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Labia reduction (LABIAPLASTY
VAGINOPLASTY)

For our sexuality, the genital area is the most important part of our body.
This is where we experience joy, pleasure and satisfaction.
It is our most intimate region.

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We keep it hidden from the eyes of others – except for those moments when we are prepared to reveal it to people we love or feel affectionate about. It is just natural that in these moments we want to feel comfortable and content with our appearance.

Given the special significance of this anatomical area, any surgical changes should be performed with the utmost commitment to a perfect new appearance.

Labia correction needs to be performed with great skill and diligence, using the appropriate technique, in order to achieve an aesthetically appealing result. Contrary to what is often assumed, the procedure is not about simply “cutting something off”, but requires a great deal of experience.


To learn more about labia reduction, go to the following menu items:

When I started to become more involved with intimate surgery many years ago and added these procedures to the range of surgical services I was offering at that time, there were only a few colleagues worldwide who were engaged in this field. In addition, I found that none of the surgical techniques described in the literature of that time were suitable to achieve truly satisfactory results.

We have developed and constantly refined the techniques presented here on our website over many years. We have presented our surgical techniques at national and international congresses and published them in most respected medical journals. Today, they are used successfully throughout the globe.

We have compiled for you an overview of these techniques as well as other interesting facts and hope that you will find answers to all your questions!

If you have any further questions or would like to learn more about a specific procedure, feel free to email us or arrange for us to call you back or make an appointment for a comprehensive personal consultation at our plastic surgery practice.

 

Related articles media publication

 
 
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2. Anatomy and function of the labia

The labia cover and seal the vaginal opening, protecting the vagina from drying out and against intrusion by foreign bodies and pathogens. Additional mechanical protection is offered by the fat pads of the outer labia.

The inner lips (labia minora) extend from the mons pubis towards the anus, encompassing the clitoris and the vaginal opening. The part of the labia adjacent to the clitoris is also referred to as the “clitoral hood”. In terms of morphology, the labia minora are equivalent to the foreskin of the penis. They are of secondary importance for sexual stimulation.

The term clitoris is commonly used to refer to a small, pea-shaped anatomical structure located somewhat above the urethral opening. However, the clitoris is not spherical but rather band-like in shape, similar to a small penis, with only the tip (glans clitoris) protruding and being visible. Its shaft (corpus clitoris) extends in a deeper layer across the pubis and is thus not visible. The clitoris plays a major role in sexual stimulation.


3. The ideal appearance

In our culture, anything that sags or hangs shapelessly is often perceived as unattractive. Since shaving public hair has become routine for most women today, the shape and form of the genitals are unveiled, regrettably including any less appealing details.

Even though the idea of what the perfect genital area should look like may vary greatly from woman to woman, there is one appearance that is considered to be ideal by most patients: Beautiful, not-too-long inner labia that are completely covered by firm, well-shaped outer labia, similar to the shape of a closed shell.

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Labia reduction

  


4. Cause and effect

For many women, the anatomic variations of their genitals can be a source of significant suffering. Hormonal influences, weak tissue, genetic factors or age-related changes may cause these deviations in shape. Large labia minora and sagging labia majora are found to be particularly distressing.

Functional problems, such as pain when wearing tight-fitting clothing, during sporting activities (horse riding, jogging, cycling), invagination of the labia minora during sexual intercourse and hygiene issues, can motivate women to have a surgical correction done. Another reason to undergo a genital correction procedure can be psychological distress with its negative impact on sex life, which can be significant in some patients.


5. Problem and aim

If the labia minora are very long – a condition called labial hypertrophy – they are no longer covered by the labia majora. Typically, labia minora are enlarged along their entire length, i.e. the part above the clitoris, the area adjacent to the clitoris (clitoral hood) and the part below the clitoris. An isolated hypertrophy of the lower part is rare.

In cases where all sections are enlarged (the most common form), a correction of all parts has to be performed to achieve a balanced and aesthetically appealing result.

In addition, attention should be paid to the position of the clitoris itself:
In some cases, the clitoral glans can protrude to a great extent. This is referred to as clitoral protrusion. In cases where full coverage of the labia minora by the labia majora cannot be achieved with the labia reduction procedure alone, surgical correction of clitoral protrusion is advisable.
 
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6. Surgical techniques

We differentiate between four types of techniques used for the reduction of the labia minora depending on the examination findings and the starting situation (see under 6).

 

A. COMPOSITE REDUCTION LABIAPLASTY

  • Reduction of the labia minora in all three sections
  • Correction of the clitoral position in case of a bulging clitoris (clitoral protrusion)
  • Additional upward tightening of the clitoral hood

The excess tissue in the areas highlighted in orange is removed. By lowering the protruding clitoral glans, correction of the clitoral protrusion is achieved. To tighten the clitoral hood, both skin flaps are tightened downwards, in addition to tightening the clitoral hood upwards.

