"One Cut Technique" - Simultaneous Reduction of Labia Minora and Clitoral Hood

Abstract

Aim: The aim of the study was to present new surgical technique of simultaneous reduction of labia minora and clitoral hood. Material and methods: 3 groups of patients (5 in each) with enlarged labia minora and clitoral hood were treated with new surgical technique. First group: 5 patients aged between 16-18 y.o., all virgins, second group: 5 women aged between 20-25 y.o., sexual active, and third group: 5 patients between 50-65 y.o., all after menopause. All patients were treated with “One cut technique” as simultaneous reduction of labia minora and clitoral hood. In all cases radiofrequency tool was used for cutting. Patients were operated under general anaesthesia. Results: The new surgical technique of simultaneous reduction of labia minora and clitoral hood was applied without significant complications. This surgery reduced labia minora in height and length, and clitoral hood in height and width. The procedure preserved natural colour and contour of this part of the vulva. Deformation of labia minora and clitoral hood with associated symptoms, like aesthetic dissatisfaction, physical and emotional disturbances were resolved postoperatively. In all cases self confidence and social openness improved. Following the procedure, body image perception also improved. Conclusions: In this group of patients, One cut technique of simultaneous reduction of labia minora and clitoral hood, was performed without significant complications. This method achieves expected good aesthetic results and improves physical and emotional selfesteem. (Z-plasty, inferior resection and superior pedicle flap reconstruction), de-epithelialized and laser labiaplasty [1-4,6-12]. All described methods apply only middle or posterior part of the labia minora. Most surgeons treat labia minora and clitoral hood as two different compartments. Author performed some of those methods and established hypothesis that we should see labia minora as an anatomical structure, which begins in the upper part of the vulva (periclitoral area) and ends as frenulum. On the other hand, you should not talk about restoring labia minora shape without touching clitoral hood. Material and Methods “One cut technique” is a simultaneous reduction of labia minora and clitoral hood. 3 groups of patients (5 in each) with enlarged labia minora and clitoral hood were treated with new surgical technique. First group: 5 patients aged between 16-18 y.o., all virgins; Second group: 5 women aged between 20-25 y.o., all sexual active, and Third group: 5 patients between 50-65 y.o., all after menopause. The most common symptoms, patients were suffering from were, persistent irritation with discomfort during physical activities or associated with rubbing while wearing close-fitting underwear, riding a bicycl or horseback riding, difficulties in maintaining hygiene, dyspareunia Introduction Since 1971 untill 2014, 38 papers about plastic surgery of the labia minora, were published [1]. First case report was made by Martincik and Malinovsky from Czech in 1971 and treated about surgical treatment of the hypertrophy of the labia minora [2]. Doctors performed posterior wedge resection. During all these years many surgeons performed a lot of similar or different techniques, but the most popular one was edge resection (direct excision). These two methods, however, have one defect all nerves and blood vessels are cut, so sensitivity of new edge of the labia can be worse then before the procedure. In this way of thinking, Choi and Kim described a new method deepithelialization, which preserves neurovascular supply to the edge of the labia [3]. Next step in the way of labia reduction evolution was made by Ostrzenski, who described in 2014 a fenestration labiaplasty technique with inferior flap transposition [4]. Thanks to this technique we obtain reduction in two dimensions of the labia minora height and length. Except symmetry, natural colour and contour of the labia are preserved, and posterior edge of the fossa navicularis (labial frenulum) is restored or created “de novo”. In 2013 reconstructive and plastic gynaecology in Poland became famous and its popularity is still growing. Despite that there are no standards or recommendations for this kind of procedures in Poland, doctors still have been doing these operations as the American College of Obstetricians and Gynaecologists (ACOG) recommended in 2007. Labia minora reduction procedures can be performed to alter the size and shape for such medical indications like “labial hypertrophy or asymmetrical labial growth secondary to congenital conditions, chronic irritation or excessive androgenic hormones” [5]. Reviewing labia minora reduction techniques author found many different techniques of labia minora reduction such as partial amputation (edge resection), wedge resection with its modifications