Do transgender women have labia minora?

Transgender Women and Labia Minora Development

Transgender women typically develop labia minora through gender-affirming vaginoplasty procedures, as they are not naturally present in individuals assigned male at birth.

Anatomical Development in Gender-Affirming Surgery

Gender-affirming vaginoplasty for transgender women includes the creation of external female genitalia, including the labia minora. This is achieved through surgical techniques that transform existing penile and scrotal tissue into structures that resemble cisgender female anatomy 1, 2.

Surgical Creation of Labia Minora

Several surgical techniques are used to create labia minora in transgender women:

1. Using penile skin:

   • In uncircumcised patients: The prepuce (foreskin) is used to create both the clitoral hood and labia minora 2
   • In circumcised patients: Distal shaft skin is utilized instead 2

2. Surgical techniques:

   • The penile skin and Dartos fascia are incised dorsally and ventrally then advanced to the posterior perineum to form the labia minora 3
   • The preputial or distal penile shaft skin is used for the clitoral hood and medial aspect of the labia minora, with proximal penile shaft skin used for the lateral surface 4

3. Aesthetic considerations:

   • Surgeons aim to create labia minora that are well-defined, three-dimensional, and frame the introitus 4
   • Interrupted horizontal mattress quilting sutures are used to define the labia minora as distinct subunits 4

Terminology and Definitions

Understanding the terminology related to transgender healthcare is important:

• A transgender woman is defined as "a woman who was assigned male sex at birth" 5
• Gender-affirming care includes medical and surgical interventions that help align physical characteristics with gender identity 6

Clinical Outcomes

The creation of labia minora during penile inversion vaginoplasty has shown good results:

• Studies report successful creation of labia minora and clitoral hood in all patients undergoing the procedure 2
• Low revision surgery rates (approximately 5.6%) have been reported 2
• Most patients report satisfaction with their new genitalia, including sensitivity and appearance 7

Important Considerations

• The goal of gender-affirming vaginoplasty is to create functionally and aesthetically acceptable female genitalia, including normal voiding function and satisfactory sexual function 1
• The procedure preserves erogenous sensation by carefully crafting the clitoris from the glans penis 1
• Potential complications include bleeding, dehiscence, and diverted urinary stream, though these are relatively uncommon 2

Pitfalls to Avoid

• Excess defatting of the labia majora should be avoided, as they are subject to initial edema and often atrophy with time 4
• Ensuring the penile skin used for the lateral aspect of the labia minora is pulled inferomedially toward the perineum is crucial to create a narrow, tapered appearance and avoid effacement of the labia minora 4

In summary, while transgender women are not born with labia minora, these structures can be successfully created through gender-affirming surgical procedures that transform existing genital tissue into female-appearing external genitalia with good functional and aesthetic outcomes.