Labial hypertrophy

The labia pudendi are divided into the labia majora and labia minora, which serve to protect the internal structures of the vulva, including the vestibule of the vagina and the urethral opening.

Hyperplasia is discussed when:

• the labia minora significantly protrude beyond the labia majora,
• there is asymmetry, thickening, or elongation,
• the tissues become excessively lax or stretched.

There is no single, fixed standard for the length or volume of the labia in medical literature. Increasingly, emphasis is placed on:

• the patient's subjective symptoms,
• the impact on daily and sexual functioning,
• the presence of dermatological or infectious complications.

Labial hypertrophy is not synonymous with pathology, but in certain cases, it may be an indication for conservative or surgical treatment.

The clinical presentation of labial hypertrophy is varied and depends on the type of structures involved. Most commonly observed are:

• elongation of the labia minora (unilateral or bilateral),
• distinct protrusion beyond the vulvar cleft,
• asymmetry – one labium significantly larger than the other,
• flaccidity, wrinkling, or excessive elasticity of the tissues,
• pigmentation changes of the skin in the vulvar area.

In some patients, the appearance is accompanied by functional symptoms such as:

• chafing and skin irritation,
• pain when wearing tight underwear or during cycling,
• discomfort or pain during intercourse,
• recurrent inflammations and intimate infections.

It is important to emphasize that appearance alone is not an indication for treatment if it does not cause discomfort or reduce the quality of life.

The etiology of labial hypertrophy is multifactorial and includes both congenital and acquired factors. The most common causes are: **Anatomical and Genetic Factors** - Individual vulvar anatomy, - Familial predispositions, - Developmental asymmetry. **Hormonal Changes** - Puberty, - Pregnancy and childbirth, - Menopause, - Prolonged fluctuations in estrogen levels. **Mechanical Factors** - Vaginal childbirth, - Intense physical activity (e.g., cycling, horseback riding), - Chronic tissue irritation. **Aging Processes** - Loss of collagen and elastin, - Sagging and stretching of the skin and subcutaneous tissue. **Inflammatory and Dermatological Factors** - Recurrent intimate infections, - Chronic inflammatory conditions of the vulva, - Dermatoses of the intimate area. In clinical practice, it is often observed that several mechanisms occur simultaneously.

Therapeutic management depends on the severity of symptoms, patient expectations, and the result of the gynecological examination. The following methods are distinguished:
 

Used for mild symptoms:

• proper intimate hygiene,
• avoiding irritating underwear and clothing,
• treatment of inflammations and infections,
• dermatological support for vulvar dermatoses.

Minimally invasive methods aimed at improving tissue tension and quality:

• laser procedures (tissue tightening and remodeling),
• monopolar and bipolar radiofrequency,
• therapies stimulating collagen remodeling.

These procedures can:

• reduce laxity,
• improve functional comfort,
• reduce irritation-related discomfort, however, they do not replace surgical treatment in cases of significant hypertrophy.

In clinically significant cases, labiaplasty, or surgical correction of the labia, is used. The procedure is performed for the following reasons:

• functional,
• health-related,
• psychosexual.

The decision for surgical treatment should be preceded by thorough qualification and the patient's informed consent.

Labia reduction procedures primarily involve surgical labioplasty techniques aimed at reducing excess tissue while maintaining the normal function and aesthetics of the vulva. In clinical practice, the following are used:

• wedge techniques,
• linear techniques,
• individually modified methods depending on the patient's anatomy.

The outcome of the procedure may include:

• reduction in the volume and length of the labia,
• improvement in symmetry,
• reduction of pain and irritation,
• enhancement of daily and sexual comfort.

Each case requires individual medical qualification, and the choice of method should be based on anatomical knowledge, the operator's experience, and the real needs of the patient.