The appearance of the external  genitalia varies in size and shape from person to person. The labia minora, which are the inside lips of the vaginal opening, can be a particular area of concern and cause insecurity for many. So when do you know if your labia minora are too big and what can be done about it?

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Labia minora hypertrophy is the medical term used to describe enlarged labia minora. This condition is largely subjective, meaning that it is influenced by personal feelings. 

Those with labial hypertrophy may begin to notice that their labia interfere with certain activities like intercourse, walking/running, swimming, or seated sports such as cycling or horseback riding. Typical symptoms include irritation of the labia on clothing due to rubbing or friction, a bulge in their underwear, or needing to fold up or push the labia inside the vagina to reduce the bulge. Some  might not experience these specific physical symptoms but may feel emotional embarrassment during intimate activities due to the size of their labia. This especially affects those that are younger and  are in the pubertal stage, as the appearance and size of labia can change significantly during this time period due to the effects of estrogen. 

On physical exam, labia minora hypertrophy is seen via pelvic exam when the external genitalia are inspected by your provider. When examining for labial hypertrophy, your provider may grasp your labia minora and pull it to be on stretch so that the full extent can be visualized. They will be examining for symmetry, coloration, sensitivity, and measuring it from its base to the tip, sometimes with a ruler to gauge the size. 

Diagnosis of labial hypertrophy is based on the presence of symptoms and size of labia on exam. Typically, symptoms that begin to interfere with daily activities and are distressing to the patient are considered abnormal. There is no standard cutoff for size of labia that is considered “normal,” however a measurement of greater than 6cm is typically accepted as enlarged and consistent with hypertrophy. 

Initial treatment of labia minora hypertrophy is via patient education and techniques that are geared towards decreasing the friction and rubbing of the labia on clothing. Two ways that this can be accomplished are by reducing the labia minora to the inside so that it is protected by the labia majora or by using a barrier protection such as aquaphor or coconut oil to reduce friction and create a protectant surface. Also, avoiding tight clothing and wearing breathable cotton underwear can help reduce symptoms.

If symptoms are persistent and bothersome, some patients may consider labiaplasty. This is a surgical procedure during which the labia minora tissue is excised, thus reducing the overall size of the labia minora. This procedure can be performed by some plastic surgeons, gynecologists, or urogynecologists depending on their specific skill set. The most common complications of labiaplasty include significant pain and soreness to this area, scarring, and pain with intercourse. This type of surgery is considered elective and is rarely covered by insurance. 

The bottom line regarding labia is that all labia will have a different appearance, they come in all shapes and sizes, and that’s NORMAL! No two labia will be the same. Most importantly, every labia is beautiful in its own way. I encourage you to take a mirror and explore the appearance of your own labia and if any concerns develop, don’t be shy to ask at your next annual appointment. If you find that your labia are particularly bothersome as discussed above, reach out to your healthcare provider. 

Let’s normalize the discussion around our external genitalia.

Have you thought extensively or had concerns regarding your labia? Please comment below!

With love,

Dr. Shweta Desai