Our Greatest Wealth Is Health

Andrew Siegel MD   12/9/2017

Presenting oneself in a physically positively way is important to many women (as it is to many men).  Coiffed hair, nicely-applied makeup, polished nails, attractive clothing and a physically fit body are pieces of the overall picture. The appearance of one’s genitals—although private and hidden—is often perceived as an important feature as well. 

Interestingly, one’s perception of what features make for attractive genitals is strongly influenced by one’s culture.  In the United States (and many other Western countries) the most desirable look is petite vaginal lips, whereas in certain Eastern countries including Japan the “winged butterfly” is the preferred appearance. In some regions of Sub-Saharan Africa, intentional inner lip stretching and manipulation are commonly performed, since large lips are prized and considered highly desirable.  

Labial Anatomy 101

Miguel Ferig, Wikipedia Commons (LM labia majora; VV vaginal vestibule; Lm labia minora; C clitoris; U urethra; V vagina; H hymen; A anus)

The vaginal lips (labia) are parts of the female external genitalia (vulva).  Within the outer lips (labia majora) are two soft, thin, hairless skin folds known as inner lips (labia minora), which surround the entrance to the vagina. A furrow on each side separates the inner labia from the outer labia. The upper part of each inner lip unites to form the clitoral foreskin (clitoral hood) at the upper part of the clitoris and the frenulum (a small band of tissue that secures the clitoral head to the hood) at the underside of the clitoris. The labia have a generous nerve and blood supply, which during sexual arousal results in substantial swelling and congestion.

Size Matters

There is tremendous variety in vulval appearance, size, shape and pigmentation among women.  The inner lips can range from petite, narrow, barely visible structures to wide, butterfly-appearing lips that can extend well beyond the outer lips and dangle downwards, as illustrated in collage below.

“Vagina Collage”  (public domain)

Large inner lips , a.k.a. labial hypertrophy (see image below) can affect one or both lips and, although there is no exact consensus, is defined as when the inner lips extend beyond the outer lips.  In a British study of 50 women, inner lip length (top to bottom) averaged 6.1 cm (2.4 inches), ranging from 2 – 10 cm (0.8 – 4 inches); depth (width) averaged 2.2 cm (0.9 inch), ranging from 0.7 – 5 cm (0.3 – 2 inches).

By Schamlippen (Own work) [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

Factoid: Intentional labial stretching is a widespread practice in many countries in Sub-Saharan Africa, resulting in significant lip enlargement as deep as 20 cm (8 inches) and low hanging lips (pendulous labia).  See image below.

Khoisan apron–Khoisan women with pendulous lips visible (public domain)

Symptoms  

Having generously-sized lips is an anatomical variant that is most often harmless and should be considered more of a cosmetic issue than a medical problem.  However, large lips can cause a number of symptoms, including discomfort as a result of compression and rubbing from tight fitting clothes and exercising.  It can also cause irritation, painful sexual intercourse (particularly upon penetration), hygienic issues and on occasion a lip can get caught in a zipper (ouch!).  Psychologically, large lips can be a source of embarrassment, self-esteem issues and concerns about the presence of a “bulge” in the underwear and with tight fitting clothes.

Factoid: Some women with particularly oversized inner lips need to fold them and tuck them within the vagina to minimize the external protuberance.

What to Do?

If your inner lips are outsized but not causing concerns, there is no need for worry.  However, if there are anatomical, functional or psychological concerns, you should know that there are effective surgical procedures to remedy the problem.  Reducing the size of the lips is known in medical speak as “reduction labiaplasty.”  There are a variety of techniques to tailor and re-contour the lips, with the goals of resolving the issues that prompted the surgery, minimizing scarring and retaining the natural lip pigmentation.

Above photo, before labiaplasty (and other pelvic reconstructive procedures), (c) Michael P. Goodman MD, used with permission

Above photo, after labiaplasty, (c) Michael P. Goodman MD, used with permission

Bottom Line: Although “loose lips sink ships,” labial hypertrophy is rarely a significant medical issue, but rather can occasionally foster a combination of cosmetic, anatomical, functional and psychological concerns.  Anthropologically speaking, what is considered attractive is highly variable across cultural lines, with some cultures favoring the petite look, others butterfly-style, wide lips, and still others practicing intentional stretching to create oversized and pendulous lips.  Reduction labiaplasty is an effective surgical procedure that can improve the cosmetic appearance of the lips and resolve the accompanying physical and emotional issues. 

Reference: Labia minora hypertrophy: causes, impact on women’s health, and treatment options, Gulia et al, Int Urogynecol J (2017) 28:1453-1461

Wishing you the best of health,

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, Apple iBooks, Nook and Kobo:

 MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD (female version is in the works): PelvicRx

Tags: Andrew Siegel MD, labia hypertrophy, large vaginal lips, reduction labiaplasty

This entry was posted on December 9, 2017 at 8:21 AM and is filed under health and wellness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.