How to treat Labiaplasty nerve damage and painful scarring? Is there new methods to treat pain?

Adalheida what you are describing is chronic neuropathic pain also called “neurogenic pain”. To control and eliminate this pain can be very elusive. Neuropathic pain is directly related to hyperexcitable nociceptive neurons (nerves) due to trauma like that seen with labiaplasty. Neuropathic pain is caused by either 1) overly aggressive reduction of labia resulting in amputation 2) Inappropriate usage of type and caliber of suture for labiaplasty which can lead to "grooving" . Grooving can cause pain if the grooving is close to nerves leading to the nerve(s) being kinked, creating tender areas in around the labia. Lastly, changes in sensitivity can occur with injury to a branch of clitoral nerve. Neuropathic pain "ENDS" when the wound site is completely healed. We are not just talking about superficial healing (how things look) rather, a healing process than cannot be seen with the naked eye and occurs on a cellular lever. Healing is considered COMPLETE when axon regeneration occurs along with re-innervation (re-growth of nerves) of the target tissue and complete elimination of the inflammatory process. 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 second option is surgical resection/ revision of affected areas. A new non-surgical adjunct for the treatment of neuropathic pain is the use of platelet rich plasma (PRP). PRP is harvested from one’s own blood that can be activated and injected to tender areas of your labia. This activated PRP causes a cascade of healing events, stimulating your body to form new blood vessels, decrease inflammation and releases growth factors resulting in axon regeneration and re-innervation of the target tissue (re-growth of nerves) ultimately eliminating ongoing pain. This 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

Adalheida, I certainly understand the discomfort you are having after a Labiaplasty that appears normal but the nerve damage cannot be seen. I have had success treating women with a cream that contains Estradiol ( estrogen), Lidocaine (a numbing agent) and Pregabalin ( a neuroleptic). This cream is rubbed into the area of discomfort. This cream has the potential to provide significant relief.

Hellothe device used for the bleeding control is very important during labiaplasty. If a regular cautery is used it may damage the surrounding area and causes scarring. I would advise you prp or adipose mesenchymal tissue transfer to the effected area. that will help the scar tissue get better. hope that answer will help. best

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​. You probably had a trimming labiaplasty which can cause discomfort along the scar line. If the scar is excised and replaced with normal tissue, the pain is often eliminated or markedly improved. 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. I need to see photos and need to know which specific areas are painful. You may need various reconstructive techniques to give pain relief and a normal appearance. Approximately 40% of the surgeries I perform are revisions of other surgeons' labiaplasties. You only get one good chance to reconstruct you, so be patient and ask a lot of questions.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY -

hi, if you can post a photo it might help you better. I cannot comment without seeing the photo.
Is there a place to be tense? After the incision is made, are the remaining parts reassembled in the anatomical plan? I need to understand. I need a photo for this

Most nerve pain resolves in 2 years. When it persists I would treat it like any other sensory nerve issue elsewhere on the body: perform a diagnostic/ therapeutic block by injection a long acting numbing medication (bupivicaine). If that eliminates the discomfort, a small amount of cortisone (triamcinolone) can be injected as well. Sometimes just interrupting the pain cycle is enough to get complete relief. Additional steps if needed are injecting Botox for its pain reducing qualities; injection of a hyaluronic acid filler, and as a last resort surgical release of any scar tissue present within the soft tissues. Hope this helps.

The short answer is : YES, there are new methods for treating vulvar pain after labiaplasty, if you work with a surgeon who specializes in treating this problem, if you work with a "labiaplasty revision specialist" who sees these problems frequently, and is savvy about new methods to treat what is medically termed "neurogenic pain" from branches of the pudendal nerve that may be injured from scarring that occurs in some LP procedures. It is impossible to "see" the irritated nerve, but usually the area can be mapped out after careful consultation with the patient. In my practice (I presently only specialize in revisional surgery and treatment of vulvar pain after LP), I work with women using both systemic and topical neuroleptic agents (usually gabapentin or pregabalin) in a soothing hormonal base to locally treat the pin, and am actually at the present time leading a study evaluating the efficacy of RP (platelet-rich plasma) injected into the area of pain to help with axonal regeneration and therapy for the triggers of the neurogenic pain. It is difficult for me to say whom you should see in Western Europe you might try Dr. Dawid Serafin or Dr. Rafal Kuzlik in Poland, or Dr. Pierre Foldes in France (unless you wish to consult with a revision specialist in the U.S.) No, you probably do not need a revision, but you do need someone who is up-to-date with the treatment of neurogenic pain... (FYI, there will be a new blog on the treatment of neurogenic pain up on my website in a week or 2...)

Regards, Michael P Goodman, MD, FACOG, IF, AAACS. Davis, CA, USA