Until recently, labial surgery appeared to be rarely performed, except when tumour excision, trauma, congenital abnormalities, or sex change procedures were indicated. Over the past few years, the author has become aware of an increasing referral of cases enquiring about surgical reduction or enhancement. Such requests have indicated that such operations have achieved popularity abroad.1
There has recently some debate on the subject of ‘cosmetic genitoplasty’ and it has been pointed out that the procedure of partial or total removal of external female genitalia for cultural or other non-therapeutic reasons is a ‘criminal offence’ in the UK under the Female Genital Mutilation Act. It has been argued that surgery is rarely an answer to psychological problems and that this surgery exploits women's lack of bodily self esteem. The author goes further to state that there is no evidence of any benefit of surgery for mental health, but ample evidence of potential and actual harm – ‘the law against female genital mutilation must be enforced’.2
A small survey of consecutive patients who requested labial surgery between 2002 and early 2007 was studied. There were 10 females age range 20–37 years (average 26.5 years). All, except one, requested reduction – one requested augmentation. None were assessed by the author as having significant desires or worries regarding other aspects of their body or had had any other plastic or cosmetic surgery. None were referred for psychological assessment since it was considered that the anatomical abnormality perceived by the patient was in tune with the surgeon. A questionnaire was returned by eight of these women and revealed some of the reasons for their wish to have surgery as well as when they became aware of it.
All the patients had surgery, reduction by either a wedge excision or for smaller tissue excess by linear excision (labia minora). The operations were performed easily under general anaesthetic and usually with a 2 or 3 day admission. Operation time was in the region of 45
min. In the one case of augmentation this was done by two separate local anaesthetic autologous fat injection sessions. It is claimed that the wedge excision method preserves the normal labial edge and anatomy.3 The only complications following the surgery for reduction cases were two haematomas, only one requiring a second operation to evacuate. All the reduction cases were happy with the results and none have required or requested further surgery. The patient who had fat injection has had some absorption of fat and is seeking an alternative treatment option if available.
The results of a questionnaire revealed no unexpected findings; the most common reason for requesting surgery was ‘embarrassed by appearance’ (100%) followed by irritation in clothes while riding bikes or horses (75%). Previous episiotomy scar complication was the main reason in one case while problems with social/sexual implications were reported in 25% of cases. With regard to when the problems started to occur, 63% started during school – usually because of comments in showers or changing rooms. In 25% of cases, the problem seemed to occur after this in early adulthood after school days. Seventy-five per cent of patients found out about labial surgery from the internet while 25% found about it from ‘others’.
The information provided on the internet seems to support and legitimise labial surgery.4 This is in contradiction to the view that it is female genital mutilation and should be prosecuted, unless the surgery is necessary for physical or mental health.2 The interpretation of this may be a matter of debate for individual cases as well as their surgeons but indicates that great care must be taken in any decision to operate. In cases of doubt, referral to a clinical psychologist before any surgery should be considered.
Labia minora enlargement can be congenital, can occur in infancy due to exogenous androgenic hormones, be due to persistent manual stretching, or chronic irritation.3 Women and young girls have probably become more aware of abnormalities as a result of wearing tight fitting clothing, going to sports clubs, waxing of the genital area, internet information, greater sexual confidence, and publications in magazines and films showing ‘normal genitalia’.
The small series described in this paper illustrate some of the situations that may arise when these patients present and what can be done to help in what appears to me to be an easy and worthwhile procedure in appropriate cases.
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