Dr. Soniya Chavan

What is a Labiaplasty?

Labiaplasty is a surgical procedure that corrects excessively long, enlarged or redundant labia minora tissue and can make the external genitalia (the “vulva”) more cosmetically appealing. Women with enlarged or elongated labia may feel very conscious when wearing tight clothing or swimwear, as the outline of the labia may be visible through the clothing. Enlarged labia may also cause women to feel self-conscious during intimate contact.  Some are concerned about asymmetry of their labias, or they may have pain or discomfort during sex or with exercise. Occasionally, redundant labia tissue predisposes to yeast infections or creates friction tears of the tissue.

During a labiaplasty, excess or stretched-out labia minora tissue is excised to create a more neat and tidy appearance to this region and to treat associated physical concerns. Occasionally excess tissue around the clitoral hood is also carefully trimmed as part of the procedure.

Who is a Good Candidate for Labiaplasty?

Labiaplasty is a personal procedure that should certainly not be associated with embarrassment or shame. Women of all backgrounds, shapes, sizes and cultures seek labiaplasty. Sometimes after childbearing, labial tissue can become stretched out or redundant, and following menopause the vulvar lips can droop with loss of collagen and elastin. Many women are congenitally born with asymmetric or excess labial tissue.

Women who experience awkwardness, pain with intercourse, or discomfort when walking or with exercise due to excess labia tissue are candidates for a labiaplasty. Other women are simply looking to improve the appearance of this part of their body to look as youthful as they feel. Rejuvenation of the labia area can be an empowering experience, potentially improving a woman’s body image, self-esteem and comfort during intimacy.

Can Labiaplasty Be Done Before Pregnancy?

A labiaplasty can certainly be performed at any time in a woman’s life. Labiaplasty is considered a “quality of life” procedure, and is a personal decision. Having surgery will in no way influence future pregnancies or childbirth delivery options.

What Are the Different Types of Labiaplasty?

Labia Minora Reduction

A labiaplasty usually involves trimming the inner lips of the labia, known as the “labia minora”. Only the inner or outer lips of the vulva are treated; the vagina is not normally addressed during a labiaplasty.

Labia Majora Reduction

Occasionally, the outer lips of the genitalia (“labia majora”) are trimmed to additionally reduce their prominence. This procedure involves incisions in the skin of the labia majora and is associated with-potentially additional scars and post-surgical swelling during healing.

Clitoral Hood Reduction

For women with redundant clitoral hood tissue, a reduction of the clitoral hood can also be performed as part of a labiaplasty. Clitoral hood reduction involves careful trimming of excess skin that hangs over the clitoris. The overlying skin is then rearranged without risking nerve injury or affecting sexual sensation or stimulation.

Labiaplasty procedure

In order to ensure complete comfort and relaxation, we perform labiaplasty as an Day care procedure in the operating room, under a short and safe general anesthesia or under local anesthesia. Local anesthetic is used to prevent bleeding and bruising during surgery, and to keep the area numb for many hours after surgery. Excess labial tissue is trimmed, the clitoral hood is reduced if appropriate, and a neat and tidy closure is performed in multiple layers using dissolving (absorbable) sutures. Antibiotic ointment is applied, and an absorbable pad is placed over the incisions. Surgery takes around 1-2 hours to complete, and women are allowed to return home a few hours after awakening.

Types of Labiaplasty

Wedge Labiaplasty

Many surgeons these days are performing wedge labiaplasty, for two main reasons:

A wedge of tissue is removed from the middle area of the labia, preserving the natural labial edge for a less obviously surgical look.

The wedge method leaves a shorter scar that’s harder to see because it runs across the labia rather than along the edge.

However, there are some potential drawbacks to this approach. The wedge technique generally only addresses the middle one third of the labia and does not treat the irregular dark hyperpigmented edge of the posterior parts of the labia. It also does not treat excessive clitoral hood tissues which commonly accompany prominent labia minora.

In addition, the wedge technique creates a condition where the amount of tissue resected must be balanced against creating wound tension with closure. Excising too much tissue may result in a potential for wound separation, whereas conservative resection may produce insufficient reduction. It takes an experienced surgeon to advise you on the anticipated results.

Trim Labiaplasty

Until recently, trim labiaplasty was the go-to choice for women who wanted to improve the appearance of their labia. This method, as the name implies, involves trimming the excess labia tissue to a more proportionate size and shape relative to the rest of the vaginal area. Many women appreciate that the trim method removes the existing edges of the inner labia, which can darken with age or following pregnancy.

The tissue is typically excised from the clitoral hood and along the edge of the labia minora to the vaginal forchette. In this manner, excess tissue from the upper, middle and lower one/thirds of the inner lips can be removed.

