Abstract and Introduction
Abstract
Background Vaginal labiaplasty has been described for the management of functional and aesthetic problems associated with protrusion of the labia minora. Despite increasing numbers of procedures performed, there is a paucity of data to guide treatment paradigms. This systematic review aims to establish a simple, unifying classification scheme for labial protrusion and summarize current labiaplasty techniques and practices.
Methods A systematic literature review was performed using the PubMed database. Additional articles were selected after reviewing references of identified articles.
Results The search returned 247 articles. After applying inclusion criteria to identify prospective and retrospective studies evaluating different techniques, outcomes, complications, and patient satisfaction, 19 articles were selected. Labiaplasty of the labia minora was described in 1949 patients. Seven different surgical techniques were used for labiaplasty, including deepithelialization, direct excision, W-shaped resection, wedge resection, composite reduction, Z-plasty, and laser excision. Patient satisfaction rates for each technique ranged from 94 to 100 percent. The most common postoperative complication for all techniques was wound dehiscence (4.7 percent). Key areas for perioperative patient management were defined.
Conclusions Labiaplasty is safe and carries a high satisfaction rate. However, current practices remain exceedingly diverse. The authors propose a simplified classification system based on the distance of the lateral edge of the labia minora from that of the labia majora, rather than from the introitus. Key areas for perioperative patient management include patient anesthesia, resection technique used, wound closure, and postoperative care. Further randomized studies using a standardized classification system are required to better compare different techniques and establish best practices.
Introduction
Vaginal labiaplasty, the surgical reduction of the labia minora,[1] was first described in the plastic surgery literature by Hodgkinson and Hait in 1984.[2] Although this was the first description of labiaplasty in the plastic surgery literature, "circumcision" of the labia minora, a social custom in some cultures, had been described in other literature, and external genital surgery had previously been performed by plastic surgeons and gynecologists for a variety of indications.[2] Over the years, labiaplasty has become an increasingly popular procedure as the practice of vulvovaginoplasty has continued to gain popularity. According to data collected by the American Society for Aesthetic Plastic Surgery, 5070 procedures were performed in 2012, up 44 percent from 2011.[3] The increasing popularity of the procedure has been attributed to increased exposure to female nudity in the media, which has helped define a narrow ideal for the appearance of female genitalia.[2,4]
Women pursue this procedure for a variety of reasons. According to a recent study that evaluated 131 patients' indications for pursuing labiaplasty,[5] although 37 percent of patients sought labiaplasty for strictly aesthetic reasons, 32 percent sought surgery for functional impairment such as pain and discomfort, and 31 percent sought surgery for both functional and aesthetic reasons. Various other indications for this procedure have been described in the literature. Hypertrophy of the labia minora can result in dyspareunia, interference with sports, difficulties with cleanliness, chronic urinary tract infections, and irritation.[6] Psychological symptoms relating to the appearance of the genitalia are not to be understated; the appearance of the labia minora can cause patients significant emotional distress, particularly in adolescent populations.[7]
Although these procedures are controversial, patients are generally very satisfied with outcomes. Overall patient satisfaction rates are in the 90 to 95 percent range.[8] However, problems remain. Although the ideal aesthetic is well defined, there are still no standardized diagnostic criteria for labial hypertrophy. According to an early definition, hypertrophy of the labia minora is present when the distance from the midline to the lateral free edge of the labial minora is greater than 5 cm when the labia are extended laterally.[9] More recently, others have proposed that this distance be reduced to 3 or 4 cm.[10,11] Despite these recommendations, there is no consensus regarding the use of these criteria in forming a diagnosis of labial hypertrophy, and it has been proposed that surgery should be pursued with the presence of any chronic symptomatology. A variety of classification schemes also exist,[12] again with no consensus regarding their use. Several different techniques for labiaplasty currently exist, and guidelines for their use have not been well defined.
In this article, we present a comprehensive, systematic review of the available literature regarding labiaplasty for aesthetic and functional indications. The ideal aesthetic is defined. Various techniques are discussed and clinical recommendations are made for their use to optimize patient outcomes. A new classification schema is proposed to better stratify patients for various treatment paradigms.
Plast Reconstr Surg. 2015;135(2):774-788. © 2015 Lippincott Williams & Wilkins
