Labiaplasty

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Labiaplasty
Labioplasty and Clitoral Hood Reduction.jpg
Result of labiaplasty (top, left-before then right-after) in combination with clitoral hood reduction (bottom)

Labiaplasty (also known as labioplasty, labia minora reduction, and labial reduction) is a plastic surgery procedure for creating or altering the labia minora (inner labia) and the labia majora (outer labia), the folds of skin of the human vulva. It is a type of vulvoplasty. There are two main categories of women seeking cosmetic genital surgery: those with conditions such as intersex, and those with no underlying condition who experience physical discomfort or wish to alter the appearance of their vulvas because they believe they do not fall within a normal range. [1]

Contents

The size, colour, and shape of labia vary significantly, and may change as a result of childbirth, aging, and other events. [1] Conditions addressed by labiaplasty include congenital defects and abnormalities such as vaginal atresia (absent vaginal passage), Müllerian agenesis (malformed uterus and fallopian tubes), intersex conditions (male and female sexual characteristics in a person); and tearing and stretching of the labia minora caused by childbirth, accident, and age. In a male-to-female sexual reassignment vaginoplasty for the creation of a neovagina, labiaplasty creates labia where once there were none.

A 2008 study reported that 32 percent of women who underwent the procedure did so to correct a functional impairment; 31 percent to correct a functional impairment and for aesthetic reasons; and 37 percent for aesthetic reasons alone. [2] According to a 2011 review, overall patient satisfaction is in the 90–95 percent range. [3] Risks include permanent scarring, infections, bleeding, irritation, and nerve damage leading to increased or decreased sensitivity. A change in requirements of publicly funded Australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the number of surgeries performed. [4] Unlike public hospitals, cosmetic surgeons in private practice are not required to follow these rules, and critics say that "unscrupulous" providers are charging to perform the procedure on women who would not want it if they had more information. [4]

Images of vulvae are absent from the popular media [5] [6] and advertising [7] [8] : 19  and do not appear in some anatomy textbooks, [9] while community opposition to sex education [10] [11] limits the access that young women have to information about natural variation in labias. [12] Many women have limited knowledge of vulval anatomy, and are unable to say what a "normal" vulva looks like. [13] : 6  [14] [15] [16] At the same time, many pornographic images of women's genitals are digitally manipulated, changing the size and shape of the labia to fit with the censorship standards in different countries. [12] [17] [18] [19] Medical researchers have raised concerns about the procedure and its increasing prevalence rates, with some speculating that exposure to pornography images on the Internet may lead to body image dissatisfaction in some women. [20] Although it is also suggested that evidence for this is lacking, [20] the National Health Service stated that some women bring along advert or pornographic images to illustrate their desired genital appearance. [21] [22]

Size of the labia

The individual size, coloration and shapes of the labia minora are subject to significant variability between women. The labia minora are completely covered by the labia majora in some women in a standing posture, while in others they protrude visibly from the pubic cleft. Labia minora variation.jpg
The individual size, coloration and shapes of the labia minora are subject to significant variability between women. The labia minora are completely covered by the labia majora in some women in a standing posture, while in others they protrude visibly from the pubic cleft.

The external genitalia of a woman are collectively known as the vulva. This comprises the labia majora (outer labia), the labia minora (inner labia), the clitoris, the urinary meatus, and the vaginal opening. The labia majora extend from the mons pubis to the perineum.

The size, shape, and color of women's inner labia vary greatly. [23] One is usually larger than the other. They may be hidden by the outer labia, or may be visible, and may become larger with sexual arousal, sometimes two to three times their usual diameter. [24]

The size of the labia can change because of childbirth. Genital piercings can increase labial size and asymmetry, because of the weight of the ornaments. In the course of treating identical twin sisters, S.P. Davison et al reported that the labia were the same size in each woman, which indicated genetic determination. [25] In or around 2004, researchers from the Department of Gynaeology, Elizabeth Garret Anderson Hospital, London, measured the labia of 50 women between the ages of 18 and 50, with a mean age of 35.6: [1]

