What is Labiaplasty?: Surgery Procedure, Side Effects, Recovery

Labiaplasty is a surgical procedure done to reduce or increase the size of the labia minora - the skin folds that surrounds the urethra and vagina. This procedure helps to improve the appearance of the labia and also helps reduce physical discomfort and irritation. The procedure is generally performed for medical, physical and cosmetic reasons.

Anatomy and Physiology of Female External Genitalia

Various structures comprise the female external genitalia, collectively known as the vulva. The mons pubis, labia majora, labia minora, clitoris, vulva vestibule, Bartholin's glands, Skene's glands, urethra, and vaginal opening makes up the entire vulva.

1. Labia Majora: The word ‘labia majora’ refers to the larger lips. This prominent pair of skin folds called labia majora forms the lateral borders of the vulval clefts. These fleshy lips protect the external genital organs and are covered with pubic hair after puberty. 
2. Labia Minora: The ‘labia minora’ refers to the smaller lips. Labia minora are a pair of small cutaneous folds that start at the clitoris and extend downward. These skin folds protect the opening of the urethra and vagina.

A female undergoes labiaplasty for various reasons including medical, physical or cosmetic reasons. Labiaplasty help treat the following conditions:

1. Urinary tract infection
2. Vulval cancer

Typical candidates for labiaplasty are women who have developed significant labial changes postpartum or who have always had large and/or irregular labia majora, minora, or both.

Labiaplasty is an outpatient procedure performed to modify the size of the labial tissues that are present on both sides of the vaginal opening. The procedure usually takes about 30 to 40 minutes to complete. The treatment approach and selection of procedures depend on the health condition and the opinion of the treating surgeon. Depending on how the labia (labia majora and/or labia minora) will be reshaped or resized, the doctor will determine the surgical technique to use. This surgery is usually performed under local anaesthesia. 

A patient can expect the following during the surgery:

1. The patient will be lying on her back with the legs in footrests (stirrups), positioned at the edge of the surgical table.
2. Depending on the procedure the patient is having, the patient may have IV sedation with local anaesthesia or general anaesthesia.
3. The procedure will briefly involve shortening or reshaping the vaginal lips. Scalpels or lasers are used to remove unwanted tissue. The surgeon will use a fine, dissolvable stitch to stitch the loose edge.
4. When the surgery is complete, all incisions are closed with absorbable stitches (sutures) that dissolve over time and don't need to be removed. Finally, a surgical dressing is applied to the surgical site.

Based on the surgical expertise or the desired outcome, the surgeon will choose one of the following approachs. The patient and the surgeon can discuss and select the surgical technique that best meets the goals and concerns.

1. Reduction procedure: To reduce the size of the labia (labia minora and/or labia majora), there are two general approaches:
   1. Trim procedure: During this procedure, the surgeon removes excess tissue along the edge of one or both sides of the labia minora so that it is even with or recedes from the edge of the labia majora.
   2. Wedge procedure: By this method, the surgeon removes a wedge-shaped or pie-shaped piece of tissue from the inner areas of the labia minora. Leaving the submucosa intact allows the wrinkled edge of the labia to remain intact when the labia is stitched. This maintains a more natural appearance for the labia minora. In the same way, an inner portion of each labium of the labia majora can also be removed if the patient is having surgery to reduce the labia majora.
2. Enlarging procedure: To enlarge the labia majora, the surgeon will remove fat from another part of the body, such as the abdomen or thigh, and inject it into the labia majora using liposuction. Injecting hyaluronic acid into the labia majora is another option.
3. Gender-affirming surgery: The surgeon will use the tissue from the penis to create the labia. In the process of gender-affirming reconstructive surgery, labiaplasty is one step. An absorbable stitch (suture) is used to close all incisions in the above procedures so that they dissolve naturally over time and do not require removal. The surgical site will be covered with surgical dressing.

Before the labiaplasty, the doctor/surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Labiaplasty

1. During the patient’s consultation, the surgeon will discuss the reasons why to undergo labiaplasty. There will be a discussion of the patient’s expectations and goals and the risks involved in the surgery. 
2. The patient may then undergo a psychological exam, in which the patient will be asked about depression and anxiety.
3. The patient will receive detailed information about the surgery, including where incisions will be made and what to expect regarding the size and shape of the labia following surgery.
4. Some presurgical tests may be performed, such as blood tests, urinalysis and chest X-rays. The patient will be given information on what to wear to the procedure, when to stop eating and drinking, how to adjust or temporarily stop some medications, and how to prepare for the surgery.
5. Depending on the type of surgery the surgeon has selected, the patient may have IV sedation with local anaesthesia or general anaesthesia. The surgeon will discuss which type of anaesthesia will be best for the patient based on other comorbidities.

