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Many women of all ages have concerns about the appearance of their labia. Sometimes one labia is much larger than the other. One may be longer than the other. Sometimes one is round and the other is pointy. Their mucosal surfaces may be of different colors. The clitoral crus may be prominent on one side and absent on the other. 

Sometimes these differences have just always been. They are genetic. Sometimes the labia are stretched out during childbirth, or as a result of pelvic surgery. Many women experience changes during menopause, and some as the result of assault or injury. Many women don't have a frame of reference to know just how unusual the appearance of their vaginas is or isn't, and are hesitant to ask their doctors for help.

It doesn't help that insurance won't pay for treatment unless there is a medical reason for major surgery for vaginal repair. And it doesn't help that some of the best-publicized procedures for vaginal reconstruction are just plain scary. The Vecchietti procedure involves connecting the labia to a traction device that gradually elongates it during a 30-day hospital stay. Sexual intercourse in your hospital room every day is necessary for the procedure to work. Balloon vaginoplasty "inflates" one side of the vagina over a seven- to ten-day period to match the other. Women born without vaginas may receive McIndoe-Reed vaginoplasty, which places tissue from the abdomen on a mold to make a vagina, or intestinal vaginoplasty, which uses a segment of the colon to make a functional vagina.

Women whose concern is cosmetic don't need these procedures.

When the concern about the vagina is size and shape, the usual technique is a "vaginal facelift." It may consist of labiaplasty, which reduces the size of one of the labia in a procedure that most often uses sutures that dissolve and leave no scars. It may also involve vaginoplasty, which tightens the muscles around the vagina to enhance sexual response as well as to improve appearance.

In the United States, these procedures may cost from $2,000 to $10,000, largely depending on where they are performed, and are not covered by insurance. Usually women who have these procedures have tried non-surgical procedures such as Kegel exercises, which strengthen the pelvic floor. Kegel exercises are almost never helpful for vaginal tightening.

Some women may try a laser procedure known as Femilift. In this procedure the plastic surgeon or gynecologist uses a laser to heat collagen in the layers of the vagina beneath the mucosal surface. This causes the collagen to contract and tighten the tissues above it. Femilift is an office procedure that can be done in 15 minutes (the entire visit might take half an hour) and results in no pain, at least until it's time to pay the bill, which is usually $1000 to $1500 for the 15-minute session and not covered by insurance. The doctor usually recommends five sessions two to four weeks apart for optimal results. Unfortunately, optimal results have more to do with the stimulation of vaginal lubrication more than with vaginal size and tightness, and providers of Femilift usually state that the results won't last more than 24 months. Exilis Intima laser treatment and diVa may give better results, but also have their limitations.

Surgical labiaplasty and vaginoplasty offer longer-lasting results, but they also involve discomfort  There is post-surgical pain, although it's usually not severe and can be treated with Tylenol or hydrocodone, and there is usually post-surgical itching for a couple of weeks. However, once the discomfort has passed, women are usually happy with the results.

Irregularities in coloration can be addressed with vaginal bleaching. This is something you can do at home. The thing to understand is that you can usually lighten but not darken. Avoid products that include the ingredient hydroquinone. Most of the time they will be fine, but there are a few women for whom they can cause purple discoloration. Always test a tiny area of skin before applying any cream you have not tried before to a small test area, to make sure there are no adverse reactions you might regret.

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