Ow! My (nether) lips! Labiaplasty?

Dear Reader,

Any chronic discomfort with any part of your body, especially one as sensitive and intimate as the labia or vulva, can be frustrating and stressful. Each woman's labia (the "lips" of the vulva) are unique, and it sounds like your particular anatomy is causing you some pain. Surgery to shorten the labia — called labiaplasty — usually involves trimming "excess" tissues of the outer labia and is requested by women who have ruled out all other solutions with their health care provider.

Although plastic surgeons who perform this procedure report low rates of complications and side effects, ranging from three to five percent, the statistics have not been confirmed by any outside organization. The American College of Obstetricians and Gynecologists (ACOG) advises against cosmetic vaginal surgery, and states that "it is deceptive to give the impression that any of these procedures are accepted and routine surgical practices." ACOG recommends that women considering labiaplasty and other vulvar alterations be informed of the potential complications like infection, swelling, bruising, altered sensation, pain, scarring, blood clotting, skin loss, asymmetrical lips, and recurrence of labial growth.

A gynecological exam might be helpful in identifying anything besides length that might be contributing to your discomfort. When, where, and in what situations do you feel the most pain? Keeping a list or journal of your symptoms can help diagnose the problem. Noticing the type of pain you're experiencing can also help to determine the cause — for instance, dull pain, itching, redness, and hypersensitivity can each be indicative of different conditions. Many women have inner labia that are longer than the outer labia without experiencing pain; it's possible something other than the length of the labia is causing you pain. A visit to a health care provider can rule out conditions like infections or allergic reactions.

Although you say you're in pain no matter what you wear, it might be valuable to try measures other than surgery to ease your discomfort. If your labia get irritated from rubbing while walking or from wearing snug-fitting clothes, the culprit could be friction or an allergic reaction. It might help to try:

• Wearing looser-fitting clothing and underwear
• Sleeping without underwear
• Wearing un-dyed, 100 percent cotton underwear and avoiding wearing undergarments made of nylon or other synthetic fibers
• Washing your vulva gently with plain warm water
• Avoiding feminine hygiene sprays and deodorants, oils, bathing products, and/or talcum powder
• Using non-deodorant tampons instead of sanitary pads during your period
• Using plain, rather than flavored and/or scented, lubes, condoms, and/or dams
• Talking with your health care provider about vaginal moisturizers

A woman's genitals come in all different shapes and sizes, and throughout a woman's life can afford her incredible pleasure and also incredible pain. Hopefully some of these suggestions can help your labia fit more comfortably in your life, and tip the scales away from the pain end of the speculum, ahem, spectrum.