What is the difference between Labiaplasty and Vaginoplasty?

Many people ask me this very question. It is probably one of the most common ones I answer on a daily basis. Even established doctors have a hard time differentiating between the two surgeries. It is actually
quite simple if you think of what you see and what you don’t see. First, what you see in a woman’s pelvic area is called the “vulva.” This includes the clitoris, inner smaller lips (labia minora), larger outer lips (labia majora), and the perineum (space between the vaginal opening and the anus. Some even include the anal area, inner thighs, and the fat pad above the pubic bone as part of the vulva since it is visible. Remember, this is the stuff you can see with your own eyes without the aid of retractors, microscopes, or other devices. This is the area where labiaplasty surgery is done. Specifically, labiaplasty usually involves the surgical trimming, reduction, or re-sculpting of the inner smaller lips. However, it can also refer to the surgical procedure to reduce the saggy skin of the larger outer lips. Together, the inner and outer lips are called the labia, hence labiaplasty. One more thing, if you have a flap of excess skin on the sides of your clitoris that is large and floppy, pulls, or is constantly irritated then a clitoral hood reduction (also called prepuce reduction) is often done as part of the labiaplasty surgery.

Next, what you don’t see is the inside of the vagina. This is the canal where tampons are placed, where babies pass through, where vibrators are placed internally. This is the inside of the vagina that is stretched over ten times its normal size when a child is born through the vagina. Even with a C-Section this inside space of the vagina can be severely stretched. When this happens, the walls of the vagina become loose and saggy on the inside, the part you don’t see. This is the area where vaginoplasty surgery is done. Specifically, vaginoplasty usually involves the surgical tightening of the unseen inside of the vagina to narrow its size by both suturing together inner deeper tissues and trimming more inner superficial vaginal skin. When you have to do surgery on the space in between the vagina and the anus it is called a perineoplasty or perineorrhaphy. This is done if there is a bulging structure in this space or if a prior delivery messed up the appearance of this region. Prior tears or episiotomies are the most common cause of looseness in this entry point into the vagina.

One thing you should remember is the way most plastic surgeons do their vaginoplasty surgeries. During a plastic surgeon’s residency program, and even in their fellowship programs, most will only get a couple of months of surgical time with the gynecology department. During these two months the plastic surgery resident typically assists the gynecology resident or fellow doing the vaginal surgery. The only other time most plastic surgeons get any vaginal surgery experience is during their two to three month rotations as medical students in the obstetrics wards. During this time, they may get a few deliveries in which they repair superficial lacerations and tears in the perineum. It is rare that the plastic surgeon will be given the responsibility of repairing deep damage since the anatomy is difficult and rips into rectum, bowel, or bladder may occur during the repairs. In their gynecology rotations a medical student is never the primary surgeon doing deep pelvic repairs. As a plastic surgery resident or fellow it is rare that they do the primary deep pelvic repairs since they have to battle with the gynecology resident or fellow for these precious learning experiences. This usually means that a plastic surgeon advertising that they do vaginoplasty is really doing a perineoplasty and only tightening the opening into the vagina and doing little to no tightening of the deeper inner canal. To be fair, most gynecologists have absolutely no training in cosmetic surgeries such as breast implants, tummy tucks, and Brazilian Butt Lifts. In fact only a very few actually do these cosmetic procedures. In almost all cases these skills were learned after graduating from their formal residencies and fellowships and were learned in seminars or as an “apprentice” to a plastic surgeon. Few gynecologists are formally trained to do labiaplasty surgeries and even fewer plastic surgeons have the training to do them safely.