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Labial reduction: Give your erogenous zone a new appearance

4500 surgical procedures!

Motivation

Most women who decide to undergo labia minora reduction do so for functional and/or aesthetic reasons. In our many years of experience, however, pure aesthetic motivation is unusual and there are usually also functional problems: recurrent skin irritation; folding in (invagination) of the labia minora during sexual intercourse; friction and pain during sporting activities, when riding a bicycle or when wearing tight clothing; deviation of the urine stream, etc.

The effects of an unaesthetic appearance often go beyond just feelings of “I don’t like it” and may even disrupt a woman’s sex life to a considerable extent.

 

Ideal appearance and surgical goals

The aim of surgery is to overcome or at least relieve functional problems, at the same time as achieving a visually optimal appearance.

Even though there are huge cultural, ethnic, and individual variations in the concept of beauty, there seems to be an image that all women in our western society would consider ideal: it is the image of firm, well-shaped outer labia that completely enclose and cover the inner labia, giving the appearance of a closed shell.

Schamlippenverkleinerung

The ideal appearance of the labia minora is somewhat more varied than that of the labia majora. Some women want their inner vaginal lips to be as short as possible, while others prefer a longer version, usually gently curved.
 

Techniques

Reduction labiaplasty can easily be performed under local anaesthetic, but also under a general anaesthetic or sedation analgesia if you prefer.

The most appropriate surgical technique will depend partly on the anatomical situation, and partly on your expectations of the visual and functional results.

The labia minora differ widely in shape and size from woman to woman. Before deciding on the right surgical technique, the following questions have to be answered:

  1. Are the labia minora enlarged over their entire length, that is to say, starting at the mons pubis (the pubic eminence) and extending as far as the perineum, or even as far as the anus? Or is only the section below the clitoris affected?
     
  2. How large is the clitoral hood? Is it very large? Does it hang loosely over the clitoris or does it sit firmly? Does it cover the clitoris?
    (The clitoral hood is not really a separate structure. The part of the labia minora that drapes around the clitoris is known as the clitoral hood.)
     
  3. How long is the section above the clitoris? Long or short? The part of the labia minora that lies above the clitoral shaft is called the clitoral prepuce.
     
  4. What does the clitoris look like? Does it protrude or does it lie flat? When the clitoris sticks out a long way, it is referred to as clitoris protrusion. The clitoris itself can also be enlarged.
     
  5. Are there any scars, shrinkage, or contour defects especially due to childbirth or episiotomy, etc.?

All the components mentioned above will be examined during your personal consultation and the most suitable surgical technique selected in agreement with your ideas.

And now for the technical bit …

 

We have four different techniques for labia minora reduction::

1. “Composite reduction labiaplasty”

The technique of composite reduction labiaplasty is the procedure that meets all conceivable requirements. It represents the maximum variant of the feasible and the possible, so to speak.

This surgical procedure is used to correct:

  • labia minora enlarged along their entire length
  • a large or overhanging clitoral hood
  • a long clitoral prepuce
  • clitoris protrusion

As the name of this procedure implies, completely separate areas result from the removal of tissue (the orange areas shown in the video). These segments must be re-assembled (composed) to a unified whole in order to achieve the desired result: a harmonious reduction of the labia minora, optimal tightening of the clitoral hood, and correction of clitoris protrusion.

2. Labia minora reduction along their entire length with correction of clitoris protrusion

This variant is similar to the composite reduction labiaplasty (see technique 1) in all aspects except that there is no additional upwards tightening of the clitoral hood.

This surgical procedure is appropriate when the labia minora are enlarged along their entire length and there is a protruding clitoris but no overhanging clitoral hood. The clitoral prepuce above the clitoris shaft is of normal length.

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3. Labia minora reduction along their entire length without correction of the clitoris

This technique is used when only the segments of the labia minora need to be harmoniously shortened along their entire length. The clitoral hood is also tightened, but not to the same extent as in the composite reduction labiaplasty. This surgical procedure does not alter the position of the clitoris.

4. Labia minora reduction only below the clitoris

This is the method of choice when the labia minora are enlarged only in the segment below the clitoris, the clitoris is in a normal position, the clitoral hood is not enlarged, and the clitoral prepuce is not too long. Unfortunately, this is very rarely the case, as hypertrophy (enlargement) of the labia minora usually affects all segments, i.e. above the clitoris, around the clitoris (the clitoral hood), and below the clitoris.

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The operating time is between 1½ and 2½ hours, depending on the surgical technique used.

Current Publication from PROF. GRESS

Aesthetic and Functional Labiaplasty

ISBN 978-3-319-60222-6

International textbook by Prof. Stefan Gress, published by SPRINGER in January 2018.

go to book published by SPRINGER ...

 
 


Preparation and postoperative care

Before surgery

No special preparation is necessary if you are having the surgery done under local anaesthetic. You do not need to be fasting and can eat normally. But please shave the whole of the genital area. Do not take any aspirin or cardio aspirins (ASA 100) for 14 days before surgery. At your initial consultation, we will give you a prescription (antibiotics and painkillers): take these medicines exactly as prescribed.

