What is Normal?

This is a common question from patients with labia when asking about the appearance of their genitalia. There is a standard of beauty that applies specifically to the labia minora that require labia to be symmetric and perfectly hidden away between the labia majora. They cannot be asymmetric, too long, have too many folds or have edges that are hyper pigmented because that's considered ugly. This is the information my patients the majority of whom are under the age of 25 usually share with me.

This has a demoralizing effect on patients. They feel shame, uncomfortable with their bodies, and less deserving of pleasure because they don't conform to societal standards. Often patients ask about labiaplasty in order to reduce the size of their labia minora.

In this article A Study of Adolescent Female Genitalia: What is Normal? Katie Brodie MBChB, et al. conducted a prospective study of 44 female adolescents aged 10 - 19 years who were elected to undergo routine surgical procedures.

1. Consent from both patient and parent was obtained
2. the patients were examined after induction of anesthesia
3. and measurements were obtained of the length and width of the clitoral hood, and the length and width of the labia minora
4. 86% of the patients were caucasian

Results showed that:

1. 43% of the time the right and left labia minora were different lengths.
2. right and left labia minora were different lengths when stretched (61%) and unstretched (55%) of the time
3. there was no correlation between size and shape of labia minora and age, height, weight or race.

Conclusions were that

1. wide variability exists in female adolescent genital anatomy with no established normal range
2. and that adolescent genital anatomy is wide ranging in it's size shape and morphology

I recommend initiating a discussion about labial appearance as a routine part of the sexual health and wellness evaluation of patients. Most patients are interested in discussing these concerns and the understanding that there is no normal is important to hear. More studies need to be done but this study can be used as a resource for all health care professionals.

Don't forget Sexual Health is Medical Health

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