Cosmetic surgical procedures on the vulva and vagina - an overview

Cosmetic surgery is defined as any procedure involving a change in the appearance or aesthetics of a normal anatomy where there are no congenital or acquired pathologies. The procedures that can be included under female cosmetic genital surgery are the following: reduction labiaplasty, vaginoplasty, hymenoplasty, “G Spot amplification”, and miscellaneous. Those who support these procedures could argue that women undergo such procedures as a matter of choice, whereas those opposed could argue that this choice is made because of society’s fascination with physical appearance and feeling young. Prima facie these procedures appear to contradict the Hippocratic principle of “primum non nocere”. There has been an increase in the marketing and conduct of the above mentioned procedures. Practitioners need to be both sceptical and cautious while performing these surgeries. Patients requesting them need to be counseled regarding the lack of data supporting their efficacy, and the potential complications of the procedures.

Personalized surgical effect of labia minora hypertrophy / 中华医学美学美容杂志

Objective:To explore an optimal surgical approach for different types of labia minora hypertrophy and to design a better personalized surgical treatment plan for patients.Methods:From October 2017 to October 2020, 71 patients with labia minora hypertrophy were treated in the plastic surgery department of Sichuan Provincial People＇s Hospital, aged 18-38 years, with an average of 26 years. According to the type and degree of hypertrophy, the appropriate surgical method was selected. The wound healing and complications were observed after operation, and the shape of labia minora was followed up.Results:Among the 71 patients, 1 patient had postoperative hematoma and no flap necrosis after active treatment. 1 patient had poor healing of distal labia minora incision and improved after dressing change. The other patients had good blood supply of labia minora, no necrosis, no postoperative infection, hematoma and other complications. The patients were followed up for 1-6 months. The appearance of labia minora was natural, bilateral symmetry, and the incision scar was hidden. The improvement was significant compared with that before operation. The patients were satisfied with the shape and function.Conclusions:According to the degree of hypertrophy of the labia minora, the specific shape and the psychological expectation of patients, we can choose the appropriate operation method, which can achieve the aesthetic standard of symmetry and beautiful shape of the labia minora, and meet the normal physiological function and aesthetic requirements of patients.

Reconstrucción estético - funcional de labios menores post amputación Iatrogénica amplia con colgajo de avance V - Y / Aesthetic-functional reconstruction of labia minora after extensive iatrogenic amputation with V-Y advancement flap

La hipertrofia de labios menores es la prolongación de estos más allá de los límites anatómicos de los labios mayores. La creencia de la simplicidad en la reducción de los labios menores y la falla en observar importantes aspectos de la técnica quirúrgica que llevan a la resección total del labio. En tales casos, la cirugía reconstructiva es la única forma posible de rectificar la situación. Presentamos el caso de una mujer de 36 años que acude por amputación de los labios menores secundario a cirugía de labioplastia por hipertrofia realizada por médico esteticista. Se realiza reconstrucción de labios menores en dos tiempos quirúrgicos. Los colgajos de avance en V-Y del capuchón del clítoris, con remanentes de tejido de la horquilla posterior, pueden lograr resultados satisfactorios y permitir la adaptación a la anatomía genital y los deseos estéticos únicos de cada mujer.

Labia minora hypertrophy is the prolongation of these beyond the anatomical limits of the labia majora. The belief in simplicity in the reduction of the labia minora and the failure to observe important aspects of the surgical technique that lead to total lip resection. In such cases, reconstructive surgery is the only possible way to rectify the situation. A 36-year-old woman with medical history of labia minora amputation secondary to labiaplasty surgery for hypertrophy of the labia minora performed by a beautician. The labia minora reconstruction is performed in two surgical stages. The V-Y advancement flaps of the clitoral hood with remnants of tissue from the posterior fork can be achieved with satisfactory results and allow adaptation to the genital anatomy and unique aesthetic wishes of each woman.

Hair tourniquet syndrome of labia minora in 14 year teen: a rare case report

Hair tourniquet syndrome (HTS) is rare clinical phenomenon in which body appendage is circumferentially entangled by string of hair leading to ischemia and necrosis or even autoamputation of the appendage. HTS commonly affects toes, finger or genitalia. Early diagnosis and prompt intervention lead to good outcome.  This article presents a case of hair tourniquet syndrome of labia minora, a rare presentation in 14 year child.

