Complementary Information on Labiaplasty

Labia minora hypertrophy is defined by excessive size of the labia minora, notably relative to the labia majora. Thus, in the standing position, the labia minora protrude and extend beyond the vulvar cleft, which leads patients to describe them as "hanging" labia minora. The hypertrophy is most often bilateral, preserving the physiological asymmetry of the labia minora, the left naturally being larger than the right; it may however be unilateral. This appearance most often appears at puberty (primary juvenile hypertrophy) but may occur after childbirth or at menopause (secondary hypertrophy through vulvoptosis or pseudo-hypertrophy whose treatment is then different from that of classic hypertrophy).

The labia minora often present hyperpigmentation due to friction in underwear. Sometimes, the hypertrophy extends anteriorly, creating folds on either side of the clitoris. Labia minora hypertrophy often causes clothing discomfort (wearing tight jeans, thongs, fitted swimwear) or difficulty practising certain sports (cycling, horse riding, climbing). Discomfort varies during sexual intercourse, less physical (interposition of labia minora during penetration) than psychological (embarrassment undressing before a partner). Sometimes this hypertrophy is responsible for recurrent yeast infections. These disorders may justify health insurance coverage in the most significant cases.

The surgical procedure, or nymphoplasty, aims to reduce the size of the labia minora, correct any major asymmetry, without omitting, if applicable, reduction of the anterior extensions on either side of the clitoris. The objective is to obtain a harmonious vulva with labia minora proportionate to the labia majora and the vulvar volume.

The procedure removes excess mucosa. Several surgical techniques have been described. The simplest involves a resection as needed following a personalised pre-established pattern, whose incision follows the free edge of the labium. This technique has the advantage of being safe and adjustable. It allows treatment of not only labia minora hypertrophy but also the anterior extension if applicable, and reduces the frequently associated hyperpigmentation. The mucosal edges are then sutured with absorbable sutures. Other methods have been described: wedge resection or the Chinese method (fenestration), but they do not offer the same adaptability and should be reserved for particular cases. A nymphoplasty can be performed from adulthood with no age limit. The procedure will have no negative consequences on sexual intercourse or childbirth.

A preoperative assessment is carried out in accordance with prescriptions. The anaesthetist will be seen in consultation no later than 48 hours before the procedure.

Smoking cessation is strongly recommended, at least one month before and one month after the procedure (smoking can cause delayed healing).

Discontinuation of oral contraception may be required, particularly in cases of associated risk factors (obesity, poor venous condition, coagulation disorders).

No medication containing aspirin should be taken in the 10 days prior to the procedure.

It is essential to fast (no food or drink) for 6 hours before the procedure.

Shaving is not necessary.

Type of anaesthesia: nymphoplasty is most often performed under twilight anaesthesia, i.e., local anaesthesia deepened by tranquillisers administered intravenously.

Hospitalisation: generally, the procedure is performed as a day case, i.e., with discharge on the same day after a few hours of monitoring. The patient may then return home once her general condition permits. However, for social, family or personal reasons, a short hospital stay may be considered.

Each surgeon adopts a technique of their own, adapted to each case to achieve the best results. At the end of the procedure, a light dressing is placed in protective underwear. Depending on the surgeon and the clinical case, the procedure may last from 30 to 60 minutes.

Each surgeon has their own protocol. Minimal bleeding lasts 2 to 3 days. Swelling and bruising are normal. Postoperative recovery is generally only mildly painful, requiring only simple analgesics. A pad is placed in the underwear. Loose clothing (skirt or loose trousers) is recommended. Intimate hygiene is maintained with twice-daily sitz baths with a standard antiseptic. A gentle hair dryer is preferred for drying the operated area. Sutures should absorb within eight to twelve days, at which time healing is achieved. Waiting two to three weeks is advised before progressively resuming sexual activity. A work stoppage is most often not necessary. Waiting one to two months is advised before resuming activities such as horse riding or cycling.

It can only be judged one month after the procedure. The vulva then has a harmonious shape. Scars fade within 1 to 2 months. The goal of this surgery is to bring about an improvement, not to achieve perfection. If your expectations are realistic, the result obtained should give you great satisfaction.

These essentially involve residual asymmetries, size inadequacy (insufficient resection) or persistence of the anterior extension. In these cases, a secondary surgical correction can be performed, but it is advisable to wait at least 6 months to 1 year.

A reduction nymphoplasty, although performed for partly aesthetic motivations, remains a genuine surgical procedure, which implies the risks associated with any medical act, however minor.

Postoperative recovery is generally straightforward following a nymphoplasty. However, complications may arise, some general and inherent to any surgical act, others loco-regional.

A distinction must be made between complications related to anaesthesia and those related to the surgical procedure.

Regarding anaesthesia, during the consultation, the anaesthetist will personally inform the patient of the anaesthetic risks. Having recourse to a fully competent Anaesthetist, practising in a truly surgical setting, means that the risks incurred have become statistically very low.

Indeed, techniques, anaesthetic products and monitoring methods have made immense progress over the past thirty years, offering optimal safety.

Regarding the surgical procedure: by choosing a qualified and competent Plastic Surgeon, you minimise these risks as much as possible.

Fortunately, true complications are rare following a reduction nymphoplasty performed according to standard practice. The vast majority of procedures proceed without problems and patients are fully satisfied with their results.

Nevertheless, despite their low frequency, you should be informed of possible complications:

• Thromboembolic events (phlebitis, pulmonary embolism), very rare overall after this type of procedure, are among the most feared. Rigorous preventive measures must minimise their incidence.

• Bleeding is rare but may require prompt reoperation.

• A haematoma may require evacuation.

• Infection is rare.

• Delayed healing or even wound dehiscence may sometimes be observed, prolonging postoperative recovery.

• Mucosal necrosis observed in certain operative techniques may cause delayed healing.

• Lasting sensitivity changes are exceptional.

Thus, in the vast majority of cases, this procedure, well planned and correctly performed, produces a highly appreciable result in terms of aesthetics and comfort.

Overall, risks should not be overestimated, but one should simply be aware that a surgical procedure, even an apparently simple one, always involves a small element of uncertainty. Choosing a qualified Plastic Surgeon ensures that the practitioner has the training and competence required to prevent these complications, or to treat them effectively should they arise.