Labia minora hypertrophy

Labia minora hypertrophy

Authors
Marc R Laufer, MD
Jhansi Reddy, MD
Section Editor
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Sandy J Falk, MD
Disclosures
All topics are updated as new evidence becomes available and our peer review process is
complete.
Literature review current through: Oct 2012. | This topic last updated: Apr 10, 2012.
INTRODUCTION Increasing numbers of girls and young women are seeking medical
and surgical attention due to concerns about the appearance of their external genitalia.
One area of concern is enlarged labia minora, which usually are a variant of normal
anatomy. Clinical labial hypertrophy remains a poorly defined diagnosis.
The clinical manifestations, diagnosis and treatment of hypertrophy of the labia minora
will be reviewed here. Congenital anomalies of the reproductive tract and vulvovaginal
discomfort syndromes are discussed separately. (See "Diagnosis and management of
congenital anomalies of the vagina" and "Congenital cervical anomalies and benign
cervical lesions" and "Clinical manifestations and diagnosis of congenital anomalies of the
uterus" and "Clinical manifestations and diagnosis of generalized
vulvodynia" and "Clinical manifestations and diagnosis of localized, provoked vulvodynia
(formerly vulvar vestibulitis)".)
DIAGNOSIS AND CLINICAL MANIFESTATIONS There are no standard diagnostic
criteria for the diagnosis of labia minora hypertrophy. Clinicians generally use labial width
measurements or the presence of symptoms to determine treatment options.
Labial width Labia minora hypertrophy is generally described as protuberant labial
tissue that projects beyond the labia majora. However, there is no consensus among
gynecologists, pediatricians, or plastic surgeons regarding the use of objective clinical
measurements to confirm the diagnosis.
In an early description of this condition, Friedrich classified labia minora as hypertrophic
when the maximal width between the midline and the lateral free edge of the labia
minora (when the labia were extended laterally by the examiner) measured greater than
5 cm [1]. Others have proposed that the normal width of the labia minora should be less
than 3 to 4 cm [2,3].
On the other hand, some have argued that patients should be offered surgical correction
if they present with persistent symptoms, regardless of measurements [3].
Symptoms Symptoms are either functional or psychological. Hypertrophy of one or
both labia minora can result in irritation, chronic infection, poor hygiene, pain or
interference with sexual activity and sports (eg, running, cycling, horseback riding, or
swimming). As an example, a woman may describe discomfort with the fact that there is

a "bulge" in her underwear. She may report that she needs to "fold up" her labia and
push them into the vagina to reduce the bulge.
In addition, concerns about the appearance of the labia minora can result in considerable
psychological and emotional distress [2-7]. Given the physical and emotional changes
that accompany puberty, adolescent girls are a particularly vulnerable group. For
example, girls may become very self conscious about the size of the labia if they need to
change their clothes within the presence of their peers [2-8].
PHYSICAL EXAMINATION A systematic approach is utilized for the gynecological
examination. It is helpful for the examining clinician to be familiar with the normal
variants of the external female genitalia. (See "The gynecologic history and pelvic
examination" and "Diagnosis and management of congenital anomalies of the
vagina" and "Gynecologic examination of the newborn and child", section on 'History and
physical examination'.)
The external genitalia are inspected (figure 1). The hair distribution, skin, labia major
and minora, clitoris, urethral meatus, introitus, perineal body, and anus are evaluated. In
particular, the labial minora should be fully extended laterally, inspected for asymmetry,
and measured from the midline to the lateral free edge (figure 2).
MANAGEMENT The initial approach to management is patient counseling and selfcare instruction. If symptoms persist after extensive counseling, then surgical correction
can be offered. Patients should be aware that surgical correction may result in scarring
and potentially lead to chronic vulvar pain and dyspareunia [2]. In addition, surgery is
considered elective, and cosmetic results vary.
Patient counseling Occasionally, concerns regarding labial asymmetry or
hypertrophy can be alleviated through reassurance that variation in size is a variant of
normal anatomy [9,10]. Furthermore, functional symptoms can often be conservatively
managed through counseling about personal hygiene (eg, use of mild soaps, avoiding
bubble baths, use of "natural" sanitary pads which do not contains chemicals) and
avoidance of form-fitting clothing. (See 'Diagnosis and clinical manifestations' above.)

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