| BackgroundFemale external genitalia plastic surgery(FGCS)is a new field of plastic and cosmetic surgery.At present,there is a lot of chaos in the FGCS market at home and abroad,and various surgical procedures have not yet established evidence-based medicine guidelines.Plastic surgeons mainly rely on their own limited experience and subjective impressions,lacking of objective standards.Therefore,understanding the anatomical characteristics of normal female genitalia from anthropometrics is very important for successful plastic surgery and aesthetic results.Labiaplasty(LP)is the most common performed procedure in FGCS.There are many methods,but there is no unified standard.We urgently need a large sample of cohort studies to evaluate the safety and effectiveness of various LP,and to provide personalized treatment strategies for each woman’s unique anatomical and aesthetic needs of the genitals.ObjectiveThe purpose of the first part of this study is to provide the basic morphological data of vulva of large-scale homogeneous population,to define the regional morphological and anatomical standard of normal vulva,and to provide an objective basis for the establishment of indications and contraindication for FGCS in China.At the same time,the related factors of female vulva morphology were analyzed to reveal the characteristics of anatomical variation and physiological changes.The second part is a retrospective analysis of the clinical application of LP to explore its safety and effectiveness.MethodsThe first part of this study is a Cross-sectional study,including 620 Han adult women in Central Plains who underwent gynecological examination in the Gynecological Clinic and Physical Examination Center of the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2019.Collected general information of all women,including age,weight,height,menstrual and reproductive history,sexual life and other general information,observed and recorded the vulva morphology of these women.A total of 24 diameter lines were measured in 4 areas,including labia minora,clitoris,labia majora and vaginal vestibule-perineum,and the mean and standard deviation were calculated.Obtained the reference range of parameters in various parts of the vulva of Han women in the Central Plains.Difference analysis,correlation test and multiple stepwise linear regression were used to study the relationship between the general data of all women and the measured values of various parameters.The second part is a retrospective study,collecting the general data of patients who received LP in the Department of plastic surgery in The First Affiliated Hospital of Zhengzhou University from September 2019 to September 2020.The operative method,preoperative and postoperative vulva examination signs and other data were collected,and the postoperative follow-up was conducted.Postoperative complications and patient satisfaction were investigated.ResultsPart one:1.A total of 620 female genitalia of Han nationality from Central Plains were observed and measured.The average age was(37.01±10.58)years old,height was(162.00±4.30)cm,weight was(61.67±10.35)kg,and BMI was(23.50±3.84)kg/m2.The shapes of labia minora in 620 women were divided into four types:arc shape(46.13%),triangle shape(35.97%),lobulation shape(11.94%)and other irregular shape(5.97%).There were 46 cases(7.42%)with skin color on the edge of the labia minora,and 574 cases(92.58%)with different shades of pigmentation on the surface of the labia minora.In 392 cases(63.23%),the left and right sides of the labia minora were not symmetrical.In 114 cases(18.39%)the labia minora did not protrude to the labia majora,and the remaining 506 cases(81.61%)had varying degrees of prominence.2.The measured values of each area of vulva of 620 Han women from Central China were obtained.In the area of labia minora,the bottom length of both sides were(43.41±10.86)mm on the left,(42.89±10.55)mm on the right,the width of both sides were(16.79±4.87)mm and(17.19±5.06)mm,and the thickness of both sides of labia were(3.61 ± 1.01)mm and(3.51 ± 1.05)mm,respectively.Clitoris area:the length of the glans of the clitoris was(4.54±1.57)mm,the width was(3.27±1.08)mm,and the length of the clitoris hood was(25.83±5.26)mm.The length of both sides of the labia majora is(82.41±15.71)mm on the left side and(82.58±15.86)mm on the right side.The width is(24.57±3.01)mm on the left side and(24.59±3.03)mm on the right side.Distance from clitoris to urethra is(21.20±2.80)mm,distance from urethra to vagina is(7.75±1.70)mm,distance from clitoris to vagina is(29.54±3.93)mm,distance from vagina to perineum is(10.35±4.25)mm and the length of perineum is(24.28±4.40)mm.There are differences in the bottom length,posterior lip distance and width of labia minora in the same individual.The measurement values of vulva parameters were different for women with different menstrual history,sexual life history,pregnancy history and vaginal birth history.3.In this study,a regression analysis was conducted on the measured values of each area of the vulva of 620 adult Han females in Central Plains and their related factors.The results were as follows:Age was positively correlated with the length of the anterior lips on both sides of the labia minora(B=0.409),the width of the lips(B=0.088),the length of the glans of the clitoris(B=0.044),the length of clitoral hood(B=0.446),the length of both sides of the labia majora(B=0.263),the distance from the clitoris to the vagina(B=0.484),the distance from the vagina to the perineum(B=0.114),and the length of the perineum(B=0.213),while it was negatively correlated with the bottom length of the labia minora(B=-0.364),the distance between posterior labia(B=-0.687),the width between labia majora(B=-0.103),the distance between clitoris and urethra(B=-0.080),and the distance between urethra and vagina(B=-0.083).BMI was positively correlated with the length(B=0.248)and width(B=0.538)of the labia majora,the distance between urethra and vagina(B=0.284),the distance from the clitoris to the vagina(B=0.284)and the length of the perineum.The age of menarche was not related to the length of clitoris,the width of labia majora,the distance between urethra and vagina,and the length of perineum,but was negatively related to the other parameters of vulva.The frequency of pregnancy was positively correlated with the base length of the labia minora(B=0.552),the distance between the anterior labia(B=0.190),the width of the labia(B=0.208),the length of the right side of the labia majora(B=1.304),the distance between the urethra and the vagina(B=1.137),the distance between the clitoris and the vagina(B=0.366),and the length of the perineum(B=0.788),while negatively correlated with the length(B=-0.284)and width(B=-0.114)of the clitoris.Number of vaginal deliveries was positively correlated with the base length of the labia minora(B=1.995),the distance between the left and right posterior lips(B=2.378),the distance between the clitoris and the urethra(B=0.497),and the distance between the clitoris and the vagina(B=0.531),but negatively correlated with the distance between the anterior lips(B=-0.755)and the right side of the labia minora(B=-0.496).Sexual frequency was positively correlated with the thickness of labia minora(B=0.045)and the distance between vagina and perineum(B=0.177).Part two:A total of 48 patients who have undergone LP were included,with an average age of(27.08±7.29)years.The labia minora did not protrude from the labia majora in 3 out of 48 patients(6.25%).The rest of the 45(93.75%)cases according to the labia minora protrudes from the extent of the labia majora degree:18 cases(37.50%)were grade Ⅰ,20 cases(41.67%)were grade Ⅱ,and 7 cases(14.58%)were grade Ⅲ.25 cases(52.08%)underwent wedge resection,20 cases(41.67%)underwent arc resection,and 3 patients(6.25%)underwent arc resection combined with wedge resection.The incidence of postoperative complications was 20.83%,there were no serious complications,and the overall satisfaction rate was 95.83%.Conclusions1.The morphology of adult female vulva of Han nationality in central China is widely variable.It is a common phenomenon that the labia minora has asymmetry on both sides,pigmentation on the surface or protruding from the labia majora.2.In this study,the normal reference range of the measured values of various regions of female vulva of Han nationality in Central Plains was obtained by measurement,providing anatomic basis for the formulation of FGCS guidelines in China.3.The measured values of female vulva were correlated with age,BMI,sexual life history,gestation and birth history,and menstrual history.Age was a significant factor correlated with the measured values of each area of vulva.4.Arc resection,wedge resection and combined operation are effective and safe methods for reduction of labia minora. |
PDF Full Text Request