Pediatric labia minora hypertrophy: Systematic review and Ibero-American survey towards diagnostic and management consensus

Labia minora hypertrophy (LMH) in pediatric patients is an under-explored condition with clinical, psychosocial, and ethical implications. Although often considered a normal anatomical variant, LMH may cause functional symptoms and distress. The absence of standardized definitions and guidelines has resulted in heterogeneous diagnostic and therapeutic practices, particularly in Ibero-America. To evaluate current definitions, diagnostic criteria, and management strategies for pediatric LMH through a systematic literature review and a survey of Ibero-American specialists. A descriptive observational study was performed using two components: a systematic review (2000–2025) across five databases following PRISMA guidelines, including studies on LMH in patients ≤18 years; and a 21-item online survey distributed to pediatric surgeons, urologists, and gynecologists from 15 Ibero-American countries, assessing clinical experience, diagnostic methods, and management practices. Forty-five studies were included, most involving adults and showing inconsistent definitions; only 17.7 % provided explicit diagnostic criteria. In pediatric cases, functional symptoms predominated, while aesthetic reasons were more frequent in adults. The survey, answered by 142 specialists, revealed wide variability in diagnostic approaches, surgical indications, age for intervention, and use of psychological assessment. Gynecologists favored delayed surgery with psychological evaluation, while surgeons and urologists leaned toward earlier intervention. Complication rates were low, with high overall satisfaction, although reoperation rates varied. Pediatric LMH remains inconsistently defined and managed. Standardized, multidisciplinary, and ethically grounded guidelines are needed. Three practices could be adopted immediately in regional recommendations: objective labial measurement under traction, prioritizing functional symptoms in patients under 16, and routine psychological evaluation in adolescents with significant distress.