What is Labial Hypertrophy?: Causes, Symptoms and Treatment

Labial hypertrophy is a harmless condition that occurs in females. It is a condition in which one or both sides of vaginal lips abnormally increase in size. Two pairs of skin folds are in the vulva (external female genital) including labia majora (big outer folds) and labia minora (tiny inner folds). In labial hypertrophy, the inner labia are frequently affected compared to the outer labia.

Most females with labial hypertrophy do not experience any symptoms. However, in some cases, labial hypertrophy may be uncomfortable, and the following signs and symptoms of labial hypertrophy may be noted:

1. Labial pain, discomfort and irritation when wearing tight clothing such as bathing suits or tights.
2. Discomfort during exercise or sexual intercourse is caused by friction against the excess tissues.
3. Hygiene problems: bigger labia can make it difficult to use tampons or menstrual cups.
4. Recurring chronic infections: difficulty in cleaning the genital area can lead to bacterial infections.

Just like everyone has different facial features or sizes of any body part, there is no such thing as the correct size or shape of labia. The exact cause of why the labia grow bigger isn't clear. However, some of the possible causes of labial hypertrophy include:

1. Genetic factors: some people are born with large or differently shaped labia.
2. Hormonal events: the labia may change in size during puberty as oestrogen, and other female hormones increase.
3. Ageing: growing old may lead to Labial Hypertrophy.
4. Restrictive clothing: regularly wearing tight clothing against labia can change the size of labia.
5. Active cycling: females who do regular cycling or are competitive bicycle riders may experience repeated trauma to the external genital area leading to the development of the condition.

The following are the probable risk factors for labial hypertrophy that might put the patient at a higher chance of developing the disease: 

1. Family history
2. Active cycling
3. Regular sexual intercourse
4. Wearing tight-fitted clothing
5. Not keeping genital hygiene

There might not be a proven way to prevent labial hypertrophy. However, some of the below-mentioned measures can help reduce the risk of labial hypertrophy.

1. Wear loose-fitted and breathable clothing
2. Use lubricants during sexual intercourse
3. Use padded seats while cycling or seating for a longer period
4. Maintain good hygiene of the external genital area

The primary care specialist will generally be able to diagnose labial hypertrophy by a physical examination. In addition to the physical examination, the doctor may also recommend following additional tests to diagnose labial hypertrophy.

1. Pelvic examination: A pelvic exam may be used to search for skin changes and analyse the region of pain.
2. Cotton swab test: The Doctor may use a swab to press on several places while asking the patient to rate their pain.
3. Blood tests: To find oestrogen, progesterone, and testosterone levels.
4. Culture tests: This test is performed to find sources like bacteria and yeast responsible for Labial Hypertrophy.
5. Biopsy: A painkiller is used to numb the vaginal area, and a small amount of tissue is extracted for examination under a microscope.

How to prepare for the doctor's consultation?

1. List down symptoms including any that may seem unrelated to the condition.
2. List down the relevant events that may be related to the condition.
3. The patient must tell the doctor the list of medications and supplements that she takes.
4. The following questions should be asked the doctor:
   1. What treatment is best suitable for me?
   2. How can I stay comfortable in this condition?
   3. Do you think I have any other conditions?
   4. Do I need to see a specialist for my condition?
   5. Why is surgery needed?
   6. Can it be managed without surgery?
   7. The optimal time for surgery in my case?

Generally, treatment is not required if labial hypertrophy is not causing any problems with overall health. However, if the condition is causing discomfort and pain, a patient can take one of the following methods to treat labial hypertrophy:

Labial Hypertrophy treatment without surgery

Some lifestyle changes can be made to alleviate any discomfort or symptoms caused by labial hypertrophy. These include:

1. Using comfortable, breathable clothing and undergarments will support the external genital without creating excessive friction.
2. Using padded seats while sitting for a long period or cycling will add comfort.
3. Choosing unscented, natural personal hygiene products (tampons, pads or soaps) will help reduce the risk of irritation caused by the chemicals in the perfumes and dyes.
4. Over-the-counter medications can be prescribed by the doctor can also be consumed to manage pain and irritation.

Labial Hypertrophy treatment with surgery

For severe labial hypertrophy, the doctor may recommend the following procedure: 

1. Labiaplasty: A surgeon removes extra tissue during a labiaplasty. They restructure and shrink the size of the labia. This procedure is normally performed under general anaesthesia. However, it can also be performed under sedation and a local anaesthetic. It takes about 1 to 2 hours to complete the procedure. Several surgical techniques include:
   1. Direct excision (Trim Procedure): Tissues are removed, the form and texture of the labia minora are eliminated, and a scar may be visible after the surgery.
   2. Wedge resection: A V-shaped wedge is removed from low on the labia minora, and the margins are stitched together. This keeps the tissue's natural edge and gives them a better appearance.
   3. De-epithelialization: This approach is best for minimal hypertrophy since it eliminates only a tiny amount of tissue while maintaining the general shape of the labia minora.

Labial hypertrophy does not require treatment in the majority of cases. Therefore, it's not harmful in most cases if not treated in time. However, at times if it is untreated, the following risks and complications of labial hypertrophy may occur:

1. Scarring
2. Problems in wound healing 
3. Infection 
4. Decreased sexual activity as a result of nerve injury
5. Problems associated with general anaesthesia
6. Aesthetical problem with asymmetry

When to see a doctor?

The patient can consult the doctor if she experiences:

1. Pain
2. Discomfort
3. Irritation
4. Chronic infection

Dietary habits can also help reduce the risk of developing any disease condition. Below-mentioned is some dietary habits to keep in mind for patients with labial hypertrophy.

1. Drink plenty of fluids to prevent the development of infection in the genital area
2. Eat healthy fibre-rich food items
3. Avoid smoking
4. Avoid alcohol consumption
5. Avoid eating spicy food