The trim technique leaves a longer scar but it is tension free and commonly is barely visible. Unlike the wedge, wound separation is less likely.

An irregular, thickened and darkened edge is what leads so many of our patients to choose trim labiaplasty as their preferred approach. For those with excess tissue limited to the mid portions of the labia only, the wedge method is an excellent option.

Wedge vs. Trim: Which Is Best?

Both procedures accomplish the primary goal of labia reduction just fine. The question of which labiaplasty technique will give you better results depends on your unique anatomy and your personal goals for surgery.

What is the Recovery After Labiaplasty?

Mild discomfort is treated with oral pain medication for a few days. Swelling and bruising of the genital region can develop over the first few days. You may shower the next day, and will apply antibiotic ointment daily. If you start your menstrual cycle, it is recommended you avoid using tampons for your next 1-2 cycles to avoid irritation of the incisions while they are healing.

At least couple of days should be taken off work or arrange to work from home during this time. Aggressive physical activity should be avoided for at least a week or two after surgery. Sexual intercourse should be avoided for approximately 6 weeks after a labiaplasty. By week 6 to 8, the healing is complete, and no restrictions are needed.

Like any surgery, it takes at least 6 weeks for the initial swelling to recede, and 6 months up to a year for the results to be absolutely complete. Incisions are hidden in the natural crease of the labia region. There is usually very little scarring, as incisions are made in the labial “mucosa” (similar to the inside of the mouth or the gums) rather than the skin.

Possible Complications of Surgery

Some complications associated with labiaplasty are specific to this procedure, while others are complications that could be encountered as a result of any cosmetic surgery, or any surgical procedure in general. Complications common to nearly all surgical procedures include bleeding, bruising, swelling, infection, and scarring. Since labiaplasty is often performed under local anesthetic and sedation rather than general anesthetic, the risks are somewhat less than with more invasive surgical procedures.

Procedure specific complications include Loss of sensation, Spotting, Difficulty urinating ,Change in pigmentation, Asymmetrical results after full healing has occurred ,Separation of the incision site; this occurs in roughly five percent of wedge labiaplasty patients, but is easily to correct. The majority of these symptoms will also be temporary, and resolve within a few days to a few weeks depending on the individual symptom and how quickly your healing progresses.

Will the procedure affect my fertility?

No, the procedure will have no affect on your ability to have children. However, you should use contraception to avoid pregnancy before and after the procedure. Your surgeon will cancel your procedure if you are pregnant on the appointed day. After surgery, you should avoid giving birth for one year following the procedure. As a normal delivery would stretch the tissue and damage the results achieved.

Will there be scarring?

There is usually evidence of scarring following surgical incisions. Your surgeon will try to make the incisions in the least conspicuous areas so that the scarring may be virtually invisible. Even visible scarring will tend to fade over time.

Will labiaplasty affect my sensitivity?

Sensitivity typically stays the same after labiaplasty when done right. After recovery, sexual intercourse is often more enjoyable, because patients feel more confident without the excess skin.

Diabetes is a long term disease. Homeopaths resorts to different approaches towards diabetes. When the blood sugar level is very high, the priority is to control it. There are homeopathic remedies that could reduce the sugar. Another approach is to understand the patient’s profile through a patho- physiological profiling and resort to treatment of his illness. There is yet another approach to understand the patient in depth through a detailed case taking, crate a profile at his physical, mental, social and spiritual level (holistic approach) and then select a constitutional remedy. Each of these approach has its own scope and limitations. The physician has to take a decision as to what approach is needed on a patient depending on his general health, progress of disease, complications, the organs affected etc. Here’s discussing the four approaches:

1) Management of blood sugar
The commonly used remedies are uranium nitricum, phosphoric acid, syzygium jambolanum, cephalandra indica etc. These are classical homeopathic remedies. These are used in physiologically active doses such as mother tincture, 3x etc. Depending up on the level of the blood sugar and the requirement of the patient.

Several pharmaceutical companies have also brought in propriety medicines with a combination of the few homeopathic medicines. Biochemic remedies which is a part of homeopathy advocates biocombination no 7 as a specific for diabetes. Another biochemic medicine natrum phos 3x is widely used with a reasonable success in controlling the blood sugar. Scientific studies on the impact of homeopathic medicines in bringing down blood sugar are limited, but many of the above remedies have some positive effects either as a stand-alone remedy or as an adjunct along with other medications.

