Danger Zones in Labiaplasty: The Importance of Sensory Nerve Mapping in Preventing Sexual Dysfunction
Goals/Purpose:
Labiaplasty has become an increasingly popular procedure, both for functional and cosmetic indications. Many have published on the surgical techniques for labia minora and clitoral hood reduction, labia majora reduction and augmentation, and vaginoplasty. Currently, there are no papers incorporating sensory mapping into surgical planning for labiaplasty. From our extensive sensory mapping experience, we have elucidated danger zones in the labia minora that helped us develop a novel, three dimensional labia minora classification.
Methods/Technique:
Aesthetic and reconstructive labiaplasty procedures were performed with a gynecologist specializing in clinical neurophysiology and urogenital pain. Sensory mapping was performed prior to all labiaplasties. From this experience, a new labia minora classification was developed which has guided subsequent surgical management.
Results/Complications:
Sensory mapping revealed erogenous zones that should not be resected (danger zones). Safe zones for resection include the pigmented labia minora caudal to the urethra, while the mucocutaneous regions tend to be sensual and should be avoided (Figure 1). Labia minora were classified according to their relative length to the vaginal opening (Figure 2). Other key technical considerations include: 1) maintaining the mucocutaneous junction aligned after resection, much like in lip reconstruction (Figure 3), and 2) resection of the height of the labia in the z axis (Figure 4 and 5), as shortening the length (y axis) or the width (x axis) may result in clitoral hood tethering, and labia eversion, respectively.
Conclusion:
Sensory mapping is crucial prior to labiaplasty, as each patient has unique neuroanatomy, and resecting vital sensory areas of the labia minora can lead to dyspareunia, pain or irritation. In conjunction with our labia classification, sensory mapping serves as a useful guide for pre-operative planning. Therefore, we believe that performing sensory mapping can optimize outcomes after labiaplasty and should be performed in all patients.
