaining tissue is normal in the vast majority of cases if the operation is done well. Wedge patients tend to return to physical and sexual activity earlier than Trim patients.
My opinion is that a well-performed Wedge is the way to go in most cases and has a lower risk profile. There are some cases in which the anatomy lends itself better to one technique as opposed to the other, but that is where a surgeon’s experience comes into play.
John Di Saia MD
Women researching labiaplasty are understandably apprehensive. The online stories on female genital surgery vary from the very low key to nightmares. It should be emphasized that not all operations down there are the same. I have expressed my practice of operating on the “outside” (Labia minora, Hood of the clitoris and occasionally the Labia majora) and staying out of the vagina. As a plastic surgeon, I do labiaplasty but not vaginoplasty. The reasons for this are to limit risk and provide for a relatively quick recovery. Women tend to want things down there to be sexually available after surgery. Many include this in their reasoning to entertain surgery in the first place.
A modification on a basic labiaplasty is to reduce the hood of the clitoris. Exposure of the clitoris is interesting in that it is sensitive afterward. Partial exposure is well tolerated. It adjusts much like a man’s glans adjusts after circumcision. Too much exposure makes this adjustment more uncomfortable and long lasting. Small exposure improvements (small reductions) make the clitoris more easily available during sex with few if any sensitivity problems. You want your labiaplasty surgeon to be experienced particularly as you move to more sensitive parts.
John Di Saia MD
I found you on the internet and you strike me as an honest man. Although the thought scares the @#^%@&^#% out of me, I am thinking about having my vaginal lips reduced. They are too big. They hurt in workout clothes and I think they make an otherwise hot body look ugly. I see you do this surgery. Am I crazy? Will I ever enjoy sex again afterward. The stuff I read online has me scared.
No, of course you are not crazy. Your apprehension is understandable though as I see the characterizations that are made online of the procedure. One forum at which I used to post has many ladies who had surgery elsewhere expressing fear and displeasure on a regular basis. Fortunately, none of those doing so are my former patients. In fact, a few of my patients have posted there indicating that they had had good experiences contrary to those described there. This surgery can be done safely.
Reduction labiaplasty can be a very satisfying operation when performed correctly on the right patient. The operation can be done safely when the Labia minorae (the inner vaginal lips) are specifically reduced. I am not a fan of inner vaginal surgery and focus my experience on the “outside. Having done the operation a number of ways over the past ten years or so, I also know that the technical aspects of the operation make a huge difference in outcome. Avoid the novice surgeon here at all costs.
My patients have been happy afterward and I follow those who are interested and locally available through several months until they are back to sexual activity. Not one who I have asked would ever want to “go back.”
Of course you need to seek out an honest and experienced surgeon and really evaluate why you are considering surgery. Make sure if you have the operation, you are doing it for yourself and not some external reason.
John Di Saia MD
“The Perfect Vagina” is a BBC documentary program hosted by Lisa Rogers exploring the question of why British women consider reduction labiaplasty, reduction of the Labia minorae or the “vaginal lips.” It is natural as a surgeon who performs reduction labiaplasty to compare the impressions left with those of my experience. After watching this program, I was left with a few thoughts:
(1) The show made the legitimate point that there is an enormous variation in what is normal in the size of the Labia minora.
(2) The program also made it sound like some women were having the surgery because of the perceptions of men. I have been doing this procedure for almost ten years and not a single woman said she was doing it because of a man. In my experience, most men do not care about the size or shape of the Labia minorae. The women considering it do of course.
(3) The show did not mention and certainly did not emphasize that many women explore the option of surgery for issues of discomfort and pain. Many women are unable to feel comfortable in tight clothing or their choice of undergarments because of pain and seek reduction to take this discomfort away. The operation almost always works for this too.
(4) The show did not explore the technical aspects of the actual surgery very well. The only operation shown on the program was simple trim technique under straight local, the technique associated with the most discomfort leaving the patient with the least normal-looking result. I do not offer the surgery under straight local for exactly the reason shown; it hurts. I perform a different technique that leaves the patient with less discomfort and a more functional and yes, “pretty” result. In my practice, the patients are operated in a surgical facility with anesthesia, again for comfort.
(5) The very premise of the show, that women were seeking to “perfect” their Labiae was a bit over the top. While there is, of course, a cosmetic aspect to this operation, many women also have functional concerns. The bit where women were showing each other their genitals as a therapy session of sorts was silly. I had not even heard of this before. The show also did not show any of the really large Labiae that I have seen.
(6) Despite the fact that the program included the story of a sixteen year old young lady having the surgery, this is not the norm. I have not performed the operation is anyone under the age of twenty. Just like in other areas of plastic surgery, labiaplasty surgeons all have their own philosophies. One even close to mine was just not presented on the show.
John Di Saia MD
Somewhere on the internet, opinion about Dr D stews:
meet Dr. John Di Saia, a plastic surgeon whom we imagine to be the “real housewife”-maker of Orange County (since, on one of his blogs, he provides advice on “Cosmetic genital surgery — labia minora reduction”). On his other blog, “Truth in Cosmetic Surgery,” Dr. Di Saia seems to reach out to Padma Lakshmi, saying, “That arm scar is really ripe for improvement.”
OK the blog itself isn’t so bad on me. Now to the comments:
diSaia is a right wing asshole.
Well I do side with the military and police pretty often.
Yeah, I remember a blog post he wrote a couple years ago on how he felt Cindy Sheehan needed plastic surgery. It was disgusting. Someone wrote a not so happy comment about it and he started in on some anti-liberal bs. The guy needs to stick to fixing pussy lips and keep his shut.
Well I didn’t say that. I never say anyone “needs” plastic surgery. It is a choice like my choice to state my opinion here.
John Di Saia MD