Labiaplasty: Everything You Need to Know

Surgery to change the external appearance of the vagina

Woman talking with her doctor

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A labiaplasty, which is a type of vaginal rejuvenation surgery, is an operation in which the labia minora and/or labia majora are surgically modified for cosmetic reasons or to reduce physical discomfort. This procedure is usually elective and is not normally done for a medical purpose. Often, health insurance payers do not cover the cost of a labiaplasty, and you would likely have to pay for it out of pocket. It takes approximately six weeks to fully recover after a labiaplasty surgery, and you would have to limit exercise and sexual activity while you are healing.

What Is Labiaplasty?

Labiaplasty is a surgical intervention that involves cutting away a portion or restructuring a section of the labia. A labiaplasty can involve reducing or increasing the size of any part of the labia.

The labia are the folds of skin on either side of the opening of the vagina, The labia includes the labia majora and the labia minora. Both of these areas are visible externally without an invasive medical examination. The labia majora is the outer area and the labia minora are directly within the labia majora. The labia majora is naturally covered with hair in most adult women, and the labia minora are smaller hairless folds of skin.

Usually, a labiaplasty is done by a plastic surgeon. Your surgeon will use either surgical cutting tools or radiofrequency to resect excess tissue from the labia. Radiofrequency uses the energy of heat. You may also have material injected during this surgery to enlarge portions of the labia.

This procedure can be done with local anesthesia or monitored anesthesia sedation while you are awake, and it is rarely done under general anesthesia.

Contraindications

There are a number of contraindications to this surgery, as well as practical issues to consider. If you have a vaginal infection or a bladder infection, you would need to postpone the surgery until the infection resolves.

You and your doctor will have to discuss the risks and benefits to determine if the procedure is right for you.

Factors to consider include:

  • Previous vaginal surgery or previous surgery near the labia may lead to scar tissue that could make you prone to complications from a labiaplasty.
  • You have to be prepared to abstain from strenuous exercise and sexual activity for approximately four to six weeks after the surgery.
  • If you become pregnant and have a vaginal delivery after a labiaplasty, your labia may change appearance, altering the results of the surgery.
  • The cost of labiaplasty averages approximately $3000 and usually is not covered by health insurance.

Potential Risks

This procedure can cause complications that are normally associated with surgery and anesthesia. Additionally, labiaplasty can also result in specific problems that can emerge after the operation.

Risks include:

  • Swelling
  • Infection
  • Bleeding
  • Scarring
  • Persistent pain
  • Pain when urinating or having a bowel movement
  • Pain with sex
  • An outcome that is different from what you wanted

Sometimes complications can be managed with medical or surgical treatment, but these problems can cause prolonged distress.

Purpose of Labiaplasty

Labiaplasty is done to change the physical appearance of the labia or to relieve physical pain or irritation that's believed to be caused by the shape or size of the labia. It is usually considered a type of female genital cosmetic surgery that is done at a woman's request—and not to treat a health problem.

Women sometimes have this surgery to change the appearance of the labia underneath clothes like swimsuits or tight pants or may be more concerned with the appearance of the uncovered labia.

You might consider this surgery if you want to reshape the uneven sides of your labia. Experts do not usually consider a variation in the size of the labia to be a disease, but instead, describe it as normal and do not recommend correction unless it is causing a negative impact.

Sometimes women may consider the procedure if the labia minora is larger than the labia majora or if the labia minora protrudes out of the labia majora.

Causes for protrusion of the labia minora include:

  • Atrophy (thinning) of the labia majora can cause the labia minora to extend outside the labia majora. Atrophy can occur due to hormone changes or menopause.
  • Labia minora hypertrophy is a rare condition in which the labia minora is unusually large and extends outside the labia majora.

Some women and adolescent females experience tenderness, irritation, or bleeding of the labia minora during sex or athletic activity if the labia minora extends out of the labia majora. This can happen because the labia minora is composed of thin tissue that is usually protected by the labia majora.

