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A Clinicopathologic Study of Labia Minora Hypertrophy: Signs of Localized Lymphedema Were Universal

Barrett, Mary M. MD; Carlson, J. Andrew MD, FRCPC

Journal of Lower Genital Tract Disease: January 2014 - Volume 18 - Issue 1 - p 13–20
doi: 10.1097/LGT.0b013e31828d3989
Original Articles

Objective To describe the clinical and pathologic features of women undergoing labioplasty for labia minora hypertrophy (LH) and to determine whether localized lymphedema plays a role in its pathogenesis.

Materials and Methods A retrospective case series of consecutive cases of labioplasties performed for LH was retrieved from a 10-year period. Clinical, histopathologic, and immunohistochemical features were evaluated.

Results Thirty-four labioplasty specimens from 31 women were identified. The women had a median/mean age of 36/35 years (range = 14–62 y) and had noted the presence of LH for a median/mean period of 36/86 months (range = 5–264 mo). A minority of patients had antecedent vaginal delivery (29%) and vulvar trauma (12%) and were either overweight (20%) or obese (27%). About half complained of vulvar appearance and approximately a third each had symptoms of pain, dyspareunia, or irritation. After a median/mean follow-up time of 40/44 months, 3 patients had recurrent LH (9%). The volume of excised tissue was greater for the patients with recurrent LH, than those without (mean of 9.8 vs 5.6 mL, respectively); however, no clinicopathologic finding predicted recurrence of LH. Histopathologically, all LH specimens showed diagnostic signs of chronic lymphedema, and compared with vulvar controls, LH had a significantly greater number of lymphangiectases (mean 15/mm2 vs 3/mm2, p = .001) and showed greater mean maximal lymphatic dilation (0.12 vs 0.04 mm, p = .004), respectively. In addition, lichenification (94%), indicating chronic irritation, and sebaceous hyperplasia (60%), perisebaceous inflammation, and Demodex folliculorum infestation (3%), a constellation of findings commonly seen in phymatous rosacea, were evident.

Conclusions Rather than an anatomic variant, LH seems to be a manifestation of chronic lymphedema, either acquired or primary with delayed onset. Because persistent lymphedema can lead to functional debilitation, recurrent skin infections, elephantiasis, and, rarely, malignancy, early excision and treatment of factors that promote lymphedema would be effective management of this rare condition.

Labia minora hypertrophy (LH) is considered an anatomic variant that shows normal histology. This case series of 31 women with LH documents histologic evidence of lymphedema, a known cause of tissue enlargement; the frequent presence of risk factors for localized lymphedema like trauma and obesity; and a low risk for recurrence of LH despite excision. Overall, this series implicates localized lymphedema in the pathogenesis of LH and argues against the belief that LH is a normal variant.

Department of Pathology, Albany Medical College, Albany, NY

Correspondence to: J. Andrew Carlson, MD, FRCPC, Albany Medical College MC-81, 47 New Scotland Ave, Albany, NY 12208. E-mail:

The authors have declared they have no conflicts of interest.

Supported in part by clinical revenues and generous donors to the Divisions of Dermatology and Dermatopathology, Department of Pathology, Albany Medical College.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology