To Plump or Not to Plump? – The New York Times

Is it dangerous to have a dermatologist inject fillers to improve the appearance of labia majora that are thinning during or after menopause?

Anonymous please, San Francisco

[Have a question about womens health? Ask Dr. Gunter yourself.]

Filler for the labia majora, the outer lips of the vulva, has not been well studied. It isnt possible to provide advice on the benefits or risks of the procedure.

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The labia majora can lose fullness with menopause. This may be caused by a reduction in estrogen levels related to menopause, aging or both. In addition, the skin of the labia majora and minora becomes thinner because of a combination of menopause-related changes and effects of normal aging on skin. For some women this may also alter the appearance of their labia. There are also skin conditions that can significantly alter the appearance of the labia, the most common of which is lichen sclerosus. This condition often starts in perimenopause or menopause.

Fillers are injections used to smooth out facial wrinkles, improve the appearance of scars and treat the localized loss of fat tissue.

There arent any major studies that have been done on the use of cosmetic fillers for loss of labial fullness. The American College of Obstetricians and Gynecologists (ACOG) advises against gynecological cosmetic procedures that are not supported by adequate studies evaluating risks and long-term satisfaction.

Based on what we currently know (and mostly what we do not know), fillers should not be used to treat any vulvar symptoms, including vulvar dryness, pain with sex, vulvar pain, itch or irritation.

Regarding fillers and the cosmetic appearance of the vulva. The labia majora and minora vary greatly in size and shape from woman to woman everyone is normal. While we know many women have distressing and uncomfortable symptoms related to the impact of menopause on vulvar and vaginal tissues, we dont have good data on the extent of the cosmetic changes or their emotional impact.

If your concern is cosmetic, a visit with a gynecologist to review typical anatomy and discuss any concerning changes is a good idea before seeking a cosmetic consultation. Anecdotally, I find that many women are reassured by a review of what is typical.

Providing proven information about the risks and benefits of fillers for the labia majora is not possible without the necessary studies. The safest way to explore fillers in the labia majora would be as part of a clinical trial overseen by an institutional review board. A detailed discussion of potential risks should be presented as part of the informed consent to be a participant in such a study. In addition, clinical trials of novel procedures should have safety monitoring so the study can be modified or halted if unanticipated complications arise. A registry of clinical trials can be found at

There has been a dramatic increase in requests for cosmetic procedures on the vulva over the past 10 years, a trend I have witnessed in my practice. The appearance of the vulva has not changed, but what has changed is the availability of office-based cosmetic procedures and their promotion.

We do not know if the availability of these procedures or their direct-to-consumer marketing is uncovering a true latent need for vulvar cosmetics or if it is causing women to feel that their typical anatomy is abnormal.

Procedures and surgeries are often promoted to the public ahead of good data about them. Novel procedures can have unanticipated consequences, which is one reason they need rigorous evaluation.

I want every woman to feel confident about her body, and if a cometic procedure is what helps her achieve that goal then I am fully supportive. However, I also want every woman to have adequate data so she can make informed medical choices about those decisions.

Dr. Jen Gunter, often called Twitters resident gynecologist, is teaming up with our editors to answer your questions about all things womens health. From whats normal for your anatomy to healthy sex and clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.

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To Plump or Not to Plump? - The New York Times

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