Is it normal to have large or long labia?
A large labia is a condition that affects many women. Although accurate statistical data has not been made available, research performed by Dr. Robert Latou Dickinson in the early decades of the 20th century revealed that in 1,000 gynecological cases, about 36% of patients showed some degree of labial hypertrophy. That means that 1 out of 3 women who underwent a gynecological exam or checkup had oversized labia, or at least one that was larger than the norm.
Regardless of the exact figures, it is clear that a large or long labia is fairly common. Although the condition has not been known to cause serious health issues, a rising number of women and young girls are seeking medical intervention to correct what they consider as a functional and aesthetic issue through surgery.
IndexChanging your bodyWhat is labia and why does size matter?What are the symptoms of an enlarged labia?What causes a large labia?How is the condition diagnosed?How is labial hypertrophy addressed?How is labia plastic surgery performed?Methods of labia surgeryWho’s it for?Who qualifies for the procedure?Who should not undergo the procedure?Difference between labiaplasty and vaginoplasty?What to look for in a surgeonQuestions to ask a surgeon before surgeryHow to prepare for the procedureType of anesthesia usedRisks associated With anesthesiaWhat to expect after surgeryFollow-Up checkupsPotential risks and complicationsFrequently asked questions
Changing Your Body
Labial reshaping to correct a larger labia is a surgical procedure that is steadily gaining in popularity. In 2006 alone, over 1,000 “vaginal rejuvenation” procedures were performed in the U.S. alone, according to the ASPS (American Society of Plastic Surgeons). In the U.K, over 2,000 procedures were completed in 2011. Although the ASPS no longer tracks the number of women undergoing vaginal rejuvenation, experts on both sides of the Atlantic estimate that the number will continue to rise.
So what exactly does this procedure hope to achieve and why is a large / long labia an issue? Here is a complete overview of the condition and the type of treatment available to correct it:
What is Labia and Why Does Size Matter?
“Labia” (plural “labium) is the Latin word for lip. The labia is an important part of the female genitalia that protects the clitoris and the vaginal canal. Essentially, labium are folds of skin that protect the clitoris and the vaginal opening.
The labia consists of two parts – the labia majora and the labia minora. Often, the part that causes the most common complaint when it comes to size is the labia minora. A large labia, to say the least, is not considered normal by many. Its medical term is labial hypertrophy.
What is Normal Labia?
The size, length, shape and pigmentation of the inner lips or labia minora vary widely. In some women, the inner lips may be so thin that they are almost invisible externally and only the labia majora can be seen. Other women, however, have a long labia while others may have a long labia, a condition that makes the inner lip easily visible.
The size of the labia minora is generally dictated by genetics, as evidenced in the case of some female members of the Khoisan group of people. In these women, the inner folds of the genitalia can be as long as four inches when they stand up.
Hypertrophy of the labial folds, it seems, is a common characteristic among the women. The most famous case of this kind was Sarah Baartman, who became a celebrity in the 19th century for what Western culture considered a unique physical characteristic.
Women in certain African tribes also attempt to increase the size of their inner lips by weighing them down. In their culture, a large labial area is considered a desirable trait, so women go through great lengths to achieve it. A long labia among women in these tribes is considered acceptable, a fact that people in other cultures and parts of the world may find surprising.
In the case of large or elongated inner lips, the question of normality is actually relative. Believe it or not, a big labia is actually normal, in the sense that the only reason why some folks might find it out of the ordinary is that it is not the image or size of the labia that we normally see in books or film.
Having a larger labia is akin to having large ears or a large nose or even thick lips – it simply is the result of the rich physical diversity we enjoy as part of the human race.
The only difference is that we could readily see the differences in the visible features of other people so we generally do not think much of the variation.
Because the female genitalia is not exposed in most cultures, a large or oversized labia is considered an anomaly and there is much mystery, stigma and shame associated with its size relative to the general population.
The truth is that every woman is different, which only goes to say that how her vagina looks like will also be different. There is nothing wrong, weird or abnormal about having a large or long labia, as long as the woman is healthy and happy about the way she looks.
In short, a large, thick or long labia is merely a type of anatomic variant and not a malformation.
