In a separate interview, Dr. Julie Strickland, immediate past-president of the North American Society for Pediatric and Adolescent Gynecology (NASPAG), also questioned the vigor of the study's methodology, and said part of the controversy lies in the use of plastic surgery in girls prior to menarche when they are neither physically or psychologically mature.
“There aren't rigid criteria of what is normal and abnormal, so we get this request a lot,” she said. “During adolescence it is really normal [for girls] to question their body composition and to worry about normalcy. They go to gym and they look slightly different from someone else, and that can really become a psychological issue that they grow out of. “So it's controversial if it should be done at all, except in extreme cases, and particularly below the age of 18 because it is a plastic procedure.”
Dr. Dietrich said that for every patient who presents with symptomatic hypertrophy, there are probably two patients who are concerned about appearance, but with counseling and education do not undergo a procedure.
The age of menarche for the group overall was about 11.5 years, but as early as 10 years, Dr. Dietrich said. Although BMI was not associated with complications, she noted that 60% of adolescents falling in the early adolescent category (10–14 years) were overweight or obese, which is a risk factor for earlier puberty and in line with girls developing earlier in the last few decades.
Recurrence in such young patients is also a critical issue, said Dr. Strickland of the University of Missouri–Kansas City. This can be particularly troublesome if a unilateral labioplasty is performed and repeat surgery is needed for the contralateral side. She observed that most recommendations and textbooks discuss labioplasty in cases of extreme symptomatic labial hypertrophy, but that it is segregated after growth is complete. Dr. Strickland defined extreme as labia that have undergone marked anatomic changes; are typically at least 8–9 cm in size; and can be pinched, difficult to clean, and eroded or irritated because of exposure to clothing.
In an interview, Dr. Santos reiterated that all of the patients were symptomatic, that they and their parents were told about the risks and benefits of surgery, and that labial hypertrophy can be managed without surgery.
'Labial hypertrophy can cause significant physical and social discomfort.'
Source DR. SANTOS