Measurements Mean [ standard deviation ]
Clitoral length (mm)5.0 – 35.019.1 [8.7]
Clitoral glans width (mm)3.0 – 10.05.5 [1.7]
Clitoris to urethra (mm)16.0 – 45.028.5 [7.1]
Labia majora length (cm)7.0 – 12.09.3 [1.3]
Labia minora length (mm)20 – 10060.6 [17.2]
Labia minora width (mm)7.0 – 50.021.8 [9.4]
Perineum length (mm)15.0 – 55.031.3 [8.5]
Vaginal length (cm)6.5 – 12.59.6 [1.5]
Tanner Stage (n)IV4.0 (8%)
V46 (92%)
Color of the genital area

compared to the surrounding skin (n)

Same color9 (18%)
Darker color41 (82%)
Rugosity of the labia (n)Smooth (unwrinkled)14 (28%)
Moderately wrinkled34 (68%)
Markedly wrinkled2 (4%)

Surgery

Contraindications

Labia reduction surgery is relatively contraindicated for the woman who have active gynecological disease, such as an infection or a malignancy; the woman who is a tobacco smoker and is unwilling to quit, either temporarily or permanently, in order to optimize her wound-healing capability; and the woman who is unrealistic in her aesthetic goals. The latter should either be counselled or excluded from labioplastic surgery. Davison et al write that it should not be performed when the patient is menstruating to reduce potential hormonal effects and the increased risk of infection. [25]

Sex reassignment surgery

In sexual reassignment surgery, in the case of the male-to-female transgender patient, labiaplasty is usually the second stage of a two-stage vaginoplasty/vulvoplasty operation, where labiaplastic techniques are applied to create labia minora and a clitoral hood. In this procedure, the labiaplasty is usually performed some months after the first stage of vaginoplasty.

Anaesthesia

Labial reduction can be performed under local anaesthesia, conscious sedation, or general anaesthesia, either as a discrete, single surgery, or in conjunction with another, gynecologic or cosmetic, surgery procedure. [26] The resection proper is facilitated with the administration of an anaesthetic solution (lidocaine + epinephrine in saline solution) that is infiltrated to the labia minora to achieve the tumescence (swelling) of the tissues and the constriction of the pertinent labial circulatory system, the hemostasis that limits bleeding. [25]

Procedures

Edge resection technique

Schamlippenreduktion 1.jpg
Schamlippenreduktion 2.jpg
Full ablation of the inner labia by use of the trim- (edge resection-) technique, that results in no protuberance of labial tissue

The original labiaplasty technique was simple resection of tissues at the free edge of the labia minora. One resection-technique variation features a clamp placed across the area of labial tissue to be resected, in order to establish hemostatis (stopped blood-flow), and the surgeon resects the tissues, and then sutures the cut labium minus or labia minora. This procedure is used by most surgeons because it is easiest to perform. The technical disadvantages of the labial-edge resection technique are the loss of the natural rugosity (wrinkles) of the labia minora free edges, thus, aesthetically, it produces an unnatural appearance to the vulva, and also presents a greater risk of damaging the pertinent nerve endings. Moreover, there also exists the possibility of everting (turning outwards) the inner lining of the labia, which then makes visible the normally hidden internal, pink labial tissues. The advantages of edge-resection include removal of the hyper-pigmented (darkened) irregular labial edges with a linear scar. Another disadvantage of the trim or "amputation" method, is that it is unable to excise redundant tissues of the clitoral hood, when present. [27] [28] [29] [30] [31] [32] Complete amputation of the labia minora is more common with this technique, which often requires additional surgery to correct. In addition, the trim method does not address the clitoral hood. Clitoral hood deformities are common with this approach, again requiring additional corrective surgery. Some women complain of a "small penis" when the trim procedure is performed, owing to the un-addressed clitoral hood tissue and completely removed (amputated) labia minor. [33] Most plastic surgeons do not perform this procedure, and instead favor the extended wedge approach, which is technically more demanding, but produces a more natural result and is able to create a natural and proportioned appearance to the vulva. [34] Reconstructive procedures are often required after the trim (amputation) labiaplasty. [35]

