LABIAL REDUCTION SURGERY – THE NEXT BIG THING?

More women than ever are asking surgeons for labial surgery - what is the reason behind this phenomenon?

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The latest fashion appears to be for labial surgery – why?

LABIAL REDUCTION SURGERY – THE NEXT BIG THING?
 
Raj Persaud FRCPsych Consultant Psychiatrist Nick Morris FRCOG Consultant Obstetrician and Gynaecologist.
 
 
Jothilakshmi and colleagues based at Fairfield General Hospital in Bury report a research finding, that labial reduction procedures in the British NHS, from 1998-9 to 2004-5, has doubled. This group of Obstetricans and Gynaecologists also describe in the Journal of Pediatric and Adolescent Gynecology, a small case series of girls under the age of 16 who have had labioplasty performed.
 
The reasons for requesting the procedure included labia getting caught in underwear, being prominent under clothing particularly including swimwear, vulval irritation due to enlarged labia, being worried about teasing due to large or unsightly labia and the appearance causing embarrassment.
 
This, admittedly small, case series found generally a good outcome for the procedure. There might be reasons to be cautious about such surgery in a young group. Adolescents are experiencing rapid changes in their bodies and with time might become more comfortable with their appearance. Wait and see might be a less invasive approach in these circumstances. Also this is a time of greater self-consciousness and sensitivity which might lessen with the passage of time.
 
An intriguing question is why are requests for labioplasty climbing so dramatically?
 
Merel Koning and colleagues from the Department of Plastic and Reconstructive Surgery, University Medical Center Groningen, The Netherlands, have recently published a fascinating survey which appears to deliver part of the answer. They performed a survey of prevailing female opinion on labia.
 
Survey participants included female medical students at the University of Groningen (394 participants with an average age, 22yrs); patients visiting the outpatient Department of Obstetrics and Gynaecology of the Medical Centre Leeuwarden (51 participants, average age, 40yrs) and female patients visiting Heerenveen, a private clinic (37 participants average age, 41yrs).
 
Amongst the fascinating results, include the finding that most participants (95%) frequently examined their own labia. Almost half of the participants (43%) found the appearance of their labia important, and 14% found the appearance of their labia to be abnormal, 7% had considered labial reduction, and 0.42% had undergone such a procedure.
 
38% of all participants paid regular attention to the appearance of labia in other women, 7% frequently. Fourteen percent had received either negative or positive remarks concerning the appearance of their labia from partners, and 7% had received remarks from other women. Almost all participants (95%) have known about the possibility of labial reduction.
 
This important survey demonstrates that the appearance of labia is perhaps much more important to women than had been previously realized. It also suggests that increased media attention to the issue could be driving requests for the procedure.
The authors of the survey argue that the growing habit of shaving the genital area combined with the increasing availability of pornography, is shaping the image and norms of labial appearance among the general public. Many who consume media images may not realize that most commercial pictures are dramatically re-touched in various ways with ever more used photographic editing software. One implication is reduction in labia size and asymmetry in the media, conveying as a consequence, the authors argue, inaccurate notion that very small, hardly visible, symmetric labia are the norm.
 
Subsequently, the authors of this survey contend, women may feel that they deviate from this norm, leading to unnecessary concern and an increase in medical care, all of which is further enforced by increased media attention.
 
In one of the largest case series published to date, a French group based at the Intercommunal Hospital in Creteil France, followed up 163 patients who had had cosmetic labial reductions surgery over a nine year period. Astonishingly high rates of satisfaction were found, for example, no surgery-related significant complications were noticed at all. Anatomic results were satisfactory for 93% with only 4% saying they would not undergo the same procedure again. Roman Rouzier, the lead author concludes that labial reduction surgery is relatively simple and associated with high levels of patient satisfaction.
 
This is a relatively new area of medical intervention. It is also the case that many times significant emotional distress has been either historically ‘covered up’ – for example bulimia nervosa was only categorized formally in psychiatry in the last twenty years of the 20th century – yet is considered common now. It is also possible that new preoccupations and sources of distress could be fostered by novel preoccupations driven by fashion and trend.
 
Breast alteration surgery and other facial aesthetic procedures are considered almost common place now but would have been regarded as outlandish fifty years ago.
 
Our approach has been when women appear in the clinic seeking this procedure is to offer a careful psychological assessment and even a psychological approach to the issues they are raising. A proportion take up this offer, though many decline this and prefer to go straight for the surgery. Only after a thorough exploration of the psychological and sociological dimension with a Consultant Psychiatrist, does surgery continue to be offered.
 
We have found this approach has lead to a small proportion of patients trying to deal with the issues that brought them to surgical out-patients, in a non surgical manner. However, the vast majority have chosen to continue with the procedure and have had excellent results, as reflected in the research on outcomes mentioned above.
 
We would argue that this approach should become the standard in the field. In particular, even if a woman goes ahead and has the surgery, management of expectations and management of the post-operative healing to ensure the best possible result, requires psychological health. Some women following surgery, don’t follow their surgeon’s advice over post-operative management, and as a result have to return for repair shortly. This raises the chances of a poor aesthetic outcome, and is often a reflection of deeper psychological issues that had not been properly addressed previously.
 
Even if the intriguing possibility that erotic imagery is driving a heightened awareness and concern over labia in the normal female population, as raised as a possibility by The Netherlands group, this doesn’t mean that requests for the procedure could be dealt with satisfactorily psychologically, or are going to go away. It does suggest we need more research on the issue, particularly in the light of the high rates of good outcomes so far reported for surgery – rates of which most psychology clinicians would be envious.
 
DR RAJ PERSAUD IS A CONSULTANT PSYCHIATRIST IN PRIVATE PRACTICE AT 10 HARLEY ST LONDON W1 AND DR NICK MORRIS IS A CONSULTANT OBSTERICIAN AND GYNAECOLOGIST BASED AT ST JOHN’S AND ELIZABETH’S HOSPITAL, ST JOHNS WOOD, LONDON NW8, AND THE PORTLAND HOSPITAL IN LONDON W1.
 
REFERENCES
 
Labial Reduction in Adolescent Population—A Case Series Study 
Journal of Pediatric and Adolescent Gynecology, Volume 22, Issue 1, February 2009, Pages 53-55 P.K. Jothilakshmi, N.R. Salvi, B.E. Hayden, B. Bose-Haider
 
Female Attitudes Regarding Labia Minora Appearance and Reduction With Consideration of Media Influence  Aesthetic Surgery Journal, Volume 29, Issue 1, January-February 2009, Pages 65-71 Merel Koning, Ingeborg A. Zeijlmans, Theo K. Bouman, Berend van der Lei
 
Hypertrophy of labia minora: Experience with 163 reductions  American Journal of Obstetrics and Gynecology, Volume 182, Issue 1, January 2000, Pages 35-40
Roman Rouzier, Christine Louis-Sylvestre, Bernard-Jean Paniel, Bassam Haddad