2) Holistic as well as individualistic approach in medicine through homeopathy

This is a unique concept in homeopathy. Even though it may sound strange, homeopathy does not treat pathological effect of the disease per se. A homoeopath treats the patient taking into consideration the mental, emotional and physical peculiarities of the person who is afflicted with pathological state. He considers diseases are a mere deviation in life force and make efforts to correct this aberration. Homeopathy regards health as a state of balancing the equilibrium of the life force and the physicians’ duty is to support the individual to maintain a harmony in health (promotive health), restore the sick to health through a rational medication (curative health) and prevent diseases whereever needed (preventive health). There is a defined philosophical approach in each of the above areas and therefore homeopathy in true sense is called holistic system of medicine. It is also known as experienced medicine because all the medicines that are used on the patients are subjected to human trial and assured of its safety even in infants. The medicines are being used for over two centuries and not even one instance of adverse drug reaction has ever been reported.

3) Constitutional treatment
Hahnemann who published his work on chronic diseases and its cure advises to give more importance to the patients past and family history to understand the genesis of illness and to prescribe constitutional medication. In the modern terminology this could be said as the genetic preponderance or modification due to the patient’s life style or circumstances or due to suppression of illness in the past. The homeopaths, therefore take long hours to understand the patient’s history to understand the constitution, temperament, history of suppression etc to arrive on a constitutional medication. This approach is unique to homeopathy and a little time consuming. It also require extreme skill, perseverance, knowledge and experience. Constitutional remedies acts deeper into the system and correct the inherent disorder of the individual. Thus the constitutional remedy not only cures the disease, but improves individual’s health in general. If patients with diabetes take his constitutional remedy, it will not only help to control his sugar metabolic process, but also the tissue to absorb and assimilate the sugar and try to make other organs function perfectly.

4) Promotive approach to diabetes.
Type 2 diabetes can be prevented by lifestyle modifications. Some of the easy tips are:

Eat small meals every 2-3 hours regularly instead of consuming large meals. Prefer to steam your vegetables rather than fry them. Reduce the consumption of sugar, alcohol and fatty foods in your diet

Eat fiber rich foods like whole grains, pulses and reduce your intake of oil. Avoid fried foods.

The lifestyle modifications that can be followed by everyone are regular exercise for at least half an hour. Prefer to climb stairs rather than using elevators or escalators unless there is any heart ailments. Avoid sitting in same position for longer duration at your workplaces. Take short breaks. Practice yoga at home in case it is not possible to go outdoors and indulge in household chores in order to keep yourself active and fit.

Even a patient who is suffering from type ii diabetes can follow life style medications and resort to regular medications under strict supervision of a qualified homeopath, will escape the serious complications of diabetes and keep his disease under control.

Tuberculosis is widely known as a disease that affects the lungs. Tuberculosis is an infection caused by a bacteria called Mycobacterium tuberculosis. Although most commonly the lungs and bowel are affected, it can affect any organ in the body including the bones and joints .

How and who:

Tubercular bacteria usually enter the body through the airway into lungs or through the gut and spread out to different areas of the body through the blood stream, spine being the most common area. They can stay dormant in the body for many years and start multiplying when the immunity goes down due to any reason. So those with reduced immunity like young kids, old age group, diabetics, those on steroid medication or other immune-suppressive medication are at a high risk of developing tuberculosis of various organs. Patients affected with HIV are also at high risk of developing tubercular infection. But it is not uncommon to see a healthy young person affected with tuberculosis of spine.

Disease manifestations:

Spine is one of the very common structures affected by tuberculosis, leading to significant disability and high risk of paralysis if undetected in the early stages. As the bones in the spine get destroyed by the disease, the spine bends abnormally at the affected level and a deformity develops. There is pus formation at the affected area which can cause compression on the spinal cord and nerves in the spinal canal and lead to paralysis of limbs and loss of bowel and bladder control. Tuberculosis of spine can affect all age groups from infancy to old age.

Spine tuberculosis initially causes pain in the back/neck, which gets worse on movements and while changing posture. Night pains that wake the patient up from sleep is another characteristic feature. Fever, weight loss and loss of appetite are usually associated. Weakness of limb muscles can lead to unstable gait and tendency to fall and the patient usually seeks a support to hold on to while walking.

Diagnosis and treatment:

With MRI being available widely, spinal tuberculosis is being detected at early stages now as compared to X-rays. Most of them can be cured well by anti-tubercular medication (ATT). The medication needs to be taken for a long duration (minimum of 6 months - upto 18 months). Drug resistance is a serious problem needing second line medicines and is more difficult to treat. There are special tests like Gene Xpert available now to detect multiple drug resistant tuberculosis.

In some patients with deformity in spine or those with spinal cord compression causing paralysis, surgery to stabilise the spine and decompress the spinal cord/nerves is required. Surgical treatment in right time can prevent spinal deformity/paralysis and help in faster and better recovery of muscle power in those who have developed paralysis.

So, any persistent back pain needs an evaluation by a Spine physician.