What is the anatomical basis of labiaplasty? A review of normative datasets for female genital anatomy

Abstract

Background: Despite increasing numbers of labiaplasties being performed, there is little quantitative information on normal labial diversity to guide medical education, patient education and surgical treatment.Aim: This scoping review will determine what is known in the published literature about the anatomical basis of normal for labia and female genital cosmetic surgery (FCGS). Materials and methods:The scoping review identified ten population-based studies that recorded labial dimensions by searching three electronic databases utilising a Preferred Reporting Items for Systematic Reviews and Meta-Analyses search strategy. Strict inclusion and exclusion criteria were applied and then reference lists were scrutinised until no further articles that met the criteria were located.Results: These studies showed significant variation in labial length (range 5-100 mm) and width (range 1-60 mm). Labia minora were wider in pre-menopausal women than in post-menopausal women, protruding labia minora were more common than not, and asymmetry between right and left labia was common. Variation in recruitment, inclusion and exclusion criteria, and measurement did not allow for summation of the data sets. Conclusion:This information could usefully be added to medical textbooks and teaching to ensure that medical graduates are sufficiently informed about normal variation in female genital anatomy to assess and advise women seeking FGCS.

The anatomical measurements of vulva in Indian women: A cross‐sectional prospective study

“…These non‐significant results can be explained by the small sample size. In their meta‐analysis, Hayes et al 18 concluded that there are sufficient studies on dimensions of labia minora, and it can be added to medical texts so that clinicians understand the physiologic diversity from graduation period only. They concluded that the length of labia majora ranges from 5 to 100 mm, while width ranges from 1 to 60 mm, and these can safely be used as standard.…”

Joint Report on Terminology for Cosmetic Gynecology

“…The labia minora are comprised of non-hair-bearing keratinized squamous epithelium and have minimal connective tissue deeper than the dermis. A systematic review identified significant variation in labia minora length (5-100 mm) and width (1-60 mm) 19 . The largest included study reported measurements of the labia minora in 657 Caucasian asymptomatic women from 15 to 84 years of age with a mean of 43 mm in length (SD 16 mm) and 14 mm in width (SD 7 mm) 20 .…”

“…A systematic review identified significant variation in labia minora length (5-100 mm) and width (1-60 mm). 19 The largest included study reported measurements of the labia minora in 657 Caucasian asymptomatic women from 15 to 84 years of age with a mean of 43 mm in length (SD 16 mm) and 14 mm in width (SD 7 mm). 20 Additional research is needed to compare these data to other ethnicities.…”

Female genital cosmetic surgery

“…7,8 Indeed there is no such demarcation, with the systematic review by Hayes and Temple-Smith which is contained in this issue highlighting the wide range of normal anatomical variation and that asymmetry between left and right side is common as is protrusion of the labia minora. 1 The crura of the clitoris is contiguous with the labia minora and a major concern with labiaplasty also discussed in this systematic review is the removal of highly sensitive and well vascularised labial tissue with a potential adverse impact on sexual function and pleasure. As discussed in the recent Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) editorial, 'Moving from critical clitoridectomy', the female organs involved in sexual pleasure have a long history of being poorly understood and under-researched.…”

“…A commonly desired outcome is 'The Barbie' vulva where the labia minora are trimmed to the extent of invisibility, with no visible protuberance beyond the labia majora. 1 The procedure can be performed by gynaecologists, cosmetic surgeons, plastic surgeons and urologists with various surgical techniques described including wedge resection and labial trimming. 2 FGCS is to be distinguished from vulvoplasty which may be medically indicated in the management of a range of congenital disorders, vulvovaginal malignancy, inflammatory conditions and following genital trauma including vaginal delivery and female circumcision.…”