Labia Majora Hypertrophy

Abstract

A case involving hypertrophy of the labia majora is described. A married 34-year-old mother of a 5-year-old daughter reported that from adolescence, her large labia majora and its protuberance have resembled male genitalia even when she is wearing a slip. For that reason, in the summer, she is ashamed of her appearance and thus has avoided swimming pools and beach areas. With the patient in supine position, the crural creases were marked. The marks were drawn 1 cm apart medially into the medial part of the labia majora parallel to the natural vulvar crease. The estimated amount of skin and fat to be removed was marked. In this case, more skin and fat needed to be removed from the left side than from the right side. The surgery was performed using sedation and local anesthesia as with outpatient surgery. To avoid excessive bleeding of this area, profuse infiltration was performed using 200 ml of anesthetic solution. Resection of the skin and fat in the area was performed with two hooks holding the area up to avoid introducing the scalpel too deeply. Only the superficial fat was removed. After meticulous hemostasia, two layers of 3/0 absorbable running sutures were placed, one in the deep fat and another in the subdermis, until the wound edges were approached. A 5/0 mononylon running suture closed the skin. These sutures provided strong support to all this very mobile area, avoiding dead spaces and bleeding because postoperative compressive bandages are difficult to hold in this region. The patient was instructed to wash the area four times a day. The surgery was ambulatory, with the patient returning to her province the day after surgery, then coming back for a control visit on postoperative day 10. On postoperative day 1, a moderate edema was observed but no hematoma. The stitches were removed on day 10 after surgery. The postoperative evolution of the case was uneventful. The sensitivity of the labia majora’s interior aspect was preserved. With legs open, the labia majora closed the entrance to the vagina without showing the labia minora. A moderate edema was observed 4 weeks after surgery, and 6 months after surgery, the patient’s external genitalia had reached a normal appearance. At 4 months after surgery, the scars were barely noticeable.