Sensitive frenulum and labia nearly 9 months post-op. Feeling like this is permanent - is this normal?

Question

Is it normal to have very sensitive frenulum knobs this far post op? Also, my labia still hurt when direct pressure is applied. Healing has been a wreck and on top of that it's not aesthetically pleasing. I'm not sure if I will have permanent pain/extreme sensitivity down there. I'm fine if i'm casually walking, sitting, etc, but if anything rubs on it too hard or even when I wipe, it hurts. I talked to my OBGYN and she said that labiaplasties can result in permanent swelling and pain.

Irena Karanetz, MD · Answer

Hello,
Thank you for the question.
First of all, I'm sorry to hear about your prolonged discomfort and pain. 
Final wound healing may take up to to a full year from your original surgery so I would recommend waiting for now and conservative management.
I would definitely discuss your questions and concerns with your Plastic Surgeon/OBGYN who performed the procedure.
I hope this helps.Best regards, Dr. Karanetz
Dr. Irena KaranetzFellowship-TrainedBoard Certified Plastic Surgeon

Christine Rodgers, MD · Answer

HI,

I am sorry to hear about your sensitivity in this area. Typically , one should NOT have permanent swelling and pain in the labia after a labiaplasty. Is your ObGyn the surgeon who performed the operation? If not, you might return to the surgeon who performed the operation for an examination.

Best,
Dr. Christine Rodgers

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. You apparently had a trimming labiaplasty which resulted in the chronic pain at the tips of the frenulum and a poor aesthetic result. 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. You will need various reconstructive techniques to give you a good appearance and to eliminate your pain. You can have a much better result by a very skilled reconstructive labiaplasty surgery. Approximately 40% of the surgeries I perform are revisions of other surgeons' labiaplasties. I would use multiple wedge excisions to remove the painful areas and reattach your frenulum. I will do other techniques to improve your result and symmetry. You only get one good chance to reconstruct you, so be patient and ask a lot of questions. I suggest you include some photos to allow me to accurately make my recommendation.

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY

Gary J. Alter, M.D.

Beverly Hills, CA - Manhattan, NY

Nelson Castillo, MD · Answer

Thank you for sharing your question.  After 9 months much of your symptoms should have improved and resolved. Without photographs to provide additional information I would recommend seeking a second opinion.

Ozgur Kartal, MD · Answer

Hello,
I have performed more than 1000 labiaplasty surgeries. I have not encountered such a problem.
What was the incision made with in your labiaplasty surgery? scalpel ? cautery? laser?

Michael A. Reed, MD · Answer

Ongoing pain/sensitivity after labiaplasty or better termed 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 is directly related to hyperexcitable nociceptive neurons due to trauma as described above. Neuropathic pain "ENDS" when the wound site is completely healed. Healing is considered complete when axon regeneration occurs along with re-innervation of the target tissue and complete elimination of the inflammatory process.
For patients who have contacted me after an undesired outcome from another surgeon I generally compound Gabapentin+Lidocaine+ Estradiol, 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

...Where do I start? First, ignore your general Ob-Gyn's unknowledgable comment. NO! Labiaplasties should NOT result in ongoing discomfort. This occurs usually only if the LP is not performed correctly. Since general Ob-Gyn's are not usually trained in proper technique, many of the cases performed by general Ob-Gyns end up poorly, especially regarding the frenulum. If the surgeon cut too closely to the clitoral glans, or did not "tie in" the resected frenulular edges to your resected labia, this can result in pain.  At nine months, "...what you see or feel is what you get." You are fully healed at this point. So, why is there pain? Most likely from either irritated nerve edges, or what is called a "neuroma," a bundle of jumbled nerves tangled together in a certain location. HOW is this treated? Usually, not by re-resection. I have treated many women with neuralgias (nerve pain) after improperly performed labiaplasties. I usually use a topical neuroleptic such as gabapentin locally applied. There is research however that suggests that PRP (platelet-rich plasma) helps with axonal regeneration and may be effective in relief of this type of pain, and I have adjusted my protocol to include the injection of PRP into the effected area(s). Bottom line: at 9 months post-op if still painful, you might consider seeing a clinician who can work with you to relieve the pain by proper use of neuroleptic medication, possibly plus possible treatments with PRP. Please understand however that the addition of PRP to the neuroleptic regimen, while very safe, should still at this point be considered experimental, as there is no "evidence-based research" verifying the true success of the therapy. You are not alone; there is help for your situation. Regards,  Michael P Goodman, MD, FACOG, IF, AAACS. Davis, CA, USA

David Janssen, MD, FACS · Answer

It is difficult to answer your question without knowing exactly what you had done. there are different techniques to labiaplasty and some are more vessel and nerve preserving. You might need to visit some experienced physicians to help determine what is going on. A detailed operative note would help, but you almost had to be there to know what was done. Try talking to the doctor who did this first.

Sensitive frenulum and labia nearly 9 months post-op. Feeling like this is permanent - is this normal?

Answers (8)

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