Central wedge resection technique

Labial reduction by means of a central wedge-resection involves cutting and removing a partial-thickness wedge of tissue from the thickest portion of the labium minus. [28] Unlike the edge-resection technique, the resection pattern of the central wedge technique preserves the natural rugosity ("wrinkled" edge) of the labia minora. If performed as a full-thickness resection, there exists the potential risk of damaging the pertinent labial nerves, which can result in painful neuromas, and numbness. A partial thickness removal of mucosa and skin, leaving the submucosa intact, decreases the risk of this complication. F. Giraldo et al. procedurally refined the central wedge resection technique with an additional 90-degree Z-plasty technique, which produces a refined surgical scar that is less tethered, and diminishes the physical tensions exerted upon the surgical-incision wound, and, therefore, reduces the likelihood of a notched (scalloped-edge) scar. [28] [36] The central wedge-resection technique is a demanding surgical procedure, and difficulty can arise with judging the correct amount of labial skin to resect, which might result in either undercorrection (persistent tissue-redundancy), or the overcorrection (excessive tension to the surgical wound), and an increased probability of surgical-wound separation. The benefit of this technique is that an extended wedge can be brought upwards towards the prepuce to treat a prominent clitoral hood without a separate incision. [35] This leads to a natural contour for the finished result, and avoids direct incisions near the highly-sensitive clitoris.

De-epithelialization technique

Labial reduction by means of the de-epithelialization of the tissues involves cutting the epithelium of a central area on the medial and lateral aspects of each labium minus (small lip), either with a scalpel or with a medical laser. This labiaplasty technique reduces the vertical excess tissue, whilst preserving the natural rugosity (corrugated free-edge) of the labia minora, and thus preserves the sensory and erectile characteristics of the labia. Yet, the technical disadvantage of de-epithelialization is that the width of the individual labium might increase if a large area of labial tissue must be de-epithelialized to achieve the labial reduction. [37]

Labiaplasty with clitoral unhooding

Labiaplasty with clitoral hood reduction and Princess Albertina piercing 1.jpg
Labiaplasty with clitoral hood reduction and Princess Albertina piercing 2.jpg
Labiaplasty with clitoral unhooding (with genital piercings)

Labial reduction occasionally includes the resection of the clitoral hood when the thickness of its skin interferes with the woman's sexual response or is aesthetically displeasing. [33] [34]

The surgical unhooding of the clitoris involves a V–to–Y advancement of the soft tissues, which is achieved by suturing the clitoral hood to the pubic bone in the midline (to avoid the pudendal nerves); thus, uncovering the clitoris further tightens the labia minora. [35]

Laser labiaplasty technique

Labial reduction by means of laser resection of the labia minora involves the de-epithelialization of the labia. The technical disadvantage of laser labiaplasty is that the removal of excess labial epidermis risks causing the occurrence of epidermal inclusion cysts. [38]

Labiaplasty by de-epithelialization

Labial reduction by de-epithelialization cuts and removes the unwanted tissue and preserves the natural rugosity (wrinkled free-edge) of the labia minora, and preserves the capabilities for tumescence and sensation. Yet, when the patient presents with much labial tissue, a combination procedure of de-epithelialization and clamp-resection is usually more effective for achieving the aesthetic outcome established by the patient and her surgeon. In the case of a woman with labial webbing (redundant folding) between the labia minora and the labia majora, the de-epithelialization labiaplasty includes an additional resection technique – such as the five-flap Z-plasty ("jumping man plasty") – to establish a regular and symmetric shape for the reduced labia minora. [25]

Post-operative care

Labiaplasty just after surgery by dr. oppenheimer.JPG
This photo demonstrates the appearance of the labia minora and clitoral hood just after surgery in the operative theater. Note that the inner labia are less prominent than before surgery.
Appearance of labia at 1 week postop from labiaplasty.JPG
This photo was taken one week after an extended wedge labiaplasty with clitoral hood reduction. The inner and outer labia can be seen as edematous, with the most swelling noticed in the clitoral hood area.

Post-operative pain is minimal, and the woman is usually able to leave hospital the same day. No vaginal packing is required, although she might choose to wear a sanitary pad for comfort. The physician informs the woman that the reduced labia are often very swollen during the early post-operative period, because of the edema caused by the anaesthetic solution injected to swell the tissues.

She is also instructed on the proper cleansing of the surgical wound site, and the application of a topical antibiotic ointment to the reduced labia, a regimen observed two to three times daily for several days after surgery. [25]

The woman's initial, post-labiaplasty follow up appointment with the surgeon is recommended within the week after surgery. She is advised to return to the surgeon's consultation room should she develop hematoma, an accumulation of blood outside the pertinent (venous and arterial) vascular system. Depending on her progress, the woman can resume physically unstrenuous work three to four days after surgery. To allow the wounds to heal, she is instructed not to use tampons, not to wear tight clothes (e.g. thong underwear), and to abstain from sexual intercourse for four weeks after surgery. [25]

Medical complications to a labiaplasty procedure are uncommon, yet occasional complications – bleeding, infection, labial asymmetry, poor wound-healing, undercorrection, overcorrection – do occur, and might require a revision surgery. An over-aggressive resection might damage the nerves, causing painful neuromas. Performing a flap-technique labiaplasty occasionally presents a greater risk for necrosis of the labia minora tissues. [25]

Criticism

Protest march in London opposing cosmetic labiaplasty surgery Muff March Harley Street 4.jpg
Protest march in London opposing cosmetic labiaplasty surgery

Labiaplasty is a controversial subject. Critics argue that a woman's decision to undergo the procedure stems from an unhealthy self-image induced by their comparison of themselves to the prepubescent-like images of women they see in commercials or pornography. [39]

In Australia, the Royal Australian College of General Practitioners has issued guidelines on referring patients with dissatisfaction with their genitals to specialists. [13] A change in requirements of publicly funded Australian plastic surgery requiring women to be told about natural variation in labias led to a 28% reduction in the numbers of surgeries performed. [4] Unlike public hospitals, cosmetic surgeons in private practise are not required to follow these rules, and critics say that "unscrupulous" providers are charging to perform the procedure on women who would not undergo it if they had more information. [4]

Increasing numbers of women in Western countries are also using Brazilian waxing to remove pubic hair, and choosing to wear tight-fitting swimwear and clothing. [13] [40] This has led to increased numbers of women complaining of pain and discomfort from chafing of the labia minora, as well as cosmetic concerns around how the appearance of genitals. [13] [41] [42] In many countries, media regulation classifies "hardcore" and "softcore" pornography – demanding that magazines with "hardcore" pornography be wrapped in black plastic and sold only to people over 18 who show photo ID. [17] [43] Sales of magazines in black plastic tend to be low, and thus many magazine publishers choose to comply with the "softcore" standards. [17] In Australian magazines, images of vulvas that do not look like "a single crease" are digitally modified to comply with the censorship standard. [17] An Australian pornographic actress says that images of her own genitals sold to pornographic magazines in different countries are digitally manipulated to change the size and shape of the labia according to censorship standards in different countries. [12] [18] [19] Community opposition to sex education [10] [11] limits the access that young women have to information about natural variation in labias. [12]

Linda Cardozo, a gynaecologist at King's College Hospital, London, told the newspaper that women were placing themselves at risk in an industry that is largely unregulated. Nina Hartley says that "she’s seen every type of vulva in her three decades working in the industry. When young women start out in porn, producers don’t send them off for a routine labiaplasty." [44]

Although female genital mutilation – the practice of cutting off a woman's labia and sometimes clitoris, and in some cases creating a seal across her entire vulva – is illegal across the Western world, Simone Davis, a professor and gender theorist at Mount Holyoke College in Massachusetts, argues that "when you really look carefully at the language used in some of those laws, they would also make illegal the labiaplasties that are being done by plastic surgeons in the U.S." [45] The World Health Organization (WHO) defines female genital mutilation as "all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons." [46] The WHO writes that the term is not generally applied to elective procedures such as labiaplasty. [47]

The American College of Obstetricians and Gynecologists (ACOG) published an opinion in the September 2007 issue of Obstetrics & Gynecology that several "vaginal rejuvenation" procedures were not medically indicated, and that there was no documentation of their safety and effectiveness. ACOG argued that it was deceptive to give the impression that the procedures were accepted and routine surgical practices. It recommended that women seeking such surgeries must be given the available surgical-safety statistics, and warned of the potential risks of infection, altered sensation caused by damaged nerves, dyspareunia (painful sexual intercourse), tissue adhesions, and painful scarring. [48]

In the UK, Lih Mei Liao and Sarah M. Creighton of the University College London Institute for Women's Health wrote in the British Medical Journal in 2007 that "the few reports that exist on patients' satisfaction with labial reductions are generally positive, but assessments are short-term and lack methodological rigour." They wrote that the increased demand for cosmetic genitoplasty (labiaplasty) may reflect a "narrow social definition of normal." The National Health Service performed double the number of genitoplasty procedures in the year 2006 than in the 2001–2005 period. The authors noted that "the patients consistently wanted their vulvas to be flat, with no protrusion beyond the labia majora ... some women brought along images to illustrate the desired appearance, usually from adverts or pornography that may have been digitally altered." [21] [22] The Royal Australian and New Zealand College of Obstetricians and Gynæcologists published the same concern about the exploitation of psychologically insecure women. [45]

The International Society for the Study of Women's Sexual Medicine produced a report in 2007 concluding that "vulvar plastic surgery may be warranted only after counseling if it is still the patient's preference, provided that it is conducted in a safe manner and not solely for the purpose of performing surgery". [49]

See also

Related Research Articles

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In amniotes, the clitoris is a female sex organ. In humans, it is the vulva's most erogenous area and generally the primary anatomical source of female sexual pleasure. The clitoris is a complex structure, and its size and sensitivity can vary. The visible portion, the glans, of the clitoris is typically roughly the size and shape of a pea and is estimated to have at least 8,000 nerve endings.

<span class="mw-page-title-main">Labia minora</span> Flaps of skin on either side of the vaginal opening in the vulva

The labia minora, also known as the inner labia, inner lips, or nymphae, are two flaps of skin that are part of the primate vulva, extending outwards from the inner vaginal and urethral openings to encompass the vestibule. At the glans clitoris, each labium splits, above forming the clitoral hood, and below the frenulum of the clitoris. At the bottom, the labia meet at the labial commissure. The labia minora vary widely in size, color and shape from individual to individual.

Genital modifications are forms of body modifications applied to the human sexual organs. When there's cutting involved, genital cutting or surgery can be used. The term genital enhancement seem to be generally used for genital modifications that modify the external aspect, the way the patient wants it. The term genital mutilation is used for genital modifications that drastically diminish the recipient's quality of life and result in adverse health outcomes, whether physical or mental.

<span class="mw-page-title-main">Female reproductive system</span> Reproductive system of female humans

The human female reproductive system is made up of the internal and external sex organs that function in the reproduction of new offspring. The reproductive system is immature at birth and develops at puberty to be able to release matured ova from the ovaries, facilitate their fertilization, and create a protective environment for the developing fetus during pregnancy. The female reproductive tract is made of several connected internal sex organs—the vagina, uterus, and fallopian tubes—and is prone to infections. The vagina allows for sexual intercourse, and is connected to the uterus at the cervix. The uterus accommodates the embryo by developing the uterine lining.

Feminizing Gender-affirming surgery for transgender women or transfeminine non-binary people describes a variety of surgical procedures that alter the body to provide physical traits more comfortable and affirming to an individual's gender identity and overall functioning.

Vaginoplasty is any surgical procedure that results in the construction or reconstruction of the vagina. It is a type of genitoplasty. Pelvic organ prolapse is often treated with one or more surgeries to repair the vagina. Sometimes a vaginoplasty is needed following the treatment or removal of malignant growths or abscesses to restore a normal vaginal structure and function. Surgery to the vagina is done to correct congenital defects to the vagina, urethra and rectum. It may correct protrusion of the urinary bladder into the vagina (cystocele) and protrusion of the rectum (rectocele) into the vagina. Often, a vaginoplasty is performed to repair the vagina and its attached structures due to trauma or injury.

<span class="mw-page-title-main">Labia</span> Parts of the vulva

The labia are the major externally visible structures of the vulva. In humans and other primates, there are two pairs of labia: the labia majora are large and thick folds of skin that cover the vulva's other parts, while the labia minora are the folds of skin between the outer labia that surround and protect the urethral and vaginal openings, as well as the glans clitoris.

<span class="mw-page-title-main">Vaginectomy</span> Surgical removal of the vagina

Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender-affirming surgery. Some people born with a vagina who identify as trans men or as nonbinary may choose vaginectomy in conjunction with other surgeries to make the clitoris more penis-like (metoidioplasty), construct of a full-size penis (phalloplasty), or create a relatively smooth, featureless genital area.

<span class="mw-page-title-main">Vulval vestibule</span> Part of the vulva that contains the openings

The vulval vestibule is the part of the vulva between the labia minora. At the innermost part are the vaginal introitus and urinary meatus. The Bartholin's and Skene's glands each have two openings to the vestibule on the inside. The outer edge, marked by a coloration difference in the tissues, is called Hart's line, named after David Berry Hart.

