By Rebecca H. Allen, MD, MPH, Editor
SYNOPSIS: In this descriptive study, the rates of labiaplasty from 2016-2019 in the United States ranged from 3,046 to 4,315 per year and were highest among women aged 18 to 35 years.
SOURCE: Luchristt D, Sheyn D, Bretschneider CE. National estimates of labiaplasty performance in the United States from 2016 to 2019. Obstet Gynecol 2022;140:271-274.
Labiaplasty is defined as the resection of hypertrophic tissue and the creation of symmetrically smaller labia, typically the labia minora. The frequency of this procedure is unknown and, anecdotally, the numbers are increasing as the result of female concerns regarding the appearance of their external genitalia. Therefore, the authors aimed to estimate the incidence of labiaplasty in the United States with this descriptive study.
The authors used the Nationwide Ambulatory Surgery Sample database from 2016 to 2019. This sample is limited to hospital-owned ambulatory surgery centers but includes all specialties and payers. Labiaplasty was strictly defined as Current Procedural Terminology (CPT) 56620 or 15839 (vulvectomy/removal of excess vulvar skin) with an associated diagnosis of labial hypertrophy (International Classification of Diseases, 10th revision: N90.6). The annual rate of labiaplasty in the United States and associated demographic and facility characteristics then were obtained.
The authors found that the rate of labiaplasty procedures ranged from 3,046 to 4,315 per year. On average, 19% of patients were younger than age 18 years, 42% were aged 18 to 35 years, 29% were aged 36 to 50 years, and 11% were older than age 50 years. The majority of procedures were labiaplasty only (77%), although some were accompanied by other procedures that were not specified in the paper (other than hysterectomy). The primary payer was found to be private insurance (65%) followed by Medicaid (18%). Patients in the highest income quartile were more likely to have the procedure compared to the lowest quartile (31% vs. 18%). The average charges were $16,287 (95% confidence interval, $15,567 to $17,006).
COMMENTARY
This study produced a recent national estimate of labiaplasty procedures. The data did not allow for a full exploration as to the indications for the procedures. Nonetheless, the authors did use a very narrow diagnosis code (labial hypertrophy). However, it is notable that almost 20% of the procedures were performed in adolescents who likely had no other reason for vulvar surgery. The study is limited to hospital-based ambulatory surgery centers and, therefore, could not capture procedures done in private, independent surgery centers.
Anecdotally, the rates of labiaplasty seem to be increasing with the current trend of complete pubic hair removal, allowing individuals to visualize their anatomy and compare their own labia to images on the internet.1 Often, these images are of idealized prepubertal labia minora that are not natural or realistic for most women. The variation of normal anatomy for labia minora is marked, and conclusions that the labia minora are too large or hypertrophied are subjective. Sometimes, patients also may complain of functional issues in terms of interference with activities (horseback riding, sexual activity, running, walking, or sitting) or discomfort with using underwear or bathing suits. Nevertheless, the diagnosis of labia minora hypertrophy has no objective standard and often clinical judgment is used.1
Prior to performing labiaplasty, assuming there is no clinical indication for the procedure, patients should be reassured as to the normal range of the size and shape of labia minora. Any concomitant issues, such as female sexual dysfunction disorder, depression, anxiety, and body dysmorphic disorder, should be explored. Functional complaints often can be managed with vulvar hygiene and the avoidance of tight clothing. If the patient desires to proceed with labiaplasty for purely cosmetic reasons, then the risks and potential complications should be discussed. These can include infection, bleeding, wound dehiscence, scarring, chronic vulvar pain, and dyspareunia.2
Adolescents are a special group, and the American College of Obstetricians and Gynecologists recommends screening these patients for body dysmorphic disorder and emotional maturity prior to performing permanent surgery.1 In addition, federal (and some state) laws prohibit surgical alteration of the labia with no medical indication in patients younger than 18 years of age, since it is considered female genital mutilation. Some states also have laws that pertain to adults. Therefore, healthcare providers must be aware of the laws in their own states. Finally, patient expectations regarding the outcome of surgery should be explored, since there is no evidence that the procedure will improve sexual function or libido.2
REFERENCES
- [No authors listed]. Elective Female Genital Cosmetic Surgery: ACOG Committee Opinion, Number 795. Obstet Gynecol 2020;135:e36-e42.
- Liao L-M, Michala L, Creighton SM. Labial surgery for well women: A review of the literature. BJOG 2010;117:20-25.
Want to earn free OB/GYN CME courses? With FreeCME you can earn accredited CME courses online for free. Get started today!
