Rejuvenation of external female genitalia Flashcards
Ageing of female genitals modified by diet
T Also; Genetic influences Childbirth Environment Cultural factors Exercise Past illness Other factors
Pubic hair becoems more curly with age
F
less curly and lost pigment
Labia minora increase in size with age
T
usually do and lose elasticity
‘labial hypertrophy’
Labia majora and mons increase in volume with age
F
loss of volume
Pigmentation of the skin and mucosa of the vulva is reduced with age
F
increased pigmentation
but loss of mucosal redness
Hyaluronic acid-based fillers used as Rx for volume restoration in mons and labia majora
T
90% of women with concerns about the appearance of the vulva have symptomatic changes
F
90% cosmetic concerns only
Symptoms of labial hypertrophy include include dyspareunia, irritation or problems with clothing or hygeine
T
Labial (minora) hypertrophy is assymetrical in 50%
F
usually symmetrical
Pts with Labial (minora) hypertrophy are often concerned about perceived masculinisation of the genitalia
T
surgery is advisable for women with cosmetic concerns due to labial (minora) hypertrophy
F
If asymptomatic reassurance and hygiene advice measures are sufficient
Consider surgery for those with irritation due to hypertrophy
Labium minus being wider than 5cm from base to free margin at its maximum height is a parameter of correction
F
wider than 4cm
Should refuse surgery if pt has high psychological vulnerability, BDD or low self esteem
T
refer to counselling
Must screen for BDD and for external pressure being put on the pt
pre and post op photos are recommended for labioplasty
T
risk of asymmetry is negligible in labioplasty
F
Must advise of this risk
Pts need full careful and slow explanation of procedure risk and side effects
5-7mls lignociane with adrenaline is recommended per labium minus
T
Amputation is the prefered technique for labioplasty
F
Does not preserve anatomic features of the free edge
Can cause parasethsia
Wedge or-V shape excision is preferred technique
S-shaped excision involves removing an ellipse from the centre of the labium
F
this is known as De-epithelialization
S-shaped excision is the same s amputation and is trimming back the free edge with placement of a running subcuticular suture
De-epithelialization can leave a redundancy in the free margin a sno tissue is excised from the edge
T
S-shaped excision is low risk for paraesthesia
F
high risk as its the same as amputation
The advantages of wedge excision include;
Preserves free margin
No free margin redundancy
Minimal nerve damage
T
Some over resection is allowable in labioplasty
F
Must never over resect
can cause discomfort and dyspareunia
dog ears should be excised immedietely in labioplasty
T
labioplasty pts shave pubic area night before surgery
F
1 week before
Swelling post labioplasty can last 6-8 wks
F
2-4 wks
Haematoma resolves quickly if present post labioplasty
T
Need 2-3 injection sites per side for fillers for the mons and lab maj
F
Can do mons and both lab maj with single injection site in midline under LA
Labial or mons fillers done with retrograde injections in deep dermis and subcutis
T
Use 7cm 21G cannula
Vulval filler injections need antiviral prophylaxis
F
But consider if Hx of genital HSV
No need for dressings or antibiotics
5-6mls is usual amount of filler for labia maj and mons
T
Additional 2-5mls may be injected at least 2 months later