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<span class="mw-page-title-main">Clitoral hood reduction</span> Cosmetic surgical procedure

Clitoral hood reduction, also termed clitoral hoodectomy, clitoral unhooding, clitoridotomy, or (partial) hoodectomy, is a plastic surgery procedure for reducing the size and the area of the clitoral hood in order to further expose the glans of the clitoris.

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<span class="mw-page-title-main">Vulva</span> External genitalia of the female mammal

In mammals, the vulva comprises mostly external, visible structures of the female genitalia leading into the interior of the female reproductive tract. For humans, it includes the mons pubis, labia majora, labia minora, clitoris, vestibule, urinary meatus, vaginal introitus, hymen, and openings of the vestibular glands. The folds of the outer and inner labia provide a double layer of protection for the vagina. Pelvic floor muscles support the structures of the vulva. Other muscles of the urogenital triangle also give support.

Clitoral photoplethysmography uses light to measure clitoral blood volume (CBV).

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References

Notes

  1. 1 2 3 Lloyd, Jillian; Crouch, Naomi S.; Minto, Catherine L.; Liao, Lih-Mei; Creighton, Sarah M. (May 2005). "Female genital appearance: "normality" unfolds". BJOG: An International Journal of Obstetrics & Gynaecology. 112 (5): 643–646. CiteSeerX   10.1.1.585.1427 . doi:10.1111/j.1471-0528.2004.00517.x. PMID   15842291. S2CID   17818072. Pdf.
  2. ↑ Miklos, John R.; Moore, Robert D. (June 2008). "Labiaplasty of the labia minora: patients' indications for pursuing surgery". Journal of Sexual Medicine . 5 (6): 1492–1495. CiteSeerX   10.1.1.486.7970 . doi:10.1111/j.1743-6109.2008.00813.x. PMID   18355172.
  3. ↑ Goodman, Michael P. (June 2011). "Female genital cosmetic and plastic surgery: a review". Journal of Sexual Medicine . 8 (6): 1813–1825. doi:10.1111/j.1743-6109.2011.02254.x. PMID   21492397.
  4. 1 2 3 4 "Women being 'upsold' into labiaplasty by cosmetic clinics, say health experts". The Sydney Morning Herald. 29 August 2015.
  5. ↑ "Honi Soit publishes vagina cover". Daily Life. Archived from the original on 23 March 2019. Retrieved 30 August 2015.
  6. ↑ "That's my vagina on honi soit (NSFW)". BIRDEE. 10 July 2017. Archived from the original on 2 March 2016. Retrieved 30 August 2015.
  7. ↑ Liao, L-M; Michala, L; Creighton, SM (January 2010). "Labial surgery for well women: a review of the literature". BJOG: An International Journal of Obstetrics & Gynaecology. 117 (1): 20–25. doi: 10.1111/j.1471-0528.2009.02426.x . PMID   19906048. S2CID   45078961.
  8. ↑ "Women and Genital Cosmetic Surgery" (PDF). Women's Health Issues Paper. Women's Health Victoria. February 2013. ISSN   1837-4417. Archived from the original (PDF) on 12 March 2018. Retrieved 30 August 2015.
  9. ↑ Andrikopoulou, M.; Michala, L.; Creighton, S.M.; Liao, L-M. (October 2013). "The normal vulva in medical textbooks". Journal of Obstetrics & Gynaecology . 33 (7): 648–650. doi:10.3109/01443615.2013.807782. PMID   24127945. S2CID   20545099.
  10. 1 2 Gilbert Herdt (1 June 2009). Moral panics, sex panics: fear and the fight over sexual rights. NYU Press. ISBN   978-0-8147-3723-1.
  11. 1 2 Irvine, Janice M. (September 2006). "Emotional scripts of sex panics". Sexuality Research and Social Policy. 3 (3): 82–94. doi:10.1525/srsp.2006.3.3.82. S2CID   144221306.
  12. 1 2 3 4 Marriner, Katy (2013). The Vagina Diaries - a study guide (PDF). Australian Teachers of Media - ATOM. ISBN   978-1-74295-374-8.{{cite book}}: |work= ignored (help)[ permanent dead link ]
