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The female genitalia are sources of immense curiosity and sexual gratification all over the world. In many cultures, they are attributed with the powers of arousing sexual curiosity and impulses in girls and women. This has led to the practice of female genital mutilation in which these parts are excised to varying extents, with other modifications of the external genitalia, to protect the woman’s virtue. This is not recognized in most developed nations who classify it as a crime.
However, other cultures, especially in Africa, have practiced labial elongation for centuries to fit their cultural ideas of what looks and feels attractive to the opposite sex during sexual intercourse. The purpose of this practice is not mutilation but addition of length to the labia minora by the female herself, by a carefully taught and long-term method. This is usually initiated and the elongation accomplished before the girl becomes sexually mature.
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The labia minora are the small folds of thin and delicate skin that lie on each side of the actual vaginal introitus. Far from being a featureless and uniform part of the female anatomy, they may vary both in length and in width from woman to woman.
In one interesting study of women who were satisfied with the current appearance and function of their labia, it was found that there was a high range of physical variation in measurements. The labia are about 4.0 to 6.4 cm in length, and about 2 cm wide, on average. It is important to note that the actual range is much wider, with normal variants being anywhere from 1.2 to 10 cm in length and 0.7 to 5 cm in width. Interestingly, the two labia of the same woman are very often of different lengths. This shows that significant variations in labial size from one side to the other, as well as between different women, are perfectly normal and should not be interpreted as hypertrophy or abnormality.
It is very clear that what is very often called labial hypertrophy by both doctors and patients is simply a variant of normal, as is supported by the few studies available on female genital dimensions. Labial hypertrophy has been attempted to be defined in terms of labial length. Felicio’s classification categorizes it into four sizes:
Others define labial hypertrophy as anything over 4 or 5 cm and advocate correction if desired, but acknowledge that most cases are congenital in origin, which implicitly means it is a normal variant.
Acquired labial hypertrophy may be due to several causes which are extremely rare, however. They include:
In most women, the labia do become larger in the reproductive years and acquire their distinctive pigmentation.
It is important for physicians to communicate the risk of cosmetic procedures to alter the length of elongated labia, as many women are set on the promise of surgery without considering the risks.
Additionally, the guidelines for when genital cosmetic surgery is recommended should be considered by professional bodies to establish better standard for procedures.
In conclusion, elongated labia should not be considered as a pathological condition, and surgical correction should not be hastily undertaken unless there is a medical rather than cosmetic indication.