After surgery

This is an extremely important time and following our instructions or recommendations is an integral part of successful treatment!

Immediately after the surgery you should remain with us to rest and to cool the genital region. Once you feel OK, you may go home or back to your hotel. For the rest of the day, you should lie down and walk around as little as possible. Before leaving the practice, you should go to the toilet again to empty your bladder. You will then have a new dressing applied. Leave it in place for as long as possible. We will explain what to do after going to the toilet later.
Wear firm panties immediately after surgery. A little pressure applied in this region prevents severe swelling and reduces the likelihood of bleeding. It is better to wear looser clothing the next day, as this is more comfortable. You do not need to cool the genital area any more.

Take a taxi or get someone else to pick you up after the procedure. We advise you not to drive yourself. The local anaesthetic will be effective for some time after the surgery so you should be home or at your hotel before its effects wear off. Take any medicines that we prescribe, such as painkillers, exactly as we tell you. We will give you a phone number to call in case you have any questions or in the event of an emergency. You can call at any time – we are always there for you.

You will come to the practice for the wound to be checked the day after the surgery. The area will be cleaned and a new dressing applied. We will give you the dressings that you will need at home. The dressing is held in place with fine mesh panties. After a labiaplasty, it is really important that you wear a long strip of moist compress between the labia for a period of two weeks, so that the two labia do not touch each other. This should prevent one lip turning over beneath the other, which might have a negative impact on the results. You can use ordinary tap water to moisten the compress.

Subsequent care: it is very important to avoid as much friction as possible for a period of at least six weeks. You can, of course, resume your normal life after a few days but you should wait at least six weeks before having sexual intercourse, going jogging, riding, cycling, etc.

 

Info

How soon can I take a shower?

You can shower again two days after the surgery. Don’t use any soap for a week. Don’t worry if you wash your hair and some of the shampoo runs down over the area – it’s OK. Don’t take a bath or a Sitz bath for six weeks, as they will soften the wound.

How soon can I go swimming?

Don’t go swimming in a public pool for four weeks after the surgery, as there tends to be a high level of germs in the water. You only need to wait two weeks before you can swim in a lake or the sea.

What sort of anaesthetic is the best?

A local anaesthetic is just like having an injection at the dentist’s. Once the anaesthetic has been injected, the whole area is numb, so that you won’t feel anything during the surgery and for about three hours afterwards. After the procedure, some more anaesthetic will be injected to prevent any pain for a bit longer. But you won’t feel that injection. Nearly all our patients opt for a local anaesthetic but of course you can have a general anaesthetic or sedation analgesia. The anaesthetist will perform the general anaesthetic and this service will be billed separately. In addition, you mustn’t have anything to eat before the surgery and you have to bring the latest results of blood tests and an ECG with you to the surgery. These tests are necessary only for a general anaesthetic or sedation analgesia.

Do the stitches have to be removed?

No, they dissolve spontaneously. However, this process may be associated with considerable itching. A mild cortisone cream for two weeks may help. The stitches can also be removed after 14 days, but it’s not always easy as they are so fine that they can hardly be seen. The stitches will be absorbed completely after 6-7 weeks.

What is the optimal length of the labia minora?

The length of the labia really means how long they are from where they start in the mons pubis to where they end at the perineum or, in some cases, the anus.

What is often called the length is in fact the height of the labia minora, starting at their base where they join the labia majora and then hang down or fold out to the side.

In the scientific world, however, there’s no normal value: enlargement of the labia minora is called labial hypertrophy if the labia minora visibly protrude beyond the level or cover of the labia majora when the woman is standing up. In our experience (of more than 4500 patients), the “optimal length” or what most of our patients want is about 1 cm in height – sometimes slightly more, sometimes slightly less. After the surgery, however, the labia minora must still fulfil their function of closing off the vagina.

Scalpel or laser?

The incisions will be made with a type of laser. It’s a high radiofrequency device that allows us to cut the tissues gently without having to apply any tension. These procedures would be very difficult or even impossible to perform with a scalpel.

What happens when I have a period?

Don’t use tampons for six weeks after surgery, just sanitary pads. Inserting tampons could tear the wound open. Don’t worry if you have your period on the day of the operation, surgery can still go ahead.

How do I look after the area after the surgery?

After two or three days you may apply medicated creams, e.g. Bepanthen ointment. Aloe vera gel helps to cool the area and reduce itching. Make sure that any products you use aren’t perfumed. If the itching is severe, which may be due to the stitches dissolving, we recommend a mild cortisone ointment for 14 days. We will be happy to send you a prescription for this treatment.

What can I do to prevent scarring?

Highly visible scars in the genital region are rare. We advise you not to use a scar cream in this area. Don’t put any strain on the wound for six weeks – that’s the best thing you can possibly do. Please contact us if the scars don’t heal as you would like. Cortisone cream may also be indicated in this case. Avoid any direct ultraviolet light for six months!

What helps healing and getting an optimal result?