On the day of Labiaplasty

The patient can expect the following:

1. The patient needs to reach the hospital before the scheduled time.
2. The patient will be asked to sign a written consent form stating that she has understood the details and the risks associated with the procedure.
3. The nursing staff will ask the patient to change into a surgical gown.
4. A healthcare provider will record the vital signs (temperature, pulse, blood pressure, oxygen level, breathing rate). 
5. Another blood test and urine analysis may be required. 
6. An intravenous line (IV) will be inserted into the arm or hand of the patient, and a urinary catheter may be inserted in the urethra.
7. The healthcare provider will cleanse the labia and the surrounding skin and shave the pubic area if needed. 
8. The patient will then be shifted to the operation theatre.
9. After that, the healthcare provider will administer anaesthesia.

A patient who has undergone labiaplasty can expect the following after the surgery:

The recovery process at the hospital

1. Post-surgery, the patient will be moved to the hospital ward so that he/she can recover.
2. The patient will be kept in observation until the after-effect of anaesthesia wears off.
3. As the anaesthesia wears off, the provider will remove the urinary catheter (if the patient has one). The health staff will also check for bleeding. 
4. The patient will be given specific details and instructions on caring for the wound before leaving the hospital. 
5. The doctor will also discuss pain control and management of pain with the patient.

Recovery process/expectation after hospital discharge

1. The patient should follow all the instructions as provided by the doctor.
2. Medicine:
   1. The patient might experience swelling, discomfort, and pain; it's usually easy to manage with over-the-counter medication, such as paracetamol, or limited prescription medications.
   2. Ice packs or cold compresses are also helpful home remedies to reduce pain and swelling.
   3. A topical antibiotic to prevent infection of the surgical wound or an oral antibiotic may also be prescribed.
3. Diet and Lifestyle:  
   1. The patient may be recommended a diet to prevent constipation so that she doesn't strain. This will help to prevent the stitches from stretching or breaking.
   2. Wound care (dressing): The patient should only use lukewarm water to wash the wound.
   3. After urinating, the patient should gently dab or wipe the area dry. Do not rub the surgical site. 
   4. The patient must follow all the surgeon's post-operative instructions for urinating and passing out faeces, keeping the surgical site clear of bacteria, and allowing it to heal.
4. Work, Activity, Restrictions:
   1. After a few days, the patient can resume work and other light activities. However, the patient might need to stay at home longer if the job requires physical activity or lifting. Avoid such activities for four to six weeks.
   2. The patient must avoid strenuous exercises such as cycling, running and swimming.
   3. The patient should also avoid sexual intercourse post-surgery.
5. Clothes: During the healing process, wear loose-fitting undergarments and pants. Tight undergarments and clothes can lead to friction against wounds, which will delay or prevent proper healing of the surgical wound.

First follow-up appointment

1. The doctor will recommend a follow-up within three weeks post-surgery.
2. At this appointment, the surgeon may remove any retained sutures and evaluate the healing.
3. The doctor might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.
4. The doctor will also advise the patient for further timely follow-ups as well.

Labiaplasty is a safe procedure with several benefits that further improve the quality of life of a female. Some common benefits of labiaplasty include:’

1. Reduces discomfort
2. Greater comfort while exercising
3. Improved hygiene
4. Improved confidence
5. More youthful appearance
6. Improved sexual pleasure

There are possibilities of complications occurring after any surgery that involves cuts and incisions. A patient may the following complications after a labiaplasty surgery:

1. Soreness, bruising, swelling
2. Allergic reaction to the anaesthesia
3. Bleeding from the surgical site
4. Infection at the incision site
5. Scarring of tissue of genitalia
6. Reduced sensitivity of the genitals
7. Chronic dryness
8. Formation of blood clots or hematoma

When is consultation with the doctor needed?

The patient must consult the doctor immediately if she notices the following symptoms:

1. Bleeding from the surgical site
2. Infection
3. High fever
4. Inflammation or swelling

The following outcomes can be expected if the labiaplasty surgery is delayed:

1. The large size of the labia might increase the physical discomfort in the patient.
2. The patient might get infected by a urinary tract infection since the large size of the labia can harbour bacteria.
3. Without the surgery, the patient might also face difficulty to 
   1. Exercise 
   2. Maintain hygiene
   3. Sexual activities

The cost of labiaplasty ranges from ₹20,000 to ₹75,000. The cost varies based on the following factors:

1. Age of the patient
2. Type of the procedure done
3. Technique and equipment used
4. The medical condition of the patient
5. The type of hospital facility availed - individual room or shared.