There are two pairs of labia the outer larger one called the labium major and the inner much smaller labium minora. There is considerable anatomical variation in their size and shape.
An enlarged labium minus can be bothersome for functional, aesthetic, and social reasons. Labia minora enlargement (hypertrophy) can be congenital or acquired by chronic irritation, exogenous androgenic hormones, or stretching with childbirth. This can cause inflammation, poor hygiene or interference with sexual intercourse. Aesthetically, an asymmetric or enlarged labium minus, cause's self-consciousness sexually when the subject wears tight clothes, or underwear.
Labia minora that protrude past the labia majora are aesthetically and functionally unsatisfactory to some women and they have sought surgical correction for this. Historically, female circumcision has been practiced in Islamic/Arabic countries for many centuries and is still commonly practiced in these countries.
It is important when performing this surgery that the natural contour and colour of the labium minus are preserved. If not, this can result in an incomplete or too tight a reduction. This can be achieved using a variety of techniques e.g. bilateral deepithelialization and reapproximation of the central portion with preservation of the nerve and blood supply to the wedge excision of the excess tissue.
Occasionally women may request surgical correction of their labia minora due to symptoms they attributed to the size of their labia. It is helpful to have a thorough gynaecological assessment. Sometimes simply reassuring the patient about the normal physiological changes of the external genitals during puberty and the enormous variety and diversity of the labia minora between women is sufficient. Others may present following a recent divorce feeling unconfident about their genitals. It is essential that women with vulvar pain syndrome and a sexual abuse history are identified. There is a risk in these women that surgery may fall short of their expectations or worse still exacerbate their complaint.
If you have been diagnosed with female stress incontinence, one surgical option your doctor may recommend is a Trans-obturator sling procedure. A sling procedure corrects stress incontinence by supporting your urethra to keep it in its correct position. Currently, Trans-obturator sling procedures have a success rate of about 85%. The operation is minimally invasive but may require an overnight hospital stay.
Stress incontinence can occur when weak pelvic floor muscles, or pressure from other organs, shift or weaken the bladder neck. When the bladder neck is out of place, the urethral sphincter may not be able to keep the bladder neck closed under physical stress. The surgically implanted sling corrects stress incontinence by supporting and repositioning the bladder neck and urethra in their correct position-which can help the urethral sphincter function properly. The end result is that after a sling procedure, most women can once again regain control of their bladder.
Laxity of the vaginal opening particularly after childbirth is common. This is sometimes also associated with a degree of prolapse or bladder disturbance. The muscles of the perineum are weak and poorly supported. Under these circumstances, the vagina is no longer at its optimum physiological state. The loss of structural architecture of the vagina results in the vagina being pulled apart rather than the muscles acting through the central perineal body this results in vaginal laxity, a loss in tone and lack of sensation.
The vaginal muscle tone, strength, and control can be improved with surgery. The effect is to decrease the lower vaginal diameter. Sometimes it is necessary to reconstruct the perineal body; this is a key structure and often is not adequately repaired following childbirth. Reconstructing the vagina to the way it was before you had a baby will improve this. It is essential your surgeon understands how your vagina functions or malfunctions and surgery should be tailored to your requirements.
The 40 minutes surgical procedure can be performed by a variety of methods, some advocate the use of lasers although this can be performed under local anaesthetic it can create superficial scaring and does little to address the primary defect. Whatever technique is used recovery is usually rapid, ideally your surgeon should be available following surgery so any post operative problems or worries can be addressed quickly so as not to delay your recovery.
Vaginal tone rejuvenation is not usually covered by health insurance nor is available in the NHS. However sometimes this may be performed in conjunction with incontinence or prolapse surgery, which will usually be covered by your health insurance policy. Further details about this are available on application. There is no way to know whether your condition is cosmetic or a necessity unless you have an examination first. *Patients with stress urinary incontinence can have this corrected with a concomitant surgical procedure such as the TOT or transobturator sling procedure.