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Introduction
Vaginal labiaplasty has been described for the management of functional and aesthetic problems associated with protrusion of the labia minora. Despite a 44% increase in the number of procedures performed in 2013, there is a paucity of data to guide treatment paradigms. This systematic review aims to establish a simple, unifying classification scheme and make recommendations for standardized management of labial protrusion.
Methods
A systematic literature review was performed using the PubMed database. Additional articles were selected after reviewing references of identified manuscripts.
Results
The search returned 247 articles. After applying inclusion criteria to identify prospective and retrospective studies evaluating different techniques, outcomes, complications, and patient satisfaction, 21 articles were selected.
Labiaplasty of the labia minora was described in 1,949 patients. The most validated technique was wedge resection, which has been described in 6 studies (620 patients), yielding a 94.3% satisfaction rate and a 10.3% complication rate. The most common complications including all techniques were superficial infection (1.4%), wound dehiscence (1.2%), and hematoma (0.3%). Wedge resection technique had the highest rate of wound dehiscence (2.4%).
Discussion
Labiaplasty is safe and carries a high-satisfaction rate, but described techniques remain diverse. We propose a simplified classification system based on the distance of the lateral edge of the labia minora from that of the labia majora, rather than from the introitus. Labial protrusion is classified as Class I (0-2 cm), Class II (2-4 cm), and Class III (>4 cm).
Recommendations based on current practices include: 1) Lidocaine 1% with 1:100,000 epinephrine +/- monitored anesthesia 2) resection technique based on length of protrusion past the labia majora 3) resection not to exceed 1 cm from the introitus 4) resection should spare the fourchette to avoid distortion of the introitus 5) excision technique should be modified to address the clitorial hood based on patient anatomy and preference 6) two-layer closure to reduce wound complications 7) oral and topical antibiotics for 5 days post-operatively 8) abstinence of sexual intercourse for a minimum of 30 days to reduce risk of wound dehiscence.
Further randomized studies using a standardized classification system are required to better compare different techniques and establish best practices.