  13. 1 2 3 4 "Female genital cosmetic surgery: A resource for general practitioners and other health professionals" (PDF). Royal Australian College of General Practitioners. July 2015. Archived from the original (PDF) on 24 September 2015. Retrieved 30 August 2015.
  14. ↑ Schober, Justine M.; Alguacil, Nieves Martin; Cooper, R. Scott; Pfaff, Donald W.; Meyer-Bahlburg, Heino F.L. (April 2015). "Self-assessment of anatomy, sexual sensitivity, and function of the labia and vagina". Clinical Anatomy. 28 (3): 355–362. doi:10.1002/ca.22503. PMID   25683213. S2CID   2202201.
  15. ↑ Schober, Justine M.; Meyer-Bahlburg, Heino F.L.; Ransley, Philip G. (September 2004). "Self-assessment of genital anatomy, sexual sensitivity and function in women: implications for genitoplasty". BJU International . 94 (4): 589–94. doi: 10.1111/j.1464-410X.2004.05006.x . PMID   15329118. S2CID   24224064.
  16. ↑ Howarth, Calida. "Neat, discreet and unseen – young women's views on vulval anatomy" (PDF).
  17. 1 2 3 4 The Labiaplasty Fad? - Sex. Hungry Beast . Australian Broadcasting Corporation. 15 April 2010. Archived from the original on 21 December 2021.
  18. 1 2 "Labiaplasty and Censorship - is there a link?". Mamamia. 25 November 2010.
  19. 1 2 "Blame it on the Brazilian". BIRDEE. 10 July 2017. Archived from the original on 4 March 2016. Retrieved 30 August 2015.
  20. 1 2 Davis, Rowenna (27 February 2011). "Labiaplasty surgery increase blamed on pornography". The Observer . Guardian Media Group.
  21. 1 2 Liao, Lih Mei; Creighton, Sarah M. (26 May 2007). "Requests for cosmetic genitoplasty: how should healthcare providers respond?". The British Medical Journal . 334 (7603): 1090–1092. doi:10.1136/bmj.39206.422269.BE. PMC   1877941 . PMID   17525451.
  22. 1 2 Banyard K (2010). The Equality Illusion: The Truth about Women and Men Today . Faber & Faber. p.  41. ISBN   978-0571258666.
  23. ↑ Masters, William H.; Johnson, Virginia E.; and Kolodny, Robert C. Human sexuality. HarperCollins College Publishers, 1995, p. 47.
  24. ↑ Sloane, Ethel. Biology of women. Cengage Learning, 2002, p. 32.
  25. 1 2 3 4 5 6 7 Davison S.P. et al. "Labiaplasty and Labia Minora Reduction", eMedicine.com, 23 June 2008.
  26. ↑ Nevárez Bernal, Roberto Armando; Meráz Ávila, Diego (June 2009). "Fusion of the labia minora as a cause of urinary incontinence in a postmenopausal woman: a case report and literature review". Ginecología y Obstetricia de México. 77 (6): 287–290. PMID   19681370. Original pdf of article (Spanish).
  27. ↑ Hodgkinson, Darryl J.; Hait, Glen (September 1984). "Aesthetic Vaginal Labioplasty". Plastic and Reconstructive Surgery . 74 (3): 414–6. doi:10.1097/00006534-198409000-00015. PMID   6473559. S2CID   43862052.
  28. 1 2 3 Alter, Gary J. (March 1998). "A new technique for aesthetic labia minora reduction". Annals of Plastic Surgery. 40 (3): 287–290. doi:10.1097/00000637-199803000-00016. PMID   9523614.
  29. ↑ Alter, Gary J. (June 2005). "Letters and viewpoints: Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora". Plastic and Reconstructive Surgery . 115 (7): 2144–2145. doi:10.1097/01.PRS.0000165466.99359.9E. PMID   15923876.
  30. ↑ Rouzier, Roman; Louis-Sylvestre, Christine; Paniel, Bernard-Jean; Haddad, Bassam (January 2000). "Hypertrophy of labia minora: experience with 163 reductions". American Journal of Obstetrics and Gynecology. 182 (1 Pt 1): 35–40. doi:10.1016/S0002-9378(00)70488-1. PMID   10649154.