Your doctor may discuss the psychological implications of the procedure with you as you are deciding whether to have the procedure. You may also have screening tests for depression or anxiety to help you and your doctor consider the reason for your interest in this surgery and whether you want more time to consider it.

How to Prepare

Prior to your labioplasty, you will be able to explain exactly what you want the procedure to accomplish when you speak with your doctor.

Your doctor will examine you to prepare for the details of your operation. You will also have a standard pelvic examination to identify any infections that may need treatment prior to your operation.

Your doctor will explain the location of the planned incision, the expectations you should have in terms of the size and shape of the labia, and what type of scar you may expect after your surgery.

And you may have pre-operative testing, including a complete blood count (CBC), blood chemistry tests, a urinalysis, and a chest X-ray.

Location

You will have your surgery in an operating room that's located in a hospital or an outpatient surgical center.

What to Wear

You can wear something comfortable to your procedure appointment. You will likely need to wear an absorbent pad after your surgery, and it is best if you have underwear that is supportive of the pad, but that isn't tight.

Food and Drink

If you are having local anesthesia and/or monitored anesthesia sedation you will not need to modify your diet prior to your surgery.

If you are going to have general anesthesia, you need to fast from food and drink beginning at midnight the night before your surgery.

Medications

Your doctor may give you instructions to adjust any hormone therapies that you take in the weeks before your surgery.

Additionally, you may be instructed to stop or reduce the dose of blood thinners that you take in the days before your surgery.

What to Bring

When you go to your appointment, you need to make sure that you have a form of personal identification. And you need to have a form of payment for the procedure. If your health insurance is covering a portion or the whole cost of your procedure, you should have your health insurance information with you as well.

If you will be having general anesthesia, you should have someone with you who can take you home after your surgery. And if your surgery will be extensive—with anticipated soreness afterward—your doctor may ask you to have someone who can drive you home on the day of your operation.

Pre-Op Lifestyle Changes

Your doctor will let you know if you should shave your pubic area before surgery. Sometimes this isn't necessary because hair may be shaved right before surgery in the operating room.

It is not recommended to use hair removal chemicals or waxes that could make your skin fragile and prone to bleeding in the days before surgery.

What to Expect on the Day of Surgery

When you go to your surgery appointment, you will register and sign a consent form.

You will go to a preoperative area and change into a surgical gown. You may have same-day tests, such as a CBC, blood chemistry panel, and urinalysis.

You will have an intravenous (IV, in a vein) line placed in your arm or hand and you will have your temperature, pulse, blood pressure, breathing rate, and oxygen saturation checked. Your oxygen saturation will be checked with a noninvasive pulse oximeter that is placed on your finger and that will stay in place during your surgery.

You may have a urinary catheter placed in your urethra, a tube near your vagina, either in the preoperative area or when you get to the operating room.

Before the Surgery

Prior to your surgery, your skin will be prepared for the procedure and your anesthesia will be started.

You will have a drape placed over your body and the skin of your labia will be exposed. Your skin will be cleansed with a cleaning solution. If needed, your pubic area will be shaved as well.

You may have a sedative medication injected into your IV to make you drowsy and reduce pain if you are having monitored anesthesia sedation. If you are having general anesthesia, you will have an anesthetic medication injected into your IV to put you to sleep and you will have a breathing tube inserted into your throat for mechanical breathing assistance during surgery.

If you are having local anesthesia during your procedure, you will have medication that controls pain injected directly near the incision after your skin is cleansed and after the IV sedation starts to work.

During the Surgery

Your surgeon will use either a surgical scalpel, special surgical scissors, or radiofrequency to remove tissue from your labia.

Your surgeon will begin by locating the area of tissue that will be reshaped.

The next steps can include any of the following:

  • Trimming a small piece of tissue from the edge of one or both sides of the labia minora
  • Cutting away a portion of tissue from the inner region of the labia minora
  • Injecting hyaluronic acid into the labia majora to enlarge it
  • Injecting fat into the labia majora to enlarge it

Bleeding will be controlled throughout your surgery. After your labia is shaped, your surgeon will close any open surgical incisions with absorbable suture. Your wound will be covered with surgical dressing.

