Abstract
Introduction and hypothesis
We provide a review of the literature about the onset and development of hypertrophy of the labia minora, together with some expert opinions on the appropriateness of labiaplasty.
Methods
We searched PubMed and used popular search engines, with a greater emphasis on the physiology and hormone-mediated metabolism of these structures, and less emphasis on their surgical treatment.
Results
We describe major embryological, cytological, and biochemical features of this anatomical part and summarize the clinical aspects of its hypertrophy, evaluating types of discomfort reported by women and the medical treatments available. Also, based on what is known about the artificial elongation and spontaneous hypertrophy of the inner labia, we illustrate and discuss the main biological factors that may trigger this medical condition. There are not enough data identifying a clear inheritance of inner labia hypertrophy in the absence of other pathological conditions; instead, we found indirect evidence for an association with transient episodes of local inflammation either before birth or during puberty. We also analyze the role played by estrogen receptors and other factors with regard to the onset of this condition and highlight the importance of their timing in determining the size of women’s labia minora. Remarkably, most cases of enlarged labia minora should be considered as outliers that are within the physiological range of size variation described for these structures.
Conclusions
We generally advise against surgical treatment of labia minora, especially in young, pre-pubertal girls, unless specific medical conditions are also present and/or the psychological impact on the patient is deemed particularly negative.
Similar content being viewed by others
References
Dobbeleir JMLCL, Van Landuyt K, Monstrey SJ. Aesthetic surgery of the female genitalia. Semin Plast Surg. 2011;25:130–41.
Bramwell R. Invisible labia: the representation of female external genitals in women’s magazines. Sex Rel Ther. 2002;17:187–90.
Braun V. Female genital cosmetic surgery: a critical review of current knowledge and contemporary debates. J Womens Health. 2010;19:1393–407.
Lloyd J, Crouch NS, Minto CL, Liao LM, Creighton SM. Female genital appearance: “normality” unfolds. BJOG. 2005;112:643–6.
Royal College of Obstetricians and Gynaecologists, Ethical Opinion Paper. 2013. [https://www.rcog.org.uk/globalassets/documents/guidelines/ethics-issues-and-resources/rcog-fgcs-ethical-opinion-paper.pdf]. Accessed 24 April 2015.
Crouch NS, Deans R, Michala L, Liao LM, Creighton SM. Clinical characteristics of well women seeking labial reduction surgery: a prospective study. BJOG. 2011;118:1507–10.
Moore KL, Persaud TVN. The urogenital system. In: Moore KL, Persaud TVN, editors. The developing human. Clinically oriented embryology, 6th ed. Philadelphia: Saunders; 1998. p. 303–47.
Puppo V. Anatomy and physiology of the clitoris, vestibular bulbs, and labia minora with a review of the female orgasm and the prevention of female sexual dysfunction. Clin Anat. 2013;26:134–52.
Puppo V. Embryology and anatomy of the vulva: the female orgasm and women’s sexual health. Eur J Obstet Gynecol Reprod Biol. 2011;154:3–8.
Schober J, Cooney T, Pfaff D, Mayoglou L, Martin-Alguacil N. Innervation of the labia minora of prepubertal girls. J Pediatr Adolesc Gynecol. 2010;23:352–7.
Yang CC, Cold CJ, Yilmaz U, Maravilla KR. Sexually responsive vascular tissue of the vulva. BJU Int. 2006;97:766–72.
Martin-Alguacil N, Pfaff DW, Kow LM, Schober JM. Oestrogen receptors and their relation to neural receptive tissue of the labia minora. BJU Int. 2008;101:1401–6.
Yucel S, De Souza Jr A, Baskin LS. Neuroanatomy of the human female lower urogenital tract. J Urol. 2004;172:191–5.
Kalloo NB, Gearhart JP, Barrack ER. Sexually dimorphic expression of estrogen receptors, but not of androgen receptors in human fetal external genitalia. J Clin Endocrinol Metab. 1993;77:692–8.
Blank J. Femalia. 1st ed. San Francisco: Down There Press; 1993.
Reddy J, Laufer MR. Hypertrophic labia minora. J Pediatr Adolesc Gynecol. 2010;23:3–6.
Choi HY, Kim KT. A new method for aesthetic reduction of labia minora (the deepithelialized reduction of labioplasty). Plast Reconstr Surg. 2000;105:419–22; discussion: 423–424.
Dickinson RL. Atlas of human sex anatomy, 2nd ed. Baltimore: Williams & Wilkins; 1949.