  31. ↑ Alter, Gary J. (July 2007). "Aesthetic labia minora reduction with inferior wedge resection and superior pedicle flap reconstruction". Plastic and Reconstructive Surgery . 120 (1): 358–9, author reply 359–60. doi: 10.1097/01.prs.0000264588.97000.dd . PMID   17572600.
  32. ↑ Maas, Sylvester M.; Hage, J. Joris (2000). "Functional and aesthetic labia minora reduction". Plastic & Reconstructive Surgery . 105 (4): 1453–6. doi:10.1097/00006534-200004040-00030. PMID   10744241.
  33. 1 2 Hamori, Christine A. (1 September 2013). "Postoperative clitoral hood deformity after labiaplasty". Aesthetic Surgery Journal . 33 (7): 1030–1036. doi: 10.1177/1090820X13502202 . PMID   24005612.
  34. 1 2 Hunter, John G. (1 September 2013). "Commentary on: postoperative clitoral hood deformity after labiaplasty". Aesthetic Surgery Journal . 33 (7): 1037–1038. doi: 10.1177/1090820X13503476 . PMID   24081697.
  35. 1 2 3 Alter, Gary J. (December 2008). "Aesthetic labia minora and clitoral hood reduction using extended central wedge resection". Plastic and Reconstructive Surgery . 122 (6): 1780–1789. doi:10.1097/PRS.0b013e31818a9b25. PMID   19050531. S2CID   39680737.
  36. ↑ Giraldo, Francisco; González, Carlos; de Haro, Fabiola (May 2004). "Central wedge nymphectomy with a 90-degree Z-plasty for aesthetic reduction of the labia minora". Plastic and Reconstructive Surgery . 113 (6): 1820–1825, discussion 1826–1827. doi:10.1097/01.PRS.0000117304.81182.96. PMID   15114151. S2CID   31285182.
  37. ↑ Choi, Hee Youn; Kim, Kyung Tai (January 2000). "A new method for aesthetic reduction of labia minora (the deepithelialized reduction labioplasty)". Plastic & Reconstructive Surgery . 105 (1): 419–422, discussion 423–424. doi:10.1097/00006534-200001000-00070. PMID   10627011. S2CID   20089801.
  38. ↑ Pardo, J.; Solà, V.; Ricci, P.; Guilloff, E. (April 2006). "Laser labioplasty of labia minora". International Journal of Gynaecology and Obstetrics. 93 (1): 38–43. doi:10.1016/j.ijgo.2006.01.002. PMID   16530764. S2CID   35056032.
  39. ↑ Veale, D. and Neziroglu, F. Body Dysmorphic Disorder: A Treatment Manual. John Wiley and Sons, 2010, p. 104.
  40. ↑ "Labiaplasty surgery on the rise in Australia but a backlash looms". Daily Life. Archived from the original on 17 October 2016. Retrieved 30 August 2015.
  41. ↑ Cornwall, Deborah (10 October 2014). "Designer vaginas: Pubic hair removal leading to increased requests for labiaplasties, doctors warn". ABC News.
  42. ↑ "The rise of labiaplasty". The Glow. 26 December 2015.
  43. ↑ Mia Freedman (30 November 2009). "Genital surgery. Two words you don't want to read in the same sentence". Mamamia.
  44. ↑ Hess, Amanda. "Insecure About Your Vagina?", Slate , 20 February 2013.
  45. 1 2 Cormier, Zoe (Fall 2005). "Making the cut". Shameless. Archived from the original on 3 October 2011.
  46. ↑ "Female genital mutilation", World Health Organization, February 2010.
  47. ↑ "Eliminating Female Genital Mutilation", World Health Organization, 2008.
    • For a discussion of elective procedures and their relationship to FGM, see Annex 2, p. 24.
  48. ↑ ACOG Office of Communications (1 September 2007). "ACOG press release: ACOG advises against cosmetic vaginal procedures due to lack of safety and efficacy data". acog.org. American College of Obstetricians and Gynecologists. Archived from the original on 21 October 2011.
  49. ↑ Goodman, Michael P.; et al. (March 2007). "Is elective vulvar plastic surgery ever warranted, and what screening should be conducted preoperatively?". Journal of Sexual Medicine . 4 (2): 269–276. doi:10.1111/j.1743-6109.2007.00431.x. hdl: 2027.42/72245 . PMID   17367421. Archived from the original on 29 February 2016.

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