Other conditions

Vulvar and perianal hyperpigmentation

Hyperpigmentation of the perianal and vulvar regions can be caused by aging, hormonal changes from preg- nancy, infections (syphilis), and medical conditions such as contact dermatitis and tight‐fitting underwear, in addition to ethnically related hyperpigmentation.

Pigmentation is caused by the combination of pigments localized in the dermis and epidermis and includes:

• oxygenated hemoglobin of arterioles and capillaries;
• deoxygenated hemoglobin of venules;
• deposits of carotenes or unmetabolized bile salts and other exogenous pigment (drug, metals, etc.)
• melanin, the main component of racially deter- mined skin coloration.

Therapy for vulvar and perineal hyperpigmentation

  Chemical peels: Ingredients such as azelaic acid, lactic acid, retonic acid, salycylic acid, and pyruvic acid gently lighten the skin and reduce the activity of tyrosinase, the enzyme responsible for “darkening” in the lower layers of the skin. Soothing anti‐oxidant agents such as vitamin C, bearberry extract, licorice extract, and mulberry extract provide a gentle moisturizing treatment to protect while continuing to lighten the skin.

  Physical treatments: Microdermabrasion is a dermatologic procedure utilizing a mechanical medium for exfoliation to gently remove the outermost layer of dead skin cells from the epidermis. Most commonly, microdermabrasion uses two parts: an exfoliating material like crystals or diamond flakes and a machine‐based suction to gently lift up the skin during exfoliation.

  Laser treatments: Laser devices such as a fractional CO2 laser have important advantages including a finding of 30% more collagen production than the Er:YAG laser [11], resulting in better cosmetic results.

The term “fractional” refers to the fact that only a fraction of skin is treated by producing columns of heat, leaving surrounding dermal tissue intact. The result is a safer treatment with less downtime.

Laser may be used for vulvar hyperpigmentation in selected cases with well‐ established protocols to prepare the skin before and after treatment.

  Self‐applied treatments: The best creams for vaginal bleaching are specifically formulated for sensitive areas. These creams, while slightly more expensive than normal skin lightening creams, have been prepared using ingredients such as vitamin B3, lemon juice, mulberry and bearberry extract, and licorice extract.

Commercially available products advertise themselves as specifically formulated for specific conditions; however, no peer‐reviewed proof exists. Medical supervision is helpful to diminish the risk of post‐inflammatory hyperpigmentation, which has been seen with the use of these products.

Labia Minora Hypertrophy

Patients that have labial hypertrophy can presente some simptoms and difficulties. Labial hypertrophy can cause a noticeable bulge in your clothing, especially when you’re wearing a bathing suit.

Other symptoms of labial minora hypertrophy include:

→ Hygiene problems
→ Irritation
→ Pain and discomfort (during physical activities, sexual foreplay or intercourse.)

The causes of Labial Hypertrophy may include the following:

• Genetics, your labia may have been that way since birth.
• Increase of estrogen and other female hormones during puberty
• Pregnancy, increased blood flow to the genital area can increase pressure and lead to a feeling of heaviness.
• Abuse of hormones.
• Infection or trauma to the area.

Is there any treatment?

If labial hypertrophy interferes with your life and your ability to enjoy physical activities or sexual relations, there is a surgery called labioplasty or ninfoplasty recommended for you.

During a labioplasty, a surgeon removes excess tissue. They can reduce the size of the labia and reshape it.

Several techniques have been described in the literature. The procedure can be done with laser or using the conventional way. It lasts between 30-45 minutes, usually done with local anesthesia and sedation, not requiring hospitalization in most cases.

The procedure brings comfort and great satisfaction to the patients making them able to wear any type of clothing without discomfort, as well as practice physical activities and have a pleasant sexual life.