Testut L, Latarjet A. Traité d’anatomie humaine, 9th ed. Paris: Doin; 1972.
Chiarugi G, Bucciante L. Istituzioni di Anatomia dell’uomo. Testo-Atlante, vol 3, 11th ed. Milan: Casa Editrice Dr. Francesco Vallardi-Società Editrice Libraria, 1975.
Koster M, Price LL. Rwandan female genital modification: elongation of the labia minora and the use of local botanical species. Cult Health Sex. 2008;10:191–204.
Martínez Pérez G, Namulondo H. Elongation of labia minora in Uganda: including Baganda men in a risk reduction education programme. Cult Health Sex. 2011;13:45–57.
Baker JR. Race. Oxford: Oxford University Press, 1974.
Seiner F, Staudinger R. Beobachtungen und Messungen an Buschleuten. Z Ethnol. 1912;44:278–288
Hailparn TR. What is a girl to do?: the problem of adolescent labial hypertrophy. Obstet Gynecol. 2014;123 Suppl 1:124S–5S.
Friedrich EG. Vulvar disease. 2nd ed. Philadelphia: Saunders; 1983.
Laufer MR, Galvin WJ. Labia hypertrophy: a new surgical approach. Adolesc Pediatr Gynecol. 1995;8:39–41.
Rouzier R, Louis-Sylvestre C, Paniel BJ, Haddad B. Hypertrophy of labia minora: experience with 163 reductions. Am J Obstet Gynecol. 2000;182:35–40.
Munhoz AM, Filassi JR, Ricci MD, Aldrighi C, Correia LD, Aldrighi JM, et al. Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction. Plast Reconstr Surg. 2006;118:1237–47, discussion 1248–1250.
Capraro VJ. Congenital anomalies. Clin Obstet Gynecol. 1971;14:988–1012.
Pappis CH, Hadzihamberis PS. Hypertrophy of the labia minora. Pediatr Surg Int. 1987;2:50–1.
Realself web site for plastic surgery [http://www.realself.com/question/Insurance-cover-labiaplasty]. Accessed 22 April 2015.
LPS web site for labiaplasty, vaginoplasty and clitoral unhooding procedures [http://www.labiaplastysurgeon.com/faq.html]. Accessed 22 April 2015.
Kato K, Kondo A, Gotoh M, Tanaka J, Saitoh M, Namiki Y. Hypertrophy of labia minora in myelodysplastic women. Labioplasty to ease clean intermittent catheterization. Urology. 1988;31:294–9.
Barrett MM, Carlson JA. A clinicopathologic study of labia minora hypertrophy: signs of localized lymphedema were universal. J Low Genit Tract Dis. 2014;18:13–20.
Chavis WM, LaFerla JJ, Niccolini R. Plastic repair of elongated, hypertrophic labia minora. A case report. J Reprod Med. 1989;34:373–5.
Fliegner JR. Vulval varicosities and labial reduction. Aust N Z J Obstet Gynaecol. 1997;37:129–30.
Laron Z. Development and biological function of the female gonads and genitalia in IGF-I deficiency. Laron syndrome as a model. Pediatr Endocrinol Rev. 2006;3(S1):188–91.
Hagisawa S, Shimura N, Arisaka O. Effect of excess estrogen on breast and external genitalia development in growth hormone deficiency. J Pediatr Adolesc Gynecol. 2012;25:e61–3.
Ashcroft GS, Mills SJ. Androgen receptor-mediated inhibition of cutaneous wound healing. J Clin Invest. 2002;110:615–24.
Pottratz ST, Bellido T, Mocharla H, Crabb D, Manolagas SC. 17 beta-Estradiol inhibits expression of human interleukin-6 promoter-reporter constructs by a receptor-dependent mechanism. J Clin Invest. 1994;93:944–50.
World Health Organization (WHO) web site. [http://apps.who.int/iris/bitstream/10665/66857/1/WHO_FCH_GWH_01.3_eng.pdf?ua=1]. Accessed 24 April 2015.
Horiuchi M, Seyama Y. Anti-inflammatory and anti-allergic activity of Bidens pilosa L. var. radiata Scherff. J Health Sci. 2006;52:711–7.
Labia stretching techniques (for adults). [http://www.labiastretching.com]. Accessed 24 April 2015.
McKinney A, Wallace JA, Alderdice JM. Crohn’s disease of the labia minora. Ulster Med J. 1995;64:92–4.
Buda A, Ferrari L, Marra C, Passoni P, Perego P, Milani R. Vulvar endometriosis in surgical scar after excision of the Bartholin gland: report of a case. Arch Gynecol Obstet. 2008;277:255–6.
Eyvazzadeh AD, Smith YR, Lieberman R, Quint EH. A rare case of vulvar endometriosis in an adolescent girl. Fertil Steril. 2009;91:929.e9–11.
Zimmer EZ, Blazer S, Blumenfeld Z, Bronshtein M. Fetal transient clitoromegaly and transient hypertrophy of the labia minora in early and mid pregnancy. J Ultrasound Med. 2012;31:409–15.
de Waard J, Weijenborg PT, ter Kuile MM, Jansen FW. Request for labia correction: sometimes more than a simple question. Ned Tijdschr Geneeskd. 2002;146:1209–12.
Miklos JR, Moore RD. Labiaplasty of the labia minora: patients’ indications for pursuing surgery. J Sex Med. 2008;5:1492–5.
Radman HM. Hypertrophy of the labia minora. Obstet Gynecol. 1976;48:78S–9S.
Tepper OM, Wulcan M, Matarasso A. Labioplasty: anatomy, etiology, and a new surgical approach. Aesthet Surg J. 2011;31:511–8.
Oranges CM, Sisti A, Sisti G. Labia minora reduction techniques: a comprehensive literature review. Aesthet Surg J. 2015;35:419–31.
Lynch A, Marulaiah M, Samarakkody U. Reduction labioplasty in adolescents. J Pediatr Adolesc Gynecol. 2008;21:147–9.
Goodman MP, Bachmann G, Johnson C, Fourcroy JL, Goldstein A, Goldstein G, et al. Is elective vulvar plastic surgery ever warranted, and what screening should be conducted preoperatively? J Sex Med. 2007;4:269–76.
Lista F, Mistry BD, Singh Y, Ahmad J. The safety of aesthetic labiaplasty: a plastic surgery experience. Aesthet Surg J. 2015;35:689–95.
Alter GJ. Labia minora reconstruction using clitoral hood flaps, wedge excisions, and YV advancement flaps. Plast Reconstr Surg. 2011;127:2356–63.
Michala L, Koliantzaki S, Antsaklis A. Protruding labia minora: abnormal or just uncool? J Psychosom Obstet Gynaecol. 2011;32:154–6.
Jothilakshmi PK, Salvi NR, Hayden BE, Bose-Haider B. Labial reduction in adolescent population--a case series study. J Pediatr Adolesc Gynecol. 2009;22:53–5.
Wu JA, Braschi EJ, Gulminelli PL, Comiter CV. Labioplasty for hypertrophic labia minora contributing to recurrent urinary tract infections. Female Pelvic Med Reconstr Surg. 2013;19:121–3.
Haldar S, Dru C, Choudhury D, Mishra R, Fernandez A, Biondi S, et al. Inflammation and pyroptosis mediate muscle expansion in an interleukin-1β (IL-1β)-dependent manner. J Biol Chem. 2015;290:6574–83.
Ameli F, Brocchetti F, Tosca MA, Schiavetti I, Ciprandi G. Tonsil volume and allergic rhinitis in children. Allergy Rhinol (Providence). 2014;5:137–42.
Singh MV, Anderson ME. Is CaMKII a link between inflammation and hypertrophy in heart? J Mol Med (Berl). 2011;89:537–43.
Paterni I, Granchi C, Minutolo F. Risks and benefits related to alimentary exposure to xenoestrogens. Crit Rev Food Sci Nutr 2016;DOI: 10.1080/10408398.2015.1126547.
Steinmetz R, Mitchner NA, Grant A, Allen DL, Bigsby RM, Ben-Jonathan N. The xenoestrogen bisphenol A induces growth, differentiation, and c-fos gene expression in the female reproductive tract. Endocrinology. 1998;139:2741–7.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflicts of interest
All authors declare that they have no conflicts of interest.
Funding
This work was not supported by external funding.
Financial disclaimer
None.
Additional information
First co-authors: C. Gulia and A. Zangari
Rights and permissions
About this article
Cite this article
Gulia, C., Zangari, A., Briganti, V. et al. Labia minora hypertrophy: causes, impact on women’s health, and treatment options. Int Urogynecol J 28, 1453–1461 (2017). https://doi.org/10.1007/s00192-016-3253-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-016-3253-8