Anatomy: The Labia

How much do you know about your anatomy? What is really considered normal? Should we even say that something is “normal?” Well with this series of blog posts, I hope to dispel some of the myths about female anatomy, as well as discuss certain changes in pelvic anatomy that would warrant a visit to your gynecologist.

As always, this post does not take the place for actual medical advice. If you have concerns or questions, please reach out to your provider. That said, to the vulva!

female sexual anatomy

In this week’s blog, I am going to discuss the labia. As you see in the picture above, there are two distinct sets of labia, the labia majora and the labia minora. The word labia comes from the Latin word for “lip,” with majora meaning “the larger,” and minora, meaning “the smaller.” I should also point out that labiamajora, and minora are plural nouns. The singular form for those structures are labiummagus, and minus, respectively.

The Anatomy of the Labia

From an anatomical standpoint, the labia majora are cutaneous folds that extend from the mons pubis (a fat pad that sits atop the pubic bone) to the perineum (the area between the vulva and rectum). They contain a number of sebaceous (sweat) glands, as well as other structures, such as hair follicles. As hormonally-sensitive structures, they are rich in estrogen receptors, and consequently, will change size and shape with puberty and menopause. Embryologically, they are an anatomic homologue (remember that term from the clitoris blog post?) to the scrotum, and are derived from the labioscrotal folds which, as a female embryo develops, split down the middle, forming the pudendal cleft. Pretty straightforward, right? Now here’s an interesting tidbit (that unfortunately leads into the next section), the word pudendum comes from the Latin word for “Shame.” There’s no doubt that the original anatomists who created the terms for our body had issues with female anatomy, but it seems…shameful…that they would name it so. Maybe this is why prior to the 20th century, virtually no art depicted female genitalia. 

I guess you could say that historically, human beings have an issue with labia.

The Controversy

Skip to the 21st century. From vilification (female genital mutilation) to exaltation (the pornography industry), we can’t seem to leave labia alone, and whereas people of the past may have only seen a few sets of labia during their lifetime, it’s become easier than ever (thanks to the internet) to have a plethora of pudenda to compare oneself to. As you may imagine, this constant comparison can lead to feelings of inadequacy, frustration, or that one’s own anatomy is not “good enough.” And how do we fix this?

Enter the labiaplasty.

Technically speaking, a labiaplasty is a surgical procedure that changes the shape, form, or size of the labia. It is currently considered (for most women) a cosmetic procedure, and therefore is often not covered by commercial health insurance. Nevertheless, more and more women are seeking surgery. According to the American Society of Plastic Surgeons, the number of labiaplasties have skyrocketed since the Society began collecting that information in 2015, and a quick google search for “Labia surgery” will direct you towards a multitude of plastic, cosmetic, gynecologic, and cosmetogynecologic surgeons willing to perform the procedure (some with better qualifications than others). As to why some women desire labiaplasties, issues with personal hygiene, symmetry, cosmetic appearance, or even wearing “cuter clothes” make the top of the list, although a few sites I searched listed some variation of “getting back to being normal” as a potential reason for undergoing surgery. 

I had to reread that a few times. “Getting back to normal,” eh? Who gets to decide that? 

Over the last few years there has been an outpouring of voices discussing “normality” of the labia in terms of size and shape. Various online publications, both health-related (Healthline.comMedical News) and otherwise (Cosmopolitan MagazineWomen’s Health magazine) have chimed in on this debate, and even the American College of Obstetricians and Gynecologists (ACOG) has made a stance on “normal size.” All in all, the take home message is the same: there is no “normal” in terms of labial size. Each set of labia, much like each woman, is unique. Furthermore, the labia don’t have to be symmetrical – one can be larger than the other, and still be completely anatomically “normal.” To further this point, Laura Dodsworth, a British photographer and author of Womanhood: The Bare Reality, photographed over 100 different vulvas in an effort to display the complete variety of anatomy that exists. Her message: there is no normal. Your anatomy, in whatever shape and size, is perfect.

There is, of course, a rebuttal to this argument: just because there isn’t a “normal,” doesn’t mean labia can’t be bothersome. I’ve personally had patients who feel embarrassed by their labia, or who complain they get caught in clothes, or are injured during intercourse. For these patients, surgery can be a lifechanging (in a good way) thing. Obviously surgery is not without risks, and careful attention to detail, as well as appropriate postoperative expectations is important. 

But this begs another question – why are we even having this conversation about cosmetic labial surgery? If I didn’t like my nose, would anyone fault me for having a nose job? Sure, maybe it would help me breathe better, but really, maybe I just don’t like my nose. What about breast augmentation? If a woman has symmetrical, yet small breasts, is her desire to increase her cup size any less important/valid than the same desire in a woman with one C cup, and one AA cup? 

The Take-Home

Our self image IS important, and no man, woman, or otherwise should have their desire to “look their best” invalidated. And yet, in terms of labia, if you look at the statistics, the vast majority of woman have labial shapes and sizes that are numerically within the” normal” range. In my opinion, if a woman desires a labiaplasty, whatever the reason, I think she should be able to have one, as long as it is performed in a safe and professional manner. I do take issue, however, with surgeons who prey upon genital insecurities, or who claim that the surgery is without any potential for complication or long-term issue. My take home message – if you’re going to have surgery, do your homework. Honestly, if you’re going to see any medical provider, do your homework.

I guess you could say, take charge of your own health! And remember – there is hope, there is help, there is Haven Center!