The labia majora are the outer folds of the vulva, the external female genitalia. Noticing changes in this area, such as a shrinking, can raise questions. This article explores common reasons for such changes.
Understanding Natural Changes Over Time
The labia majora, like all body tissues, undergo natural transformations throughout a person’s lifespan. From birth, where they might be swollen due to maternal hormones, they gradually reduce in size before puberty. During puberty, the labia majora become larger and thicker, with increased prominence and pigmentation.
After puberty, a natural slimming can occur as subcutaneous fat levels decrease. Later in life, the aging process contributes to a reduction in collagen and elastin production. This decline in these structural proteins can lead to a loss of skin elasticity and firmness, affecting the volume and appearance of the labia majora over time.
The Role of Hormones
Hormonal shifts play a significant role in the changes observed in the labia majora, with estrogen being particularly influential. Estrogen is responsible for maintaining the structure, elasticity, pigmentation, and moisture of the labial tissues. As estrogen levels decline, especially during perimenopause and menopause, the labia majora can become thinner and less elastic. This process, known as atrophy, involves tissues losing fat and tone, resulting in a less plump and more lax appearance.
Menopause marks a substantial drop in estrogen, leading to widespread changes in the vulva and vagina, often termed genitourinary syndrome of menopause (GSM). GSM can cause the labia majora to appear dry, wrinkly, and to lose volume. These changes are a direct result of reduced estrogen, which leads to a breakdown in collagen and elastin, decreased blood flow, and a thinner epithelial layer. While menopause is a primary cause, other conditions that lead to hormonal imbalances, such as certain medical treatments or the surgical removal of ovaries, can also contribute to these changes.
Other Factors That Can Contribute
Beyond natural aging and hormonal changes, other factors can influence the appearance and volume of the labia majora. Significant or rapid weight loss can lead to a reduction in the fatty tissue that provides fullness to the labia majora. This can cause them to appear thinner or deflated, sometimes referred to as “Ozempic vulva” often associated with rapid weight loss from certain medications, though the drug itself does not directly act on the vulva.
Certain medical conditions can also contribute to changes in labial appearance. Lichen sclerosus, a non-contagious inflammatory skin condition, can cause thinning skin in the genital area, leading to patchy, discolored skin and, in some cases, a flattened or shrunken appearance of the labia. Lifestyle factors, such as smoking, can accelerate skin aging and reduce elasticity due to collagen breakdown. Poor nutrition and dehydration may also negatively impact skin and tissue health, indirectly affecting the labia majora.
When to Talk to a Doctor and What Can Be Done
If changes in the labia majora cause persistent concern, discomfort, pain, or are accompanied by new symptoms like itching, burning sensations, or painful intercourse, consulting a healthcare professional is advisable. A doctor can evaluate changes, discuss medical history, and perform a physical examination to determine the underlying cause. Early assessment is particularly important if conditions like lichen sclerosus are suspected, to prevent potential scarring and long-term inflammation.
Various approaches are available to manage symptoms or address cosmetic concerns. For hormonally-driven changes, low-dose topical estrogen creams, suppositories, or rings can be effective in restoring hydration and thickness to these tissues. Non-hormonal options include vaginal moisturizers and lubricants to alleviate dryness and discomfort. In cases of volume loss, cosmetic options such as fat transfer (injecting a person’s own fat) or dermal fillers can restore fullness. Surgical procedures, like labia majoraplasty, may be considered if there is excess skin, while radiofrequency and laser treatments can tighten skin and stimulate collagen for mild to moderate changes.