 

B. VREDUCTION OF THE LABIA MINORA
IN ALL SECTIONS
(WITH CORRECTION OF THE CLITORAL POSITION)

  • Reduction of the labia minora in all three sections
  • Correction of the clitoral position in case of a bulging clitoris (clitoral protrusion)

This technique is almost identical to the variant described above. In this case, however, no skin area is removed above the clitoris.

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C. REDUCTION OF THE LABIA MINORA
ALL SECTIONS
(WITHOUT CORRECTION OF THE CLITORAL POSITION)

  • Reduction of the labia minora in all three sections

Removal of the excess tissue (highlighted in orange). In contrast to the variants described above, only a downward tightening of the clitoral hood is performed, but no correction of the clitoral position and no additional upward tightening of the clitoral hood. Two skin triangles at the sides are removed to prevent engorgement of the tissue that would develop as the flaps are pulled downwards.

  

D. REDUCTION OF THE LABIA MINORA
ONLY IN THE AREA BELOW
THE CLITORIS

This variant should only be considered in cases with isolated enlargement of the labia minora limited to the part below the clitoris. However, these cases are rare.

Excess tissue highlighted in red is removed.

 

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7. The procedure

Typically, the procedure is performed under local anaesthesia; however, analgosedation (twilight sedation/twilight anaesthesia) or general anaesthesia is also available on request. Prior to surgery, we will decide together with you every detail of the changes you desire. To this end, we take exact measurements to determine how much skin and tissue needs to be removed to achieve a perfect, ideally symmetrical result.

To make the necessary incisions, we use a radiofrequency surgical device (similar to a laser scalpel) to enable very precise and tissue-conserving surgery with little bleeding. This results in a markedly improved and significantly accelerated healing process. The edges of the incision wound are closed carefully with fine, absorbable sutures.


8. Before the surgery

If the procedure is performed under local anaesthesia, no special preparation is required. If the procedure is to be performed under general anaesthesia or twilight sedation, you should be fasting, i.e. refrain from eating, drinking and smoking at least 6 hours prior to your surgery.

You should stop taking medications that affect coagulation, e.g. aspirin or ASS 100 mg, etc., two weeks prior to your surgery. Please completely shave your genital area before the procedure..


9. After the surgery

After the surgery, you can rest in our practice rooms.
Please do not drive home or back to the hotel yourself. Get someone to pick you up or we can call a taxi for you. Cool the area and rest. You should walk as little as possible. You may experience a mild burning or pressing sensation, especially during the first night. This is normal. However, some patients feel it more than others and, despite the pain medication prescribed by us, a few patients experience great discomfort. Typically, the sensation disappears or significantly improves after the first night. On the first postoperative day, the wound is checked and the dressing is changed at our practice.

After the third day, you can start showering again, but use only water and no soap during the first week. Since absorbable suture is used, the stitches do not need to be removed. Absorption of the suture may sometimes be associated with severe itching, which can be alleviated by using special creams or ointments.

The surgery will only affect your daily activities for a short time. Depending on your profession, you may be able to return to work as early as 2-3 days after surgery. It is very important that you try to avoid any friction and mechanical forces acting on this area for 6 weeks following the procedure: no sexual intercourse, no jogging, no cycling, no horseback riding, etc! Likewise, tampons may only be used again after this period.

You should wear a firm pair of panties immediately after surgery that you can pull upwards to put some pressure on the area. This helps prevent excessive swelling and reduces the risk of postoperative bleeding. Then from the first day after surgery, you will feel more comfortable wearing loose clothing.

To optimise the healing process, you should place a compress between the labia so that they do not touch. You should do this over a period of two weeks. Then, you should firmly squeeze the labia along their entire course using your thumb and index finger. You should do this 2-3 times daily over a period of four weeks. In this way, any swelling will disappear more rapidly and scar healing will be improved. However, be careful not to rub or massage the labia.

You will be provided with the mobile phone number of Professor Gress so that you can contact him any time, should you have any questions or in case of an emergency.

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​10. Risks and potential complications

After the procedure, there will be some swelling which will generally start to gradually resolve after the first or second day. Approx. 80% of the swelling will subside within the first 6 weeks after surgery; the remaining swelling takes comparatively longer to disappear, occasionally up to 6 months. You may experience minor bruising. You can help prevent this by wearing a firm pair of panties immediately after the procedure to put some pressure on the area.

In addition, varying degrees of pain can be expected, especially in the first night after surgery. However, if you take the pain medication prescribed by us, you should be able to cope with it quite well.

Wound healing may be disturbed, especially if the area is exposed to mechanical forces too early. Therefore, it is crucial that you avoid any kind of strong friction (e.g. sexual intercourse) during the first 6 weeks after surgery. Likewise, you should not use tampons during this period.

