Genital structures, like others areas of anatomy such as noses, ears and breasts will vary from one person to the next. While there is a wide range of so-called “normal”, only you can decide whether the appearance, size, shape or arrangement of a structure pleases you, irrespective of what someone else feels is “normal”. The choice to seek surgical alteration is yours alone and while advice and a frank discussion of your options are a part of our normal consultative practice, no attempt will be made to convince you that you should have surgery.
Women choose labiaplasty for many reasons, including genital pain, cosmetic reasons or to enhance sexual satisfaction. Overly large labia minora and labia majora (the inner and outer labial folds of the female genitalia) can cause both intimate embarrassment and physical discomfort.
The good news is that these conditions can be corrected functionally and cosmetically by a simple operation which trims away the excess tissue. Plastic surgeons using fine instruments and sutures get excellent results.
Some women have a foreskin hiding the clitoris that reduces sensitivity during sex. This can be reduced effectively during labiaplasty. Another popular option is to have a ‘vaginoplasty’ or tightening of the back wall of the vagina done at the same time, or in combination with another surgery.
Labiaplasty usually takes about an hour under local anaesthesia with sedation, or a light general anaesthetic plus a local anaesthetic (for postoperative comfort), on an outpatient basis. Any ‘extras’ that increase the length of the surgery will increase the cost. Alternatively, you can ask for local anaesthetic with tablet sedation, which reduces the cost considerably compared to general anaesthesia. This works well for those who are psychologically robust!
The exact surgical plan will depend on the individual patient’s wishes and physiology. Generally, if there is a finger-like projection of excess tissue, this can be removed by ‘wedge’ excision with a short vertical scar. If the whole length of the labia is enlarged, a lengthwise piece of tissue may be removed – preserving at least 5mm of the inner lips. After carefully stopping any bleeding points, closure is done with inner and outer layers of absorbable sutures. Lastly, antibiotic ointment and a pad are applied.
Although complications after such surgery are very uncommon, just like any surgical procedure, labiaplasty and functional vaginal surgery are not without potential risks. These, together with any specific concerns or questions you may have, will be fully discussed with you at the time of your consultation. The general risks include infection, bleeding and scarring. More specific risks associated with this surgery include possible changes in sensation, pain and anxiety although the vast majority of well-prepared patients have a problem-free postoperative course.
Postoperative instructions will be reinforced to you in the immediate postoperative period, however it is important that you have an understanding of what to expect during this time. This will assist in a speedy and uncomplicated recovery.
1. Sutures do not specifically need to be removed and will dissolve.
2. Pain following this surgery is usually of a mild to moderate degree of discomfort.
3. Cool packs used following surgery may help to reduce swelling which will tend to increase for the first two or three days following surgery.
4. From this point, the resolution of swelling is usually quite rapid and the majority of the swelling has resolved at one week for most women.
5. Gentle bathing of this area is carried out morning and night following surgery.
6. Patients apply petroleum jelly, wear panty liners, loose cotton underwear and non-restrictive clothing to prevent irritation of the wound for the first 7 to 10 days.
7. Most life activities are being undertaken normally for seven days although it does take longer to reintroduce tight-fitting clothing, activities such as exercise and sexual intercourse.
8. Occasional patients will take longer to recover but most will return to sedentary jobs within a few days, low-impact sports from two weeks, more exertive sport from about three or four weeks and sexual intercourse by four weeks.
9. You must have a carer organised for your constant care for at least three to four days following your discharge from Hospital. You will not be able to drive yourself home from your Surgery, and may not be able to drive for up to ten days following your Surgery depending on the extent of the area treated.
10. You will require time away from your workplace, the length of which will vary according to your post-operative condition and recovery time. This varies between individuals. Allow at least 7 days for swelling to decrease and discomfort when sitting to become less obvious.
11. It is important that you do not go home expecting to continue with day-to-day duties that were the norm prior to your surgery, as you must allow time for recuperation and recovery. Surgery and anaesthesia impose stress on your body and it is important that you allow adequate recovery time postoperatively.