Your anesthesia will be stopped. If you have had general anesthesia, your anesthesia team will remove your breathing tube and make sure that you are breathing comfortably on your own. Then you will go to the recovery area.

After the Surgery

In the recovery area, you will start becoming more alert. You may have some pain, and your medical team will give you pain medication as needed. You will also have assistance with walking. Your urinary catheter (if you have one) will be removed and you will get help if you need it as you use the toilet or bedpan.

Your medical team will check for bleeding and will explain to you how much bleeding you should expect.

Before you are discharged to go home, you will get instructions about wound care, bathing, pain control, activity restrictions, and your follow up appointments.

Recovery

After your labiaplasty, you will need to heal and recover. During this time, you will see your doctor for one or more follow-up appointments. You will likely have absorbable sutures that do not need to be removed.

You will have instructions for pain control, which may include prescription pain medication or over the counter pain medication like acetaminophen. Your doctor may also give you a prescription for oral anti-inflammatory medication and/or topical antibiotics to apply to your surgical wound.

Healing

While you are still healing, you shouldn't exercise, run, ride a bike, swim, or begin sexual activity. You should take it easy in the first few days by just walking around your home or minimally outside. Don't push yourself too hard so you won't pull on the sutures. You may need to stay home from work if your job involves a lot of physical activity.

As you are healing, you need to follow instructions regarding wound care, bathing, and cleaning yourself after you use the toilet. You may have some bleeding, and you can wear a sanitary pad to absorb the bleeding.

You will need to keep your wound clean. You may be instructed to wash it with lukewarm water and to avoid placing soap or other chemicals on your wound in the first week after your surgery. You will need to avoid rubbing the surgical area by gently wiping or washing after urinating or having a bowel movement.

You can also use pain medication as directed. Be sure to let your doctor know if your pain is not adequately controlled with the pain medication that is recommended to you.

You can expect to have some swelling. You can use ice packs on swollen areas, but don't place ice packs directly on your skin.

Your doctor may recommend a diet or medication to prevent constipation because straining can increase pain and may stretch or break your sutures.

Warning signs of post operative complications to look out for include:

  • Excessive or worsening pain
  • Increasing blood
  • Clumps of blood
  • Discolored discharge or pus
  • Opening of the wound
  • Severe pain with urination or bowel movements
  • Fevers

Call your doctor if you have any of these symptoms.

Coping With Recovery

As you are continuing to recover, you can gradually increase your physical activity. You should be able to drive, and you might be able to go back to work if your work doesn't involve intense physical activity. Check with your doctor before you begin running, riding a bike, swimming, or having sexual intercourse.

After about a week, your swelling should begin to go down and you might not need to use any pain medication anymore. You may still have some bleeding, but it should be decreasing.

You should still make sure your wound is clean and continue to use any antiinflammatory and antibiotic medications as directed.

Long Term Care

As you are continuing to improve, you will follow up with your doctor to ensure that healing is complete. You may be instructed to use vaginal lubrication to avoid abrasion during sexual activity if you have developed a tendency to dryness or tenderness after your surgery.

Some women may have dysuria (discomfort with urination) after labiaplasty due to exposure of the labia to the urine (which can be acidic). This should improve over time as your skin adjusts. However, you should discuss dysuria with your doctor, because it can be the sign of a urinary tract infection.

Possible Future Surgeries

Generally, a labiaplasty is a one-time procedure that doesn't involve multiple surgeries. However, if you have complications, you may need additional surgical intervention to repair problems arising from the initial surgery.

Lifestyle Adjustments

Over time, you shouldn't have to adjust your activities or lifestyle after you recover from your labiaplasty. You should be able to have sexual intercourse, exercise, and move around without any special restrictions or limitations.

A Word From Verywell

A labiaplasty is a procedure that is gaining popularity. Generally, it is done for cosmetic reasons. You might think about having a labiaplasty at some point in your life. Consider your options and objectives carefully as you decide if this surgery is right for you.

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