Labial hypertrophy as a cause for vulvae pruritis

Labia minora hypertrophy is a relatively uncommon surgical condition being popularised in the realm of vulvovaginal plastic surgeries. Apart from the unaesthetic appearance of the hypertrophied minora, these cases are also associated with itching, hygiene problem, pain while sitting down, sports activities, difficulty in wearing tight clothing, bleeding and discomfort while or after sexual intercourse, social embarrassment, insecurity and psychological diminution of confidence and self‐esteem. In a country like India, due to sociocultural reasons, patients hesitate to consult a doctor for such deformities. Most of the patients suffer in silence for years. Although common in the west, very few surgeons in the country perform this simple and rewarding surgery. Here, presenting a case of married women of reproductive age group presented to the study side with complains of severe vulvar itching, the cause of itching was labia minora hypertrophy.

A large fibroma polyp of labia majora

Fibroepithelial stromal polyps are benign proliferations which are usually polypoid or pedunculated, and less than 5cm in size. They are generally single lesions but can be multiple during pregnancy. They can be polypoid or pedunculated and are usually solitary. Symptoms usually include bleeding, discharge and general discomfort with sensation of a mass. They typically have a central fibrovascular core and contain stellate and multinucleated stromal cells which are best seen beneath the surface epithelium. True myxoid stroma is absent. Although vulvovaginal fibroepithelial stromal polyps are well documented, a giant variant such as the one authors report here is rather rare. To the knowledge, present case is the largest fibroepithelial stromal polyp compared to others reported in the literature.

The same-stage reduction plasty for labia minora hypertrophy with redundant praeputium clitoridis / 中华医学美学美容杂志

Objective To evaluate the clinical outcome of reduction plasty for labia minora hy-pertrophy with redundant praeputium clitoridis .Methods A total of 84 cases were included from June 2013 to December 2016 .Arc-shaped resection of labia minora and crescent resection of redundant pra-eputium clitoridis were the two essntial surgical procedure ,and 5-0 VICRYL Rapide was used for su-turing the incision .Results The 84 cases were operated with this mothod with satisfactory aesthetic result .Complications ,such as hematoma ,infection and poor wound healing ,were not observed .Ede-ma was resoluted after one to two weeks .After the reduction plasty of the labial labia ,the vagina and perineum were completely covered in the natural state ,without scar ,also the sensitivity of clitoris was improved due to the better expoure post-operationally .Conclusions The same-stage reduction plasty for labia minora hypertrophy with redundant praeputium clitoridis is a reliable and effective method . Both satisfactory aesthetic result and improved sexual sensitivity are achived ,without hematoma ,in-fection and poor wound healing .

A new classification of labia minora hypertrophy and surgical methods / 中华整形外科杂志

Objective@#To introduce a method to classify the labia minora hypertrophy and to investigate its significance to the selection of surgical method.@*Methods@#From August 2014 to April 2018, 1 058 patients with labia minora hypertrophy were treated in the Plastic Surgery Hospital. According to the hyperplastic degree of the labia minora and praeputium clitoridis, the labia minora hypertrophy was classified to three types, namely simple clitoridis hypertrophy, simple labia minora hypertrophy and mixed type. For patients with simple labia minora hypertrophy, the methods of margin resection, or wedge resection or combination were applied. For patients with simple clitoridis hypertrophy, the reduction of clitoris hood could be performed. For mixed type, firstly the relationship of clitoris hood and labia minor should be recognized, then the appropriate surgical method should be taken.@*Results@#The age of the patients was 18 to 46 years (mean age was 25 years). 83 cases (7.8%) were simple labia minora hypertrophy. 25 cases (2.4%)were simple clitoridis hypertrophy. And 950 cases (89.8%) were mixed type. All the patients received appropriate surgical method to repair the malformation. All the surgeries were successfully performed and the cosmetic results were satisfying.@*Conclusions@#As the homologous tissues, whether praeputium clitoridis hypertrophy or labia minora hypertrophy could result poor appearance of female vulva. The concept of holism should be kept in mind when repair surgeries are performed. The labia minora hypertrophy was classified to three types and appreciate surgical methods were applied to repair the hypertrophy. The cosmetic result was satisfying.

Application of the modified peeling method by divisional design in labia minora reduction / 中华整形外科杂志

Objective@#To investigate the clinical outcome of modified peeling method by divisional design in labia minora reduction in the treatment of labial hypertrophy.@*Methods@#From Feb 2015 to Oct 2017, 32 nympha hypertrophy patients underwent labia minora reduction by the modified peeling method with divisional design. The labia minora area was divided into medial and lateral divisions, from which the dermis and subcutaneous tissue were removed asymmetrically.@*Results@#The patients were followed up 1 to 6 months postoperatively. All incisions healed with excellent blood circulation of labia minora, except for 1 case with V-shaped dehiscence. All of the patients were satisfied with the eventual aesthetic appearance and the functional improvement.@*Conclusions@#The modified peeling method by divisional design in labia minora reduction is a safe and effective method with many advantages, such as nature contour, wide range of indications, fewer complications, and high satisfaction.

Labioplastía genital, experiencia y resultados en 500 casos consecutivos / Genital labiaplasty, experience and results in 500 consecutive cases

ANTECEDENTES: La cosmetoginecología se ha instalado, no exenta de controversia, en la práctica ginecológica durante la última década. OBJETIVO: Presentar los resultados obtenidos en una serie de 500 labioplas-tías de labios menores realizadas por dos cirujanos en el curso de 10 años. MÉTODO: Estudio descriptivo del universo de labiobioplastías practicadas por dos cirujanos entre octubre de 2003 y abril de 2014. La decisión de intervención quirúrgica se basó en razones estéticas, funcionales y psicológicas, y no por una clasificación de hipertrofia de labios menores. RESULTADOS: Aproximadamente la mitad se realizó utilizando láser y la otra mitad electrobisturí, sin ventajas de alguna técnica sobre la otra, en cuanto a complicaciones, grado de satisfacción y resultado final estético. Las indicaciones fueron: estética en 95,4% de las intervenciones, funcional en 37,2% y psicológicas en 17,4%. Los resultados fueron satisfactorios en el 99% de las pacientes, según un autoreporte. No hubo complicaciones importantes y sólo en dos casos se presentó hemorragia post operatoria que requirió una sutura. El procedimiento, cuando fue único, fue ambulatorio, requiriendo no más de 8 horas de hospitalización. En esta experiencia, el 46% se asoció a otra cirugía ginecológica. CONCLUSIÓN: A nuestro parecer, la hipertrofia de labios menores, aún cuando pueda considerarse subjetiva, es una condición que merece ser corregida cuando es requerido por la paciente y que las técnicas actuales ofrecen resultados seguros y satisfactorios.

BACKGROUND: Cosmetogynecology is installed, not without controversy, in gynecological practice in the last decade. Aims: We present a descriptive study of 500 labia minora labiaplasty performed by two surgeons in the course of 10 years. METHOD: A descriptive study of the universe of labiobioplastys performed by two surgeons between October 2003 and April 2014. The decision for surgery was based on aesthetic, functional and psychological reasons and not on a classification of labia minora hypertrophy. RESULTS: Approximately, half was performed using laser, and electrocautery the other half, without any technical advantages over the other, in terms of complications, satisfaction and aesthetic final outcome. Indications for surgery were: in 95.4% of interventions, functional in 37.2% and 17.4% psychological. The results were satisfactory in 99% of patients, according to a self-report. There were no major complications and only two cases presented postoperative bleeding that required stitches. The procedure was ambulatory when it was unique, requiring no more than 8 hours of hospitalization. In this experience, 46% was associated with another gynecological surgery. CONCLUSION: In our view, the labia minora hypertrophy, even though it may be considered subjective, is a condition that should be corrected as required by the patient and the current techniques provide safe and satisfactory results.

