Protruding labia minora: abnormal or just uncool?

Abstract

There is a wide variety in the appearance of normal female external genitalia. Nevertheless a specific prototype is promoted by the media, leading to a false sense that all other appearances are abnormal. As adolescents become sexually aware at an earlier age, most of them are worried about the appearance of their genitalia, especially when labia minora protrude beyond labia majora. This is a prospective audit of adolescents presenting for assessment of their perceived abnormal genitalia. Sixteen girls aged 10.2 to 17.8 years presented between June 2009 and December 2010 to a specialist adolescent gynecology service. Their mean labial width was 36 mm (range: 20-55 mm). In six girls, the reason for attending the service was inequality of the size of labia ranging between 6 mm and 35 mm (mean of 20 mm). Among the remaining 10 girls, the concern had arisen through comparison with a prepubescent sibling (one case), change of genitalia during puberty (four cases), looking at internet pictures (four cases), and looking at an anatomy book (one case). Risks of Female Genital Cosmetic Surgery (FGCS) have not been adequately documented, especially with regards to sexual function and long-term patient satisfaction. External genitalia are likely to change during puberty and therefore, any genital operation in the absence of clear pathology should be deferred until adulthood. Even then, women should have clear expectations of what will be achieved with the operation in terms of appearance and function.

Audit of referrals for concern regarding labial appearance at the Royal Children's Hospital: 2000–2012

“…There was no standard for measuring patient satisfaction following the consultation and no objective definition of labial hypertrophy. The definitions of normal labial size in the adult literature are limited to four studies, but there were no definitions of the normal range for the paediatric/adolescent population where change is occurring through puberty …”

What's normal? Influencing women's perceptions of normal genitalia: an experiment involving exposure to modified and nonmodified images

“…A strength of the study is that the sample of women in the 18 to 30‐year age bracket is representative of the age range at which women are most likely to undergo labiaplasty . Despite this, research shows that girls as young as 10 years and women up to 45 years whose labia are within the normal range are presenting to healthcare professionals seeking labiaplasty or genital assessment.…”

“…Yet women with normal labia are seeking labiaplasty and healthcare professionals are performing these procedures . There is no relationship between the size of the labia minora and sexual pleasure or physical discomfort, with aesthetic concerns the primary reason for requesting the surgery among adult women and adolescents . Research indicates that the majority of women believe that normal labia minora do not protrude beyond the labia majora, whereas the vast majority of physicians agree that this aesthetic represents society's ideal …”

The Normal Vulva, Vulvar Examination, and Evaluation Tools

“…16 No differences were found related to parity, ethnicity, hormonal use, or sexual activity. 13 In postmenopausal women, vaginal length was significantly shorter and labia minora narrower, when compared with premenopausal women. 15 In conclusion, the data regarding the appearance of the vulva are scarce.…”

“…The authors point that development of labia minora during puberty was never described in detail or categorized to stages as the development of breasts and pubic hair, making it hard to diagnose abnormalities. 13 Several papers published in the last decade tried to set normal measurements for the different vulvar parts. Lloyd (Table 2).…”