However, a long labia can present a number of issues, such as:
Discomfort
A long labia can rub against the fabric of the underwear and become sore due to friction. This condition may lead to small tears in the labial tissue which could later lead to infection, pain and inflammation. This is especially true among women who are active or engage in sports, or wear tight clothing.
Embarrassment
Any concerns about the size and appearance of one’s genitalia could lead to emotional and psychological distress which, in some women, is considerable enough to make them feel ashamed of the way they look.
This is especially true among adolescent girls who also have to struggle with the emotional and physical changes that occur during puberty. Their appearance may cause them to feel embarrassed and self-conscious, especially when they are in a situation where they might have to dress up in front of other women.
Low Self-Esteem
Women may react to the idea of being different in, well, different ways. Some may embrace their own physical uniqueness while others may feel unsatisfied. Some women, for example, may feel embarrassed about their bodies especially during intimacy and would rather have it changed.
Painful Sexual Intercourse
Some women may experience pain or discomfort during sexual intercourse because of labial size.
What are the Symptoms of an Enlarged Labia?
Some women with thick labia may feel or experience no discomfort or symptoms because of their condition. However, there are women who experience symptoms such as:
Visible inner lips that appear to protrude between the outer lips; the condition is especially obvious when the woman is standing upright
Discomfort, pain or irritation of the vulva (both inner and outer) when wearing underwear, swimsuits, leggings and other tight items of clothing; discomfort may extend to the general area of the crotch as a resultA bulge may appear in the crotch area when wearing tight clothingDiscomfort when performing or engaging in physical activities such as gymnastics, running, horseback riding or cyclingDiscomfort when engaging in sexual intercourseIncreased risk of vaginal yeast infectionWhat Causes a Large Labia?
The real reason why labial hypertrophy happens is unclear. What is known is that some women are simply born with the condition, which makes it congenital. The size of the labia minora develops at the moment of the baby’s birth and simply grows as she gets older.
There are cases, though, where labial hypertrophy may occur as a result of physical manipulation (such as when the inner lips are stretched) or trauma. Childbirth, for example, can cause the lips of the woman’s genitalia to become stretched. In some women, the folds of skin simply return to normal after some time post-pregnancy but they may remain enlarged in other women after the baby’s birth.
Another possible cause of enlarged inner lips is massive weight gain followed by extreme weight loss. Increased weight may contribute to the enlargement of the size of the inner lips and the condition may affect either side of the labia, or both. Weight loss may be followed by sagging of the inner lips, which results in its elongated appearance.
Labial hypertrophy may also come as a result of age. The inner folds of skin will continue to develop and grow in women with enlarged labium. With time, loss of tissue and fat in the area occurs, leading to sagging. The process is natural and harmless barring any associated condition that could lead to discomfort, inflammation or pain.
Although uncommon, labial piercings may also result in a long labia because of the weight of the piercings. The heavier the ornament, the more weight is placed on the inner vulva, causing the inner folds to stretch out.
How is the Condition Diagnosed?
Since there is no standard size, shape or length established for the female genitalia, determining the ideal size of the labia is impossible. There simply is no established medically-based criteria to make a feasible or accurate diagnosis.
When a surgeon assesses the patient, he or she simply considers the size of the inner labium relative to the labia majora and the rest of the genitalia.
What we now know of labial hypertrophy as a type of abnormality or disorder is actually a recent phenomenon.
A decade ago, this issue was considered non-existent and probably only spoken about in private. It was only in the early years of the 21st century when adult and teenaged women began asking for medical attention, citing aesthetic concerns.
Although some studies have been done regarding labial size, medical experts and professionals have not agreed on what consists a “normal-sized” labia minora.
That being said, in cases where a medical professional is approached by a patient who wishes to undergo a cosmetic and/or corrective procedure, a systematic approach may be used for an effective physical examination.
During a diagnostic exam, the genitalia will be inspected and evaluated to determine its symmetry and size in relation to the other parts of the genitalia.
How is Labial Hypertrophy Addressed?
After a diagnosis rules out other possible (and/or temporary) causes of an enlarged labia, the usual solution available for women who want a permanent solution is a surgical procedure known as labiaplasty.