Of course, you have to carry on with your day-to-day life. That’s not a problem. But don’t do anything that you don’t have to: no sexual intercourse, no jogging, no cycling, no horse riding, etc.

In addition, wear a long strip of moist compress between the labia for a period of two weeks, so that they don’t touch each other and can heal well.

After these two weeks, you have to apply pressure to each of the labia, using your thumb and forefinger to press firmly along the whole length twice a day, mornings and evenings. Don’t rub or massage! We’ll show you how to do this properly the day after the surgery. This pressure is important to reduce the swelling more rapidly and make the scar softer.

What sort of sex is allowed during the healing phase?

Full intercourse is not allowed for at least six weeks, and then gently at first, without excessive strain. It may still hurt a little bit at the beginning. It’s a good idea to use a lubricating gel. Careful anal or oral sex is allowed, but not until three weeks after the surgery. Gentle masturbation is also permitted after three weeks.

May I do any sporting activities during the healing phase?

You may do anything that doesn’t put a mechanical strain on the genital region. Neither stretching nor friction is good for wound healing, so wait at least six weeks. After two weeks you can use a stair stepper or elliptical trainer, as your legs are somewhat further apart when you use these machines. Yoga is also permitted after two weeks, as long as you don’t have to do the splits or similar positions.

What do I do if I have any questions after the surgery?

You are free to call us at any time on our practice number, no matter how long after the surgery. You will be given a mobile number to use in the case of emergency. Thanks to modern technology, it’s possible to transmit photos very quickly should it be necessary for us to see something straightaway from a great distance. You can use the internet or a mobile phone.

Appointments for consultations and surgery if you have to travel a great distance

Patients who have to travel some distance often find it difficult to visit us twice – once for a personal consultation and again later for the surgery. In this case, we offer a combined package so that the initial consultation, surgery and check-up can all be carried out during one stay in Munich.

You have to come for the initial consultation one day before the surgery is planned. The surgery will take place the following day. The check-up will take place the day after the surgery, so that you will have to spend two nights in Munich.

We can help you find a suitable hotel.

How long do the different procedures take and how much do they cost?

Labia minora reduction purely below the clitoris approx. 1 - 1½ hours operating time € 2300
Labium minus correction on one side only approx. 1 - 1½ hours operating time € 2300
Labia minora reduction along their entire length without clitoris correction approx. 2 hours operating time € 3500
Labia minora reduction along their entire length with correction of clitoris protrusion approx. 2½ hours operating time € 4000
„Composite reduction labiaplasty“ approx. 2½ hours operating time € 4500

If surgery is being performed for cosmetic reasons alone, 19% VAT is applied to the fees, in accordance with the law in Germany.

If the main reason for the surgery is medical, e.g. pain on intercourse or during sports, skin irritation, frequent blisters, or fungal infections, then VAT is not applicable. You will, however, need confirmation from your gynaecologist that there is a medical indication for surgery. A brief written confirmation is sufficient – it doesn’t have to be a long medical report. You must present this confirmation before surgery.

The surgical fee also has to be paid by the day of your surgery.

Does the health insurance cover the costs?

Statutory health insurance companies are very reluctant to bear the costs. And we don’t work in partnership with any of the statutory health insurance companies. Private insurance companies, on the other hand, often cover part or all of the costs. In any case, it’s advisable for you to ask the insurance company concerned whether they will assume the costs and obtain a declaration to this effect. If you wish, we can give you an estimate of costs together with a medical certificate stating the necessity of the procedure, as part of your personal consultation.

Is it possible to get any financing?

We don’t offer any financing ourselves. However, our long-time partner Medipay is available for uncomplicated and speedy financing. You can find all the relevant information on their website www.medipay.de

What are the possible risks?

The risks and side effects are few when the procedure is performed by an experienced specialist. Unfortunately, that is not always the case!

The following risks will be explained to you during your initial consultation, and you will be given an information sheet which lists all the risks once again. You will have to sign the consent form at the end of this information sheet and bring it with you when you come for the surgery.

The most important side effects and risks are:

Swelling
there is always swelling: up to 80% will have resolved after six weeks, and it will have disappeared completely in six months’ time

Pain
as a rule, up to three days postoperatively, rarely longer

Bleeding, bruising
bleeding that requires surgical revision is rare, slight bruising is possible

Delayed wound healing
statistically speaking, this is the most common complication, occurring in 4% of cases – that’s why you need to avoid any friction

Scars
the scars usually heal without problem; painful or abnormal scarring is very rare

Disorders of sensation
disorders of sexual sensation are not to be expected if the procedure is performed correctly and the wounds heal without complication. There may be temporary changes along the incision lines, which become oversensitive or slightly numb. Sensation returns to normal after the wounds have healed.

Infection
thanks to the good blood supply in this region, infection is rare and virtually ruled out by the routine administration of antibiotics

Asymmetry
with any labia minora correction, asymmetry may be caused purely by a difference in the healing process between the right and left sides

Possible revision
e.g. due to asymmetry or a disorder of wound healing

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