Once wound healing is completed, scars in the genital area are usually very inconspicuous and hardly noticeable, even on closer inspection. Theoretically, scars can develop into thick, reddened or painful scars. However, this has so far not been observed in the genital area. Special ointments would help here. To promote good scar healing, you should squeeze the scars using your fingers 2 weeks after surgery. We will show you exactly how to do this at our practice.

Sensory disturbances are not to be expected. In the beginning, you may experience some numbness or sensitivity to touch, but this will disappear once wound healing is complete. When a correction of a bulging clitoris (clitoral protrusion) is performed, the clitoris is shifted closer to the vaginal opening, which may enhance sexual stimulation.

Postoperative bleeding, minor asymmetries, wound infections, etc. are very uncommon.


11. Costs

The fees for labia surgery depend on the type and duration of the procedure and range between EUR 1,900 and EUR 3,800; fees for complex reconstructions are somewhat higher.

Where the procedure is performed under twilight sedation or general anaesthesia, the anaesthetist fees are charged in addition.

German statutory health insurances only cover these costs at their rates, if at all, and only after evaluation by the Health Insurance Medical Service (MDK). In contrast, private health insurances are less restrictive and cover all or part of the costs in patients with medical indication. A medical indication requires the presence of functional impairments, such as pain associated with sexual intercourse, sporting activities and wearing tight-fitting clothing, or skin irritation due to hygiene problems, among others. In addition, a medical indication can be based on psychological impairments.

Procedures performed solely for appearance-enhancing, aesthetic reasons, i.e. in the absence of a medical indication, are not covered by health insurances. In this case, value-added tax has to be charged on the surgical fees, adding 19% to the costs.

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​12. Frequently asked questions about labia reduction

What intimate hygiene is best for me after surgery?
You may already take a shower after two days, but use only water for one week. Please only use pH-neutral products. Do not bath the area as this would soften the wound edges! We only use absorbable sutures. Unpleasant itchiness may be experienced along with suture absorption. We recommend that you use Bepanthen ointment or pure Aloe Vera gel to alleviate this symptom.

Are scar creams recommended?
Since scars in the genital area generally tend to heal perfectly, this is usually not necessary.

Does labia reduction have an impact on giving birth?
No, if you become pregnant after the procedure, you can give birth naturally. The surgery does not affect the process of giving birth, and conversely, giving birth has no negative impact of the result achieved with the procedure.

What kind of clothing is advisable?
On the day of surgery, please bring along a firm pair of panties to wear after the procedure to put some pressure on the area. This helps prevent excessive swelling and reduces the risk of postoperative bleeding. Then from the first day after surgery, you will feel more comfortable wearing loose clothing.

When can I start shaving again?
Please completely shave your genital area before the procedure. After surgery, you should not shave the area for 6 weeks, also no waxing, etc.

When will I be able to return to work?
If you have a sedentary job, you can return to work after only two days. You should seek a sitting position that you feel is comfortable for you. Should your work involve quite a bit of walking, allow at least 3 days for recovery.

When can I expose myself to the sun or sun bed again?
Sun and UV rays have a negative impact on scar healing. Please ensure that the area is protected from them for a period of 6 months.

Can the procedure be performed during menstruation?
Having your period on the day of surgery does not constitute a problem. However, please keep in mind that for six weeks you should not use a tampon as it may open up the wound edges when you insert it.

When can I resume sporting activities?
To ensure proper healing, it is important that you avoid any friction in the genital area for at least 6 weeks. Sexual intercourse, horseback riding, jogging, cycling, etc. is prohibited during this time! We recommend that you use a cross trainer or stepper if you would like to exercise during this period. With these, the leg position is somewhat wider so that no friction occurs.

When can I resume swimming?
You should avoid the chlorine-treated water in public swimming pools for six weeks. You are allowed to swim again in a lake or the sea after 4 weeks.

When can I resume sex?
During the first 6 weeks after surgery, sexual intercourse should strictly be avoided, as the significant friction would open up the wound edges again. As long as the sutures are not perceived as a problem, you can have oral sex again 4 weeks after surgery.

What can I do to promote healing?
Take the medications as prescribed by us. You will receive a pain killer that reduces the swelling plus an antibiotic. Please avoid any kind of friction for at least 6 six weeks after surgery! To ensure good healing, please place a compress between the labia during the first 2 weeks after surgery so that they do not touch each other. Then, you should start squeezing the labia between your index finger and thumb over their entire course, even if it is painful. In doing so, you promote scar healing and accelerate the time it takes for the swelling to subside. You should do this 2-3 times daily over a period of four weeks. We will show you exactly how to do this on the day of your first wound check.

Laser or scalpel?
We perform the procedure using a radiofrequency surgical device. Similar to a laser, the tissue is cut using thermal energy; however, the tissue is separated through contact between the wire and the skin, instead of a light beam. The advantage is that any trembling of the hand is not transferred to the incision line, as it is the case with laser. It is virtually impossible to perform this procedure using a scalpel, because, given the looseness of the tissue, a precise incision line cannot be achieved.

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