Laxity of Major Labia

As with the labia minora and other parts of the vulva, there are individual anatomic differences. Labia may be flattened or robust. With pregnancy, age, significant weight loss, and/ or genetics, the labia majora may become redundant, and the skin may “sag” or appear excessively prominent, causing an embarrassing perineal fullness while erect that women pejoratively term “camel toe,” most noticeable upon wearing tight fitting clothing.

Women request size modification of their labia majora for a variety of reasons. A common personal reason is the appearance of “bulging,” usually found in healthy younger women with robustly full labia. This is in no way “abnormal,” but, as with many requests for cosmetic alteration, stems from a feeling of “fullness,” a desire to be “trim,” or the appearance of “camel toe” described above.

Another common reason, usually in multiparous or “older” women, is the redundancy and “saggy” appearance produced by loss of skin tone, pregnancy‐related stretch, or other weight reduction


Mons Pubis(Mons Veneris) Enhanced or with Laxity and/or Ptosis

The mons pubis (MP) is also referred to as the mons veneris or the suprapubic region [16]. Overgrowth or excessive size has been termed hypertrophy and may be associated with laxity and/or ptosis.

Treatment may be described as a monsplasty but others have called this “rejuvenation.” Good results are most commonly achieved using mons reduction and/or suspension techniques. In the event of good skin laxity, interventions may range from simple volume reduction with lipectomy, most com- monly performed with suction‐assisted lipectomy, with or without combinations of ultrasound‐assisted lipoplasty [19], laser‐assisted lipolysis, and external or internal RF‐assisted lipolysis.

RCH (“clitoral unhooding”)

Clitoral hood reduction (CHR) or reduction of clitoral hood (RCH) procedures are most often performed con- comitantly with a reduction of labial size.

As the labia minora “begin” superiorly, “flowing down” from one or more of the varying folds of epithelium making up the central, (frenulum. central hood), medial (lateral folds of the central hood), and lateral (prepucial) folds of the “clitoral hood,” these hood folds are frequently a part of the “tissue protrusion” that is bothersome to the patient.

Only occasionally are hood size reductions performed solo, without labial reduction. As noted in the anatomic descriptions of labial reductions and in many photo- graphs and diagrams above, hood reduction is either continuous with the labial excision line, or separate, if the anatomic area of hood hypertrophy does not con- nect directly with the area of labial reduction.



Hymenoplasty, a “plastic” repair/reconstruction of the hymenal ring, is the surgical restoration of the hymen. The term comes from the Greek words hymen meaning "membrane", and raphḗ meaning “suture”.

Hymenoplasty can be done in two ways – if the remnants of the hymen are present, then it can be stitched back together. The second option is to reconstruct a new hymen using tissues from the patient’s body. Along with restoring the hymen, you can also get the vaginal walls tightened. This surgery will repair the hymen, but you will experience bleeding and discomfort the next time it ruptures.


Prolapse and sexual function

Female sexual dysfunction is defined as a disorder of sexual desire, sexual arousal, orgasm, and/or sexual pain contributing to personal distress. Sexual dysfunction is a multifactorial disorder; biological, psychosocial, and relational factors can contribute to female sexual dysfunction.

Among these factors, the pelvic floor appears to have an important influence. Dysfunction of vaginal support leading to incontinence, prolapse, and sexual dysfunction is highly prevalent. Surprisingly, little research has been undertaken regarding the sexual function part of pelvic floor dis- order. One would agree that surgery to correct pelvic organ prolapse or incontinence is justified.

Vaginal rejuvenation surgery is one of the latest trends in elective vaginal surgery for women. It is a restora- tion of the vaginal caliber in women who suffer from decreased vaginal sensation or feelings of a loose or wide vagina that affects their sexual life. In many instances, women who present with these symptoms are found to have other urogynecologic pathology such as prolapse that must also be addressed in any repair contemplated.

Sexual dysfunction or decreased sexual sensation may be one of the first symptoms that women suffer from in the progression of prolapse and therefore a proper examination is vital prior to any repair.


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