Sometimes called labioplasty, it is a type of surgery that aims to reshape and/or reduce the appearance and size of a long labia. The procedure is cosmetic and is usually performed on women who have a congenital condition characterized by a long labia and want to change it permanently.
How is Labiaplasty Performed?
Labiaplasty is performed in the operating room of a clinic or hospital by a licensed, trained and experienced surgeon. The patient first undergoes a pre-surgery assessment, after which she is scheduled for surgery. She may be prepped prior to surgery to ensure that the genital area is clean and free from dirt and hair.
The patient will then be asked to change into a surgical or hospital gown to make her more comfortable. She will then be asked to lay on her back on the operating table.
Anesthesia will be administered (if general anesthesia will be used) and the patient’s vital signs will be monitored by the surgical staff. The surgeon will then mark the area of the tissues that will be trimmed. If the surgeon will be using local anesthesia, it will be applied at this point to keep the site numb for several hours.
Once the area has been marked, it will be trimmed off until the desired shape and size of the inner labia are achieved. The incision will then be closed using absorbable sutures, which are usually applied using a multiple-layer closure. This consists of 2 or 3 layers of surgical stitches.To prevent infection, the surgeon may apply an antibiotic ointment and place mesh panties that have an absorbent pad.
Note, however, that some surgeons may not use absorbable sutures, so the patient may be required to go back to the clinic sometime later to have them removed.
After the surgery, the patient may undergo a final checkup to determine if she is ready to go home. After care instructions may also be given at this point. Once she has the doctor’s go signal, she may leave the clinic or hospital.
It is advisable for patients not to drive themselves home after the surgery. They may be in some pain and pain medications may affect their ability to focus and react. They may arrange to be picked up by a taxi or have someone drive them home.
Methods of Labia Surgery
Two of the most common methods of labial reduction are the “Trim” method and the “Wedge” method. The Trim method is simpler and is usually the method often employed by surgeons. It involves trimming off the unwanted portion of the labia minora to the same level as the labia majora. This method removes the dark edges of the inner labia and reveals the pinkish, lighter edge of the exposed tissue.
The Wedge method, on the other hand, alters the length and thickness of the labia minora by trimming a V-shaped wedge. Once the unwanted tissue is removed, the open edges are sutured to form a straight line. This method does not leave a visible scar on the edge of the inner lips and reduces their size as well.
Who’s it For?
Women who have enlarged labia are not required to undergo labia surgery unless their condition causes emotional distress and/or physical discomfort and pain. Reduction surgery is indicated for women who:
suffer from the physical discomfort of having a long labiaexperience discomfort, pain and chronic infection as a result of having a long labiaexperience pain in the region during or after sexual intercourseexperience considerable shame or embarrassment because of her appearanceWho Qualifies for the Procedure?
The doctor will perform a thorough medical evaluation of the patient to ensure that she is physically and emotionally healthy to undergo the procedure. In terms of age, labia surgery actually does not have age requirements, so basically a woman of any age can undergo the surgery. However, surgeons will require parental approval for patients younger than 18.
Some surgeons may also avoid operating on patients unless they are 18 years or older. They may also refuse treatment for patients who may be unsuitable candidates due to their health and/or lifestyle choices.
Here is a video about different labia and labia majora surgery. Please be warned it is quite graphic.
Who Should Not Undergo the Procedure?
Labia reduction is not recommended for women who have an untreated gynecological disease, such as a sexually transmitted disease, a malignancy or other types of infection. It is also not indicated for patients who smoke and cannot quit even temporarily a few weeks before and after the surgery.
Another reason why some patients may be rejected is if they have unrealistic expectations about the results. They may be asked to undergo counseling and/or professional evaluation for further assessment. If they pass, they may be allowed to undergo the surgery. If not, they may be excluded.
What is the Difference Between Labiaplasty and Vaginoplasty?
There is some confusion over labia surgery and a related procedure called vaginoplasty. Labiaplasty is simply a procedure that involves the reshaping of the vulva while vaginoplasty alters the shape and size of the vagina, usually to make it tighter or smaller. Sometimes, both procedures may be performed together, depending on the patient’s case. Find out more about vaginoplasty here.
What to Look For in a Surgeon
The surgeon who performs large labia correction surgery is usually a plastic or cosmetic surgeon. However, not all cosmetic surgeons are qualified to perform this operation. There are also Ob/Gyn physicians who have surgical and medical experience, and can perform the operation just as well. To make sure you receive the best possible treatment, consider a surgeon who:
is board certified, licensed and trainedspecializes in cosmetic/functional impairment surgery of the genitaliahas good experience performing the operationhas excellent track recordis comfortable to talk to
Keep in mind that very few surgeons perform labial reduction on a regular basis, so it pays to do your research before signing up for surgery. Look for a surgeon who performs this type of surgical procedures several times a month, say 3 to 4 times each month. If the surgeon is able to do this operation at least once a week, then he or she has very good experience and exposure to the type of procedures and methods used to give the patient the very best service.
Never choose a surgeon because of the proximity of his or her clinic to your home or office, or because of the price of the operation. Keep in mind that this type of surgery is permanent. Once tissue has been removed, it can never be replaced. Repairs may be done but whatever has been trimmed off is gone permanently.
Questions to Ask a Surgeon Before SurgeryAre you board-certified in Cosmetic/Plastic Surgery or Gynecology?Does your clinic or facility have state certification?What type of experience do you have performing this operation?How many labial procedures have you performed so far? How many were performed in the last few months?Were patients happy with the results? How many patients were unsatisfied and why?Considering my case and condition, what types of risks and complications can I expect? How can these be minimized?Can you show me pre- and post-operative images of your past work?Can you explain to me why a particular method was used for a particular patient?What type of method is a good fit for me and why?Can you show me a digital simulation of the possible results of the procedure if it will be performed on me?How much is the cost of the operation? What is included in the price?What methods of payment do you accept? Is it possible for me to finance the cost?Do you perform revisions? How much will you charge?How to Prepare for the Procedure
The surgeon may ask you to undergo a brief interview to assess your suitability as a candidate for the surgery. He or she may also review your medical history to determine if you have diseases or conditions that make you unsuitable to undergo the procedure. This will also help rule out any issues you may have that could contribute to an unsuccessful labial reduction surgery. Do not withhold information that may be vital for the doctor to make an excellent evaluation of your health. If you smoke or take certain types of medications, let the doctor know. Be honest with your answers to avoid complications later.
Your surgeon will also advice you on how to care for your body before the procedure. For example, you may be asked to take a daily shower and to keep the genital area clean to avoid infection. Your surgeon may also prescribe preventative or prophylactic antibiotics that you have to take orally to rid your system of any microorganisms that could possibly cause an infection during and after the surgery.
Patients who smoke or take medications and/or nutritional supplements that increase bruising and bleeding may also be advised to stop for a minimum of 6 weeks before the operation. If the patient has health issues such as hypertension, heart conditions, autoimmune disorders or diabetes, she must ensure that these are controlled weeks before their scheduled procedure.
Type of Anesthesia Used
Surgery to correct a large or long labia may be performed using different types of anesthesia depending on the surgeon, the patient and the type of procedure that will be performed. The kinds of anesthesia that may be used include:
Local Anesthesia
Anesthesia applied only to the part of the body that will be operated on. The numbness can only be felt in and around the site where the anesthetic was administered. The effects can last for several hours. The term local anesthesia is used interchangeably with other terms such as regional anesthesia and conduction anesthesia.
Procedural Sedation
Also known as conscious sedation, involves the application of a sedative to allow the patient to relax during surgery. It may or may not be administered with an analgesic. The patient remains awake during the surgical procedure but kept in a relaxed, calm state. This type of sedation affects the patient’s reaction to stressful conditions such as during surgery and maintain their cardiorespiratory function at the same time.
General Anesthesia
Essentially a medically-induced coma that eliminates the patient’s protective reflexes and ability to feel and react to pain. It induces sleep and loss of automatic reflexes. It also helps relax the skeletal muscles, allowing the surgeon to perform any type of surgery without risk on the part of the patient.
Type of Anesthesia UsedRisks Associated With Anesthesia
Local anesthesia may result in hematoma, fluid buildup, nerve and/or tissue damage at the site of injection or infection. Local anesthesia may not work effectively if the patient has an infection in the region to be treated, which is why a complete pre-surgical checkup is necessary. A few patients may also experience an allergic reaction to the anesthetic agent.
In procedural sedation, risks and complications can be minimized by following standard sedation protocols and ensuring that the patient’s vital signs such as the pulse, heart rate and blood pressure are monitored carefully and constantly during surgery. Supplementary oxygen may also be provided.
General anesthesia is generally safe with healthy patients, although many will experience mild symptoms post-operation. These symptoms, however, are temporary. There is a very low percentage of severe risks or complications associated with general anesthesia. Risks, of course, are still present, especially among patients who may have health and/or lifestyle issues. Some factors that may affect how well a patient reacts to anesthesia include:
ObesitySmokingDiabetesHypertensionDrug AllergiesObstructive Sleep ApneaDiseases or conditions involving the vital organs such as the heart, kidneys or lungsAlcohol intakeUse of certain medications, especially anti-coagulants
To ensure the patient’s safety during and after the surgery, the surgeon will discuss the risks and complications involved. The anesthesiologist will also review the patient’s health history using pre-surgical test results and information obtained by interviewing the patient and checking her medical records. As long as the procedure is performed by a trained and experienced medical doctor/surgeon, there should be no problems with the use of anesthesia for the procedure.
What to Expect After Surgery and During Recuperation
After the surgery, your doctor will advice you on how to care for yourself to minimize pain and discomfort, and avoid infection and other complications. You will also be prescribed medication that will help alleviate any pain. Note that some pain relievers such as ibuprofen and aspirin may not be recommended because of the risk of bleeding or bruising.
Expect to feel or see some swelling and/or bruising at the site and general area. To keep the swelling down, you may apply an ice pack to the area. To avoid stains, you may have to wear panty liners or sanitary pads for the first few days to address any bleeding or spotting. Expect minimal bleeding for the first few days. In case you have your period during this time, avoid wearing a tampon and use a sanitary pad instead. This may be necessary for the first and second menstrual cycles after your surgery.
Although you may shower on the second day, you may not be advised to soak in the bathtub since this will soften the skin in the wound area and expose you to bacteria in the water. Just take a shower, pat yourself dry with a clean, lint-free towel and apply an antibiotic ointment on the site. This will help prevent an infection and hasten the healing process.
You may also be advised to stay at home for a few days, so make prior arrangements at work. Otherwise, you may be allowed to work at home provided you do not perform heavy or labor-intensive work. If you have to sit for long hours, use a soft pillow to cushion your body and protect it against hard surfaces.
You should also avoid doing any rigorous physical exercise during your recovery period. It is not advisable to participate in sports, especially biking, running, horseback riding or other activities that require vigorous physical effort or weight lifting. It is also a good idea to wear loose clothing to avoid irritating the genital area.
To expedite your healing, rest as much as you can and take your medications on time. Eat healthy and follow the post-operation instructions provided to you by the surgeon and medical staff. Never touch yourself with unwashed hands and always keep yourself clean. Be patient. Do not compare your recovery with others because they are different. Your body has its own way of healing itself, so let it do its job.
Follow-Up Checkups
Your doctor will probably ask you to come back for your first checkup a few days after the surgery. Your next visits will usually be scheduled at 2 to 3 weeks, then 6 weeks, then 6 months, and lastly, a year after the procedure. The checkups are necessary so your doctor can monitor your progress.
Potential Risks and Complications
All surgical procedures carry certain risks. To help you understand what you might expect, here are some of the risks associated with labial reduction surgery:
Reactions to anesthesia such as headache, nausea, itching at the site or temporary loss of memorySwelling, numbness, bruising, pain and a feeling of tenderness at the site of the surgeryAsymmetry, although it is common among women not to have perfectly symmetrical labium. Whatever asymmetry may be present will be minimal at best.Pigmentation at the site, although this is temporary and will resolve on its own after full recovery
If the risks and complications make you uneasy, feel free to discuss your concerns with your doctor.
Frequently Asked QuestionsWhat are the most common reasons why women go through this type of surgical procedure? In a 2008 study that was published by the Journal of Sexual Medicine, the number of women who underwent labia plastic surgery did so for several reasons:Purely Aesthetic – 37%Purely to Correct Functional Impairment – 32%Both Aesthetic and Functional Impairment Correction – 31%Is a thick labia a serious condition?
Hypertrophy of the labium is not a serious condition and neither is it a medical issue. It is simply a physical characteristic that is present in some women.
If I have labial hypertrophy, does that mean that my mother has it as well?
She may or she may not. How your mother looks may be different from the way you look.
I have given birth before. Can I still undergo the labia reduction surgery?
In general, you can, depending on your health and general condition.
What types of tests am I required to undergo before the surgery?
The doctor will require you to undergo the standard tests prior to surgery, such as blood work and urine to determine if you are healthy enough for the procedure. A pregnancy test may also be performed. A thorough physical check up will also be done and the doctor may interview you to check your medical history.
Is the procedure painful?
To ensure the patient’s comfort and safety, anesthesia will be administered, so you are assured of a pain-free procedure from beginning to end. Once the anesthesia wears off after the surgery is completed, you will be given pain medications to help manage any residual pain and discomfort you may feel. Expect the pain at the surgical site to subside in a few days as your body heals.
How does the surgeon perform accurate incisions? How do I know he or she will not be cutting too little or too much tissue?
The surgeon will make a physical assessment before the surgery so he can decide on what part of the tissue to cut. He will also discuss this issue with you so you can tell him how you want to appear. Before actual surgery, the areas are marked clearly to help guide your surgeon. Precise instruments will also be used and the surgeon will be wearing surgical loupes (also known as microscope glasses) to help him or her get a closer view of the area to be repaired.
How is bleeding minimized during surgery?
Your surgeon will use a cautery pen when performing the procedure. This helps stop the blood by causing the blood vessels to coagulate immediately upon contact with the instrument. This will minimize bleeding and prevent any associated complications.
Is labiaplasty an outpatient procedure?
It can be an outpatient procedure if performed using local anesthesia. If the patient had undergone general anesthesia, she may be required to stay at the hospital for a day to ensure that she is well enough to go home.
How long is a typical procedure?
The surgery will only require 1 1/2 hours to 2 hours to complete.
Will the procedure result in scars?
Since the procedure requires cutting into tissue, expect to have scars at the site of surgery. However, these scars are not likely to be noticeable. A well-trained and experienced surgeon will ensure that precise incisions are done to keep scarring at the minimum. He or she will also ensure that incisions are made at or near the natural folds, creases and lines of your skin to hide any scars.
How long before the final results are seen?
The length of time before the final results could be seen varies, depending on the type of operation performed and on your healing capacity. Some people, for example, do not heal as fast as others and there are also some individuals who bruise more easily. However, you can expect any bruising and swelling to resolve within one to two weeks. You could also expect to experience the final result a few months post-operation.
How soon after the procedure can I go back to normal activities?
In general, you can expect to go back to work within a week depending on how fast you recover. Should complications occur, you might have to spend more time recuperating.
Can I have children after I undergo the procedure?
You can. However, you might want to consider that although a labiaplasty will not affect your pregnancy, giving birth might affect the results. Depending on what happens to your body after, the procedure may be redone to achieve the same results. To avoid undergoing another procedure, it is best to wait until giving birth before having a surgery.
Do I have to avoid sexual activity after surgery?
Labiaplasty is a surgical procedure that requires some tissue removal, the extent of which will depend on how much the surgeon and the patient will agree on to eliminate. As such, expect to have wounds on the surgical site. As with anyone who undergoes a surgical procedure, the length of time required for you to heal completely will vary depending on how much tissue was removed and on your own healing capacity. In general, expect to refrain from sexual activity for at least 3 weeks post-surgery.
How much is the cost of surgery?
The cost of labia reduction surgery can range from $2500 to $5000 depending on the facilities, surgeon’s fees and other related cost. Other factors can also affect the cost, such as the type of procedure that has to be performed, the location of the clinic and the experience of the surgeon.
Is the procedure covered by insurance?
All labia reduction procedures are self-pay. Insurance companies usually only cover the cost of the procedure if the patient could prove that her case is a medical necessity. Otherwise, they list labia reduction as cosmetic and will not pay for its cost.
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