Ninfoplastia em estrela: técnica para redução dos pequenos lábios vulvares / Star nymphoplasty: a surgical technique for labia minora hypertrophy

Introdução: O cirurgião plástico tem sido consultado com frequência, nos últimos anos, sobre a forma e as dimensões dos pequenos lábios vulvares e outras estruturas circunvizinhas, não só pela questão estética, mas também pela funcional, da dispareunia. Os autores apresentam uma técnica de tratamento estético e funcional da genitália externa feminina, a vulva, com o intuito de corrigir a hipertrofia dos pequenos lábios (ninfas), sem alterar­lhes a forma. Método: A técnica consiste na abordagem do pequeno lábio vulvar, com uma incisão em forma de estrela, produzindo um encurtamento das ninfas tanto ântero-posteriormente como crânio-caudalmente. O estudo é de tipo retrospectivo de um período de 15 anos, com seguimento clínico e cirúrgico de 64 pacientes de sexo feminino, com uma faixa etária entre 14 e 58 anos, todas submetidas à ninfoplastia em estrela, técnica proposta neste estudo. Resultados: Os resultados foram obtidos da ficha dos pacientes operados no período compreendido entre janeiro de 1996 e dezembro de 2011, no Hospital da Lagoa e na Interclínica-Centroplástica, Jardim Botânico, Rio de Janeiro-RJ. Alto índice de satisfação das pacientes com o tamanho e o formato estético da genitália. Houve uma baixa taxa de complicações e queixas residuais. Conclusão: Este ato cirúrgico é feito com o objetivo de remanejar a estrutura tecidual hipertrófica dos pequenos lábios vulvares. De um ponto de vista técnico, pode-se considerar como um procedimento simples e eficaz no tratamento tanto funcional como estético da genitália feminina.

Introduction: In recent years, women have been frequently consulting the plastic surgeon concerning the shape and dimensions of the labia minora and other surrounding structures, not only for aesthetic but also functional reasons, e.g., dyspareunia. The authors present a technique for the aesthetic and functional treatment of the external female genitalia, the vulva, with the purpose of correcting hypertrophy of the labia minora (nymphs), without changing their form. Method: This technique consists in the incision in the shape of a star leading to a shortening of nymphs both anteroposteriorly and craniocaudally. This is a 15-year retrospective study, with clinical and surgical follow-up of 64 female patients with an age range between 14 and 58 years, all submitted to star nymphoplasty, the technique proposed in this study. Results: The results were obtained from the patients operated from January 1996 to December 2011, at the Hospital da Lagoa and at Interclínica-Centroplástica, Jardim Botânico, Rio de Janeiro, RJ. A high rate of patient satisfaction with the size and aesthetic shape of the genitalia was achieved. There was a low rate of complications and remaining complaints. Conclusion: This surgical procedure is done with the objective of reshaping the tissue structure of the hypertrophic labia minora. From a technical point of view, it can be considered as a simple and effective functional and aesthetic treatment of the female genitalia.

Vulvar Lymphangioma Circumscriptum.

Lymphangioma circumscriptum (LC) is a rare benign disorder of lymphatic channels in deep dermal and subcutaneous layers. Typically fluid filled vesicles that contain lymphatic fluid with frogspawn-like appearance are seen over any part of body. Vulvar LC is seen as congenital condition or might develop secondary to radiotherapy or surgery. LC involving the vulva is very rare; only 33 cases of vulvar LC have been reported. Surgical treatment is the most commonly used method to treat vulvar LC. In this report we present a case with LC secondary to radiotherapy and lesions regressed with cryotherapy.

Myxoid neurofibroma of the labia majora: A case report / 대한산부인과학회지

Myxoid neurofibroma is a benign tumor of perineural cell origin, which is demonstrated with a positive immunohistochemical stainig for S-100. The most common locations of the myxoid neurofibroma are face, shoulder, arm, periungual and foot. We experienced an unusual case of myxoid neurofibroma which originated from labia majora area then reported it. To our knowledge, this is the first time that a labia majora location is reported.

Myxoid neurofibroma of the labia majora: A case report / 대한산부인과학회지

Myxoid neurofibroma is a benign tumor of perineural cell origin, which is demonstrated with a positive immunohistochemical stainig for S-100. The most common locations of the myxoid neurofibroma are face, shoulder, arm, periungual and foot. We experienced an unusual case of myxoid neurofibroma which originated from labia majora area then reported it. To our knowledge, this is the first time that a labia majora location is reported.

