Many women are concerned about the size, shape and appearance of their inner labia. Each woman’s labia minora are unique! There is no typical shape of the inner labia. Some women have long inner labia, while others have only a thin ridge of labia minora tissue that is completely hidden by the outer labia. Both appearances are considered “normal”; Both are considered typical. Some women have asymmetry of the inner labia where one labia is long and the other is short. This can lead to protrusion of one side of the labia “poking out” from between the labia majora. Yet other women have a prominent clitoral hood where tissue is bunched up at the top of the vaginal cleft or vaginal opening. This can be from elongation of the clitoral hood tissue as well as the clitoris itself. Remember that the clitoris is not just a ball of tissue, but rather should be viewed as a shaft much like the shaft of a penis. There can be elongated and shortened clitoral shafts: most often the hood tissue corresponds to the clitoral length.
There are many terms used to describe the appearance of long labia. Some women feel that their inner labia look like “chicken skin” or that the labia look like “cauliflower” or similar terms. While I don’t use these words in my clinic, it can be helpful to know that all of these appearances are also normal. Some women have thickening of the labia overtime in response to hormones. This can lead to a rough outer texture to the labia which is known as rugae. Rugae is another word for folds or wrinkles. Estrogen is responsible for the changes in thickness, texture and even color of the inner labia. Of course estrogen begins to circulate at high levels during puberty, but pregnancy can also cause hormonal spike and subsequent changes to the labia.
Puberty is a time when most women (and men for that matter) become aware of the changes in their bodies. Awareness of these “secondary sex characteristics” is a stressful process. When changes are unique and seemingly uncommon for the young individual going through puberty, stress can arise. This can be seen in men with the development of breast tissue, also known as gynecomastia. Much like gynecomastia in young men, labia minora enlargement also occurs during puberty. In these select young women, the inner labia may become elongated and may be “sticking out.” I have even heard from some patients that during puberty they were concerned that they were possibly intersex: contain characteristics of both men and women (in layman’s terms: a hermaphrodite). Of course those intersex conditions are quite rare, but it can be a significant source of stress to have a penis like protrusion from the labia with hanging skin. While this is a more severe example there are a variety of appearances that can raise concern for the developing young woman. As a parent to these children, reassurance is almost always the only required intervention. But as the young woman proceeds through puberty into young adulthood, a consultation may be beneficial to evaluate for labiaplasty should it be a continued source of stress.
Pregnancy can also cause changes to the labia minora, again related to circulating maternal estrogens. Most commonly, thickening and elongation of the inner labia can occur. Darkening of the labia minora can also occur. A dark labia minora edge can seem undesirable to many women. A labiaplasty can remove this tissue, resulting in a smooth, clean and pink appearance to the inner labia. And addition to pregnancy, childbirth can cause injuries to the vagina. The labia minora, vaginal canal and perineum can sustain tears when the baby is born. Labia minora tears occur most commonly at the fragile point of the labia crus, where the inner labia attaches to the clitoris. This tissue, also known as the frenulum, is a common location for labia minora tears during childbirth and vaginal delivery. This tissue can be repaired with a labiaplasty and this is often required to prevent continued chafing, rubbing, pulling and re-injury tears of the labia minora.
Pregnancy can also cause changes to the outer labia, namely atrophy of the labia majora. Atrophy is another word for shrinkage. When the outer labia shrink and become smaller, the inner labia by definition appear larger. This can cause an imbalance in the appearance of the inner labia and can actually make the inner labia seem more protruding.
Notice that I did not mentioned intercourse (sex) as a cause of long labia. This is a complete myth: sex does not cause the labia to become longer. Similarly, masturbation does not increase the length of the labia. These myths are propagated by a male gaze “locker room culture” and are a complete fallacy. The only things that cause longer labia are genetics and hormones. The combination of your DNA and your hormones determine the length of your inner labia and the prominence of your clitoral hood tissue. Sex does not cause long labia, nor does sex change the appearance of the vagina at all. Childbirth is the only true cause of vaginal injury in a woman’s life cycle.
Regardless of the hormonal changes that occur throughout life, sometimes genetically we are just made differently. For women who have small outer labia, the inner labia can seem more prominent and “stick out more.” In these patients there may not be any functional issues but it may just seem uncomfortable and lead to self-consciousness from having larger and more protruding inner labia. These issues can become a source of stress during intimacy as well as causing self-consciousness wearing certain clothing.
While these patients may not have issues of chafing or pulling during intercourse, where the inner labia get pinched or trapped during sex, they still may benefit from a labiaplasty to allow a more liberating lifestyle. Regardless of your genetics, your development, or simply your feelings about your labia, please be reassured that there is a large variety of types of inner labia: labia that are asymmetrical. Labia that are rough. Labia that are discolored. And labia that simply are just less aesthetically pleasing to you. Regardless of your concerns, a consultation for labiaplasty is the best way to get peace of mind. As with any part about our appearance, there are always two options: acceptance and plastic surgery. Sometimes a liberated life requires both.