Female genital cosmetic surgery

Female genital cosmetic surgery includes operations to address the shape or volume of the inner and outer labia and widening of the vagina. Changes in the genital area may be related to natural anatomy or childbirth. During the consultation, you can describe which area you would like to change and learn about procedures that may be suitable for you.

Long or sagging inner labia can cause some difficulty with clothing choices or during sexual intercourse. We also see loss of volume in the outer labia. Reducing the inner labia, adding volume to the outer labia, and tightening the vagina are procedures that address different tissues.

Anatomy of the genital area

The vulva (external genital area) includes the inner and outer labia, the clitoris, and the vaginal opening. The vagina is the canal extending inward from this opening. Labiaplasty addresses the external labial tissue, while vaginoplasty addresses tissues inside the canal.

The size and shape of the inner labia vary from person to person, and the right and left sides may also differ. Visible inner labia alone do not require surgery. You can describe your expectations about appearance or difficulties with contact against clothing without using medical terms.

The clitoral hood is continuous with the skin folds at the upper part of the inner labia. The clitoris beneath it and the hood itself are separate anatomical structures. The length of the hood, the distribution of folds at its sides, and its junction with the inner labia determine the boundaries of a plan for this area.

Fat beneath the skin of the outer labia contributes to their fullness. The perineum (the area between the vagina and anus), below the vaginal opening, is related to the supporting structures around the opening. Labial size, fat volume, and perineal support are distinct areas for intervention.

Who may be a suitable candidate?

Pinching of inner labial tissue against clothing, discomfort with the length of a particular area, or a wish to change a difference between the two sides may prompt a consultation for labiaplasty (inner labia reduction). The decision about surgery rests on the person’s own concerns and wishes. Comments about appearance from people close to them do not, on their own, create a medical need.

There is no single accepted size or appearance for the genital area. The color, edge shape, and length of the inner labia can vary. The surgical plan explains the relationship between the function of the existing tissue and the part the person would like to change.

An active genital infection, an undiagnosed skin change, or an uncontrolled medical condition needs to be assessed first. Elective cosmetic surgery is postponed during pregnancy. For people whose anatomical development is not complete, a request to change appearance requires a separate assessment of developmental features and medical need.

Not every difficulty in sexual life is caused by tissue size or vaginal width. The examination includes questions about where the concern occurs, in what circumstances it arises, and any accompanying symptoms. Anatomical intervention addresses the tissue change that has been identified. The basis of expectations about sexual function and the tissues that surgery would reach are explained separately.

The genital cosmetic surgery examination

The length, thickness, and edge structure of the inner labia are examined, along with the area where they join the clitoral hood. Whether the length extends along the entire edge or is concentrated in a particular section affects the incision plan. If the two sides differ, the distribution of tissue to be removed is planned separately on each side.

If your concern is vaginal widening, sharing your childbirth history and previous operations helps clarify changes around the opening. The examination also includes the pelvic floor (the muscles and connective tissues supporting the bottom of the pelvis) and support of the vaginal wall. Separate concerns, such as urinary leakage or tissue protruding from the vagina, may require assessment by gynecology and other relevant specialties.

An area described as the inner labia may sometimes be the outer labia or the vaginal opening. Pointing out the area of concern helps resolve confusion over terminology. Examining the external appearance and assessing the vaginal canal and supporting tissues are different parts of the examination.

Explaining which area will be examined and why helps the person understand the scope of a genital examination. A consultation about the appearance of the inner labia may not require the same examination as a concern involving the vaginal canal. If you have reservations about the examination, you can express them and ask for an explanation of the purpose of the proposed assessment.

Plans for pregnancy and childbirth are among the details that can be shared during a surgical consultation about the supporting tissues around the vagina. In someone who has given birth, previous repairs around the opening, the amount of tissue, and muscle support affect the plan. Requests concerning inner labial size and childbirth-related changes in support are therefore considered separately.

Labiaplasty and the clitoral hood

In labiaplasty (inner labia reduction), we reduce and reshape the inner labial tissue, called the labia minora. We can discuss your expectations about the length or sagging of the inner labia within the scope of this procedure.

The clitoral hood (the skin covering the clitoris) may be elongated along with the inner labia. When needed, we also reduce excess tissue in this hood during labiaplasty.

In the edge reduction technique, excess inner labial tissue is removed along the free edge. The incision follows the boundary of the section to be shortened, and the tissue edges are joined with stitches. This approach reshapes the edge of the inner labium.

In the wedge technique, a wedge-shaped piece of tissue is removed from a specific section of the inner labium and the remaining edges are joined. The size is adjusted while preserving part of the outer edge. This technique differs from edge reduction in the section of tissue removed and the position of the incision line.

Whether the clitoral hood needs intervention is determined separately from inner labia reduction. The plan is limited to the skin folds over and beside the clitoris. Incisions for the hood’s skin folds are marked separately from those on the inner labia. Clitoral hood surgery does not need to be added to every labiaplasty.

The length of an inner labium may differ in its upper, middle, and lower sections. Reduction markings may therefore call for different amounts of tissue removal along the edge. The location of folds on the right and left labia, the junction with the clitoral hood, and the area near the vaginal opening are shown separately in the incision design.

Adding volume to the outer labia

If there is a loss of volume in the labia majora (outer labia), we aim to add fullness with fat injections.

Loss of outer labial volume and excess overlying skin are different findings. Fat transfer may be considered for a lack of volume. If excess skin is pronounced, surgery to reshape the skin may also be considered. The choice depends on the skin and fat components of the outer labia.

For fat injections, the fat to be taken from the person’s own body and the treatment area are planned separately. The prepared fat is transferred to areas of the outer labia that need volume using a cannula (a thin delivery tube). The small entry site where fat is taken and the entry site in the genital area are in different locations.

Vaginal tightening

Vaginoplasty (vaginal tightening) is an operation we perform for vaginal widening and reduced tightness. As we remove excess internal tissue from the widened area, we also bring the muscles around the vagina closer together with internal stitches. Narrowing the vaginal opening is also included in the plan.

Concerns about the vaginal opening and concerns about the size of the inner labia are examined separately. The shape of the opening and the width of the canal are different anatomical features. Identifying which area is related to the concern helps explain the boundaries of a vaginoplasty plan.

A vaginal tightening plan considers the mucosa (the inner lining of the canal) separately from the supporting tissues beneath it. Incisions are placed where there is excess tissue inside the vagina. If support needs to be adjusted at the lower part of the vaginal opening, perineal repair may also be included in the plan.

Outward displacement of the vaginal wall due to loss of support requires assessment for pelvic organ prolapse. If this finding is present in someone seeking vaginoplasty, the scope of the procedure is reassessed accordingly. Inner labia reduction does not address support of the vaginal canal or pelvic floor.

Perineoplasty surgically reshapes the perineal tissues below the vaginal opening. While vaginoplasty reaches tissues inside the canal, perineoplasty focuses on the supporting area around the opening. A change in the shape of the opening may not require tightening of the entire canal, and an examination clarifies which layer needs repair.

Planning genital procedures together

Genital cosmetic surgery also includes procedures on the mons pubis (the fatty mound over the pubic bone) and repair of the hymen (the tissue fold at the vaginal opening). These procedures address anatomical structures distinct from the inner labia and vaginal canal.

Labiaplasty, clitoral hood reshaping, adding volume to the outer labia, and vaginoplasty can be included in a combined plan if there are separate needs in the relevant areas. Wanting to change one area does not make treatment of other areas necessary. The aim and incision site of each intervention are explained in relation to the tissue involved.

The mons pubis is the external area over the pubic bone, and fullness here is a different finding from enlarged inner labia. Liposuction may be considered for excess fat, while skin reshaping may be considered for excess skin or downward displacement. The continuity of the lower abdominal tissues with this area may also require consideration of a surgical plan for the abdomen.

Anesthesia options for genital surgery include local anesthesia with sedation or general anesthesia. Local anesthesia numbs the treatment area, while sedation is a method of calming administered by the anesthesia team. Reshaping limited to the inner labia and a repair extending into the supporting tissues inside the vagina differ in scope, so the anesthesia plan is based on the procedures to be performed and overall health.

Privacy during surgery

Only the healthcare staff needed for the procedure are present in the room during genital cosmetic surgery. We ensure there is no entry or exit during the operation and use female healthcare staff whenever possible.