A Case of Cutaneous Mastocytosis with Hypertrophy of Labia Majora in a Child / 대한피부과학회지

Mastocytosis is an uncommon disease characterized by an abnormal accumulation of mast cells in a variety of tissues, most commonly, in the skin. It may mimic other conditions because of numerous signs and symptoms produced by mast cell mediators. We report a case of an unusual manifestation of cutaneous mastocytosis in a 7-year-old girl who had hypertrophy and periodic swelling of the left labia majora with urticaria pigmentosa.

Simetrização estético funcional da vulva com retalho tubular de coxa interna / Aesthetic and functional vulvar simetrization with tubular flap of the internal thigh

O estudo demonstra a técnica proposta pelos autores na resolução de um quadro dramático de seqüela pubiana pós-traumática, causando assimetria pubiana e desconforto social. Isto porque durante o ato da micção o jato urinário era ejetado na coxa esquerda da paciente. O tratamento consistiu na confecção de um retalho na coxa interna, que após ser desepidermizado e tubulizado e foi introduzido na intimidade do arcabouço cutâneo da labia major. A tática proporcionou além da simetrização anatômica com a lábia major contra-lateral, também a medianização do jato urinário.

In this study a successfully resolution of a pos- traumatic deformity of the unilateral lábia major in a 20 year old woman is demonstrated. The strategy based in a pre-delayd cutaneous flap of the inner thigh that was deepitelized and introduced into the inner part of the labia major cutaneous tunnel. The result showed a good symmetry of the pubis with medianization of the urinary stream. The authors proposed this technique to treat similar deformity and as an option to threat the natural senile labia major atrophy in post-menopause women.

Aesthetic Labia Minora Reduction with Bilateral Deepithelialization and Straightforward Technique

The hypertrophic labia minora presents many problems in both cosmetic and functional aspects. Local irritation, problems of personal hygiene during menses or after bowel movements, interference with sexual intercourse, and discomfort during cycling, walking, or sitting are generally accepted as indications for surgical reduction. We preserved the natural contour and anatomy of the labia minora by simply reducing its most prominent part (anterior two thirds) width through bilateral deepithelialization and primary closure of the edges with preservation of the neurovascular supply to the edges. This method is very simple and straightforward technique only the most prominent part of the tissue removed without morphologic alteration and minimal aesthetic and functional morbidity. Six patients have undergone this aesthetic procedure with excellent results without specific complications. This new technique is very simple and effective wound healing methods and can greatly enhance the patient`s confidence.

A Case of Folliculosebaceous Cystic Hamartoma on the Labia Majora / 대한피부과학회지

Folliculosebaceous cystic hamartoma is a distinctive skin malformation, which presents as a solitary, smooth- surfaced, skin-colored papule or nodule. This hamartoma usually occurs on the central part of the face, particularly on the nose. In 1998, Bolognia et al. described a genital variant of folliculosebaceous cystic hamartoma, which has not been reported to date in Korea. We herein report a rare case of folliculosebaceous cystic hamartoma which occurred on the labia majora of a 28-year-old woman. Histopathologically, multiple, dilated, follicular, cystic structures were observed with numerous sebaceous lobules arising from its wall. There was an excess of fibrous components around these structures, which included small venules, adipocytes and neural tissue.

A Case of Lymphatic Metastasis on Labia Majora from Gastric Carcinoma / 대한피부과학회지

Genital lymphedema may be a presenting feature of cutaneous metastasis of gastric carcinoma. This underscores the importance of evaluation in persistent genital swelling and erythema. We report a case of cutaneous metastasis from gastric carcinoma by lymphatic spreading. A 30-year-old female presented faintly erythematous swelling with pruritus and prickling sensation on labia majora for 1 month. Five years ago, she had diagnosed as gastric carcinoma, and gastrectomy was done. Also, she had received oophorectomy due to matastatic gastric carcinoma, Krukenberg tumor. Histopathologic finding showed glandular structures composed of hyperchromatic cells and signet ring cells within dilated lymphatic vessels in edematous dermis, which were consistent with lymphatic metastasis from gastric carcinoma.