Constant burning/nerve pain 3 years post-op labiaplasty - what are my options?

Question

The thicker labia of the two is the only one causing me grief 3 years post op. I've been to pelvic floor therapy, and multiple surgeons and obgyns and no one has any answers - as they said a revision could just disrupt other nerve endings and create painful scar tissue all over again. I feel so defeated and hate living my life as if someone is holding a lighter up to my left labia. It feels swollen as well. Any insight or help would be so much appreciated. :(

Zoran Potparic, MD · Answer

Every surgery that involves tissue removal, including labioplasty, will end up with cutting numerous nerve endings which supply sensation to that area. As they grow  back, sensation recovers (3-6 months). In some cases, however, nerve may be entrapped in the scar and create condition that is known as neuroma. Surgical excision and repositioning of the nerve (if visible), may be needed. It may not be a bad idea to see plastic surgeon who does  lots of nerve repair (plastic trained hand surgeon for example) and have a consultation. Good luck.

Gary J. Alter, MD · Answer

As the inventor and innovator of the wedge technique in 1994, I reconstruct many women who have had labia reductions by other surgeons, both wedge and trimming techniques. The reconstruction is much more difficult than a primary labiaplasty and should be done by a plastic surgeon with extensive experience in labia reconstruction. I published the first and most extensive paper on labia reconstruction in the prestigious journal "Plastic and Reconstructive Surgery" about ten years ago. Many of the causes of persistent pain after a labiaplasty result from painful scars. If these scars are removed, the pain will be eliminated or much improved. Depending on the location of the painful area, it can be removed and primarily closed or healthy tissue can be placed, such as tissue from the side of your clitoral hood. You may need various reconstructive techniques to eliminate your pain and give you a good appearance, but it requires a very skilled reconstructive labiaplasty surgeon. Approximately 40% of the surgeries I perform are revisions of other surgeons' labiaplasties. Other treatments are also available such as steroid injections or cream. platelet rich plasma, and stem cells. You only get one good chance to reconstruct you, so be patient and ask a lot of questions. I would like to see photos that outline the area of your pain.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY

Ozgur Kartal, MD · Answer

You had labiaplasty surgery 3 years ago and one side was long?
And there is pain in the long labium.
Have you had a complication like hematoma after your surgery?
or any other complication.
if you share a photoI can answer more easily.

Laura A. Katz, MD · Answer

I am so sorry that this happened to you.  From your description, it sounds like you have experienced nerve damage or nerve entrapment of the dorsal nerve of the clitoris after labiaplasty.  This can happen if dissection occurs too close to the base of the clitoris where the nerve courses.  This is a known potential complication of labiaplasty.  The key nerves in the pelvis are the pudendal, genitofemoral, ilioinguinal, and the dorsal clitoral nerve.  There are surgical options to go back to surgery and attempt to free the scar tissue around the nerve, but this is very invasive.  Some patients have found oral Topamax to be helpful with the discomfort, but this is not always the case.  There is more success reported with selective nerve blocks.  During the nerve block, 1% lidocaine is inserted into the pudendal nerve where it divides into the dorsal nerve of the clitoris.  Another option for a nerve block is to injection 1% lidocaine just above and to the left of the clitoris and clitoral hood.  This sometimes results in immediate relief.  This may need to be repeated more than once with varying frequency.  If you are able to proceed with nerve block, then it is also a good idea to start on a medication like Duloxetine daily as well to help your serotonin and noradrenaline to circulate longer in the brain and make the effects of the nerve block last longer and you can feel better longer. These nerve blocks can actually be done in the office.   I hope this helps.

Saima Jehangir, MD · Answer

So sorry you are experiencing this. Using medication that will slow down the firing of the pain receptors will help down regulate your pain. Have you tried topical CBD? What about topical gabapentin?

Adam Ostrzenski, MD, PhD · Answer

Q: Is there any hope to correct labial burning pain following cosmetic surgery?
A: Yes, it is possible to correct it.
I’m answering questions for the RealSelf company strictly for helping women since I see too many of them for corrective surgery. To help yourself, you need to answer three questions:1. Did burning pain occurs immediately after surgery? It means that the nerve was entrapped into the suture. Surgically decompressing the nerve with local anesthesia usually resolves the problem.
2. Did you begin having burning pain later on the following surgery? Scar formation and adhesions cause nerve compression. Again, surgical neurolysis (removing adhesions and scars) would eradicate the burning pain perception.
3. When did you get pelvic pain after your surgery? When pain is felt at the side of the incision, it is neuropathy; when pain migrates to the pelvic areas, it is known as neuralgia (referral pain). In both diagnoses, you need surgical treatment. Some advisors suggest treating entrapment nerves with neuroleptic medicine or PRP injections. However, contrary to the answers to your question by RealSelf advisors, no single research documented the safety and effectiveness of these medications in entrapment nerves.
An additional question is about the surgical intervention was used by your surgeon, since very often, labial over-resection causes nerve damages. Photograms and postoperative notes should clarify it. This condition’s therapy may require two-step corrective surgery: a) labial tissue expansion; b) corrective labial surgery.
You need to identify a surgeon who understands the mechanism of your suffering; know how to operate using magnification, either microscope or surgical loup; must be familiar with how to recognize nerve during surgery; have intimate knowledge of labial and adjacent structure, and surgical anatomy. 
With regards,Prof. Dr. Adam OstrzenskiUS Cosmetic Gynecologic Surgeon

Michael A. Reed, MD · Answer

Christine what you are describing is chronic neuropathic pain also called “neurogenic pain”. To control and eliminate this pain can be very elusive.  Often times, patients are prescribed neuroleptics such as Gabapentin and Pregabalin but are unable to tolerate the excessive sedation associated with these medications.  However, you may have some success by compounding Gabapentin+Lidocaine+ Estradiol, and massaging this compound to tender areas resulting in significant improvement in sensitivity and pain syndromes. A new adjunct for the treatment of neuropathic pain is the use of platelet rich plasma (PRP). Once platelets are activated a cascade of healing events occurs leading to angiogenesis (new blood vessel growth), reduction in inflammation and the production of promoting factors resulting in axon regeneration and re-innervation of the target tissue. Neuropathic pain can begin to improve 3 weeks after the application of PRP. Reference article: Platelet-Rich Plasma and the Elimination of Neuropathaic pain by Damien P Kuffler Best of Luck! Dr Michael Reed aka @thecosmeticgyn

Michael P. Goodman, MD, FACOG · Answer

Hello Christine, YES-- there is relief for you; you just haven't yet seen the right person. Nerve pain is medically termed "neurogenic pain," and as such is best treated with a "neuroleptic medication." This typically ia gabepentin or pregabalin (Lyrica.) As these medications can cause some side-effects (mostly drowsiness), I tend to compound them in a hormonal cream base for topical application which side-steps the side effects. Also, there is compelling research evidence that injecting platelet-rich plasma (PRP) into the site of the pain can help with axonal regeneration to rehabilitate the damaged nerve supply. I am not aware where you live, but many clinicians, myself included, do "virtual" consultations & care, via phone, Zoom, of Facetime.  Best wishes,  Michael P Goodman, MD, FCOG, IF, AAACS.  Davis, Northern CA, USA

David Janssen, MD, FACS · Answer

The idea that it is the thicker side leads me to think of a type of abnormal scarring like a keloid that can be painful or itchy. I would recommend a physical exam by a Plastic surgeon who is used to treating keloids and consider a steroid injection. It might resolve the problem. Best of luck to you!

Constant burning/nerve pain 3 years post-op labiaplasty